Academic journal article The Hastings Center Report

Executive Summary of Project Conclusions

Academic journal article The Hastings Center Report

Executive Summary of Project Conclusions

Article excerpt

1. High-tech home care is a complex phenomenon. Whether or not a particular deployment of high-tech home care is morally problematic will depend upon various contextual features of the situation, e.g., the intensity, technical difficulty, and duration of the treatment; the extent of family support; the degrees of benefit and burden to both patients and caregivers. Simply calling a particular piece of equipment "high tech" does not advance the debate about either morality or access.

2. One distinctive ethical issue, broadly construed, of high-tech home care is the tendency to medicalize the home environment, subjecting the traditionally private sphere of home to the intrusions of medical personnel, timetables, and equipment. Although not an ethical "dilemma" in the usual sense, this effect of the care has important implications for the way we live and structure our living environments.

3. High-tech home care can generate difficult "Problems of meaning" relating to body image, family identity, and the meaning of "home." For example, as Arthur Kohrman notes in his paper, our society has yet to truly come to terms with the meaning of children receiving chronic, long-term ventilatory support-that is, children who are, in a sense, part human and part machine.

4. High-tech home care can place excessive burdens on family and friends charged with caring for patients. In the majority of cases, these burdens fall disproportionately on women caregivers. Our traditional, patient-centered moral framework must give way to a new ethic for chronic home care based upon notions of reasonable accommodation of competing legitimate interests, compromise, and mediation.

5. Family caregivers are often ill-prepared to undertake the high-tech care of loved ones at home. They often receive inadequate information about the patient's future course, the likely burdens of caregiving, and the technical details of treatment. Families must be helped to give truly informed consent to this undertaking, and their consent must be explicitly subject to revision as the patient's condition changes and the burdens to family increase.

6. High-tech home care is rarely organized into an efficient, coherent, and comprehensive package for patients and their caregivers, many of whom must assume the onerous tasks of their own case management without the requisite knowledge, skills, and connections. …

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