Vanessa Schouten

Background: There is an international trend for frail older adults to move to residential care homes, rather than ageing at home. Residential facilities typically espouse a person-centred philosophy, yet evidence points to restrictive policies and surveillance resulting in increased loneliness and diminished opportunities for intimacy and sexual expression. Residents may experience what has been termed social death, rather than perceive they are related to by others as socially alive. Aim: To consider how the loss of intimacy and sexuality in residents’ lives contributes to iatrogenic loneliness experienced in residential care, and the importance of considering these issues together. Research design: The study utilised a constructionist methodology, investigating the meanings associated with intimacy, loneliness, and ageing. Participants and research context: Qualitative data used in this study are drawn from a larger dataset of a mixed-methods study. Interviews were completed as follows: staff, 21 individual interviews, and two groups with a total of 13 additional people; residents, 26 interviews with 28 people; and family members, 12 interviews with 13 people. Findings: Five key themes were identified in the data analysis: loneliness and relational identity, loneliness and functional relationships, loneliness and disrupted intimacy, loneliness and liminality, and loneliness and the built environment. Ethical considerations: The study was approved by a University Human Ethics Committee. Participation was voluntary. Consent was gained and confidentiality upheld. Discussion: Residents’ expression of intimacy and sexuality can be compromised through paternalism, ageism, restrictive policies, care-rationing and functional care, alienating residents from sustaining and developing significant relationships. Attitudes and cultural beliefs of staff and family members about ageing and intimacy, compounded by architectural design, may intensify loneliness. Conclusions: Nurses have a pivotal role in ensuring policies and practice enhance social citizenship.

Prudential hedonism has been beset by many objections, the strength and number of which have led most modern philosophers to believe that it is implausible. One objection in particular, however, is nearly always cited when a philosopher wants to argue that prudential hedonism is implausible—the experience machine objection to hedonism. This paper examines this objection in detail. First, the deductive and abductive versions of the experience machine objection to hedonism are explained. Following this, the contemporary responses to each version of the argument are assessed and the deductive version is argued to be relatively ineffective compared to the abductive version. Then, a taxonomy of the contemporary critical responses to the abductive version is created. Consideration of these responses shows that the abductive version of the objection is fairly powerful, but also that one type of response seems promising against it. This response argues that experience machine thought experiments seem to elicit judgments that are either too biased to be used as evidence for the objection or not obviously in favour of reality. It is argued that only this type of refutation seems likely to convince proponents of the abductive version that the objection is much weaker than they believe it to be. Finally, it is suggested that more evidence is required before anything definitive can be said on the matter

Background The existing literature on sexuality and intimacy in residential care tends to focus on either the question of rights, or the value of autonomy. Where the literature does reference values other than autonomy, such values are considered in the context of being a guide to whether or not a resident is autonomous, rather than being important values in their own right. Objective This paper draws on qualitative data gathered as part of a larger study in order to inform practice on how care workers respond to intimacy issues that arise with residents with dementia and to inform a general ethics of sex and sexuality, demonstrating that an approach which permits value pluralism can be appropriate in certain contexts. Research Design The qualitative data referred to in this paper was gathered from semi-structured interviews undertaken as part of a larger mixed-method research project. The interview text was analysed using Thorne’s methodological approach, interpretive description. Participants and research context The qualitative arm of the project consisted of semi-structured interviews conducted between October 2018 and October 2019 with participants (staff, residents and family members) recruited from 35 residential care homes in Aotearoa New Zealand. Ethical Considerations Participation was informed, voluntary and written consent was gained before interviews. The project was approved by the Massey University Human Ethics Committee (Northern), number NOR 18/25. Findings Analysis of the scenarios presented in this paper shows that decision-making around sexual intimacy involving people with dementia in a residential care setting is complex and requires recognizing and weighing the different values that may be a in play. Conclusion A focus on safety and consent to the exclusion of other values which matter morally in this context is a mistake which prevents care workers from providing appropriately person-centred care to residents, as policies which focus on the goal of care allow space for critical examination of issues which are likely to be highly context-sensitive.

Background To investigate attitudes of staff, residents and family members in long-term care towards sex and intimacy among older adults, specifically the extent to which they conceptualise sex and intimacy as a need, a right, a privilege or as a component of overall well-being. Methods The present study was a part of a two-arm mixed-methods cross-sectional study using a concurrent triangulation design. A validated survey tool was developed; 433 staff surveys were collected from 35 facilities across the country. Interviews were conducted with 75 staff, residents and family members. Results It was common for staff, residents and family members to talk about intimacy and sexuality in terms of rights and needs. As well as using the language of needs and rights, it was common for participants to use terms related to well-being, such as fun, happiness or being miserable. One participant in particular described receiving intimate touch as a ‘kind of care’—a particularly useful way of framing the conversation. Conclusion While staff, residents and family frequently used the familiar language of needs and rights to discuss access to intimate touch, they also used the language of well-being and care. Reframing the conversation in this way serves a useful purpose: it shifts the focus from simply meeting minimum obligations to a salutogenic approach—one that focuses on caring for the whole person in order to improve overall well-being and quality of life. No data are available.

The global pandemic needs to mark a turning point for the peoples of Aotearoa New Zealand. How can we make sure that our culturally diverse nation charts an equitable and sustainable path through and beyond this new world? In a less affluent future, how can we ensure that all New Zealanders have fair access to opportunities? One challenge is to preserve the sense of common purpose so critical to protecting each other in the face of Covid-19. How can we centre what we have learnt about resilience within Māori and wider Pacific communities in our reforms? How can public understanding of Covid-19 science create a platform for the future social valuing of expertise? How can we ensure that the impact of Covid-19 in New Zealand results in a more sustainable, and inclusive workforce–for instance by expanding our perceptions of the value of our workers through promoting digital inclusion? To meet these challenges, we must reimagine our existing traditions of thought, breathing new life into perennial concepts and debates. Our paper indicates some of the ways that Philosophy is central to this collective reimagining, highlighting solutions to be found across our rich philosophical traditions.