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We take the example of cardiac devices, specifically the implantable cardioverter defibrillator, or ICD, to explore the complex cultural role of technology in medicine today. We focus on persons age 80 and above, for whom ICD use is growing in the U.S. We highlight an ironic feature of this device. While it postpones death and 'saves' life by thwarting a lethal heart rhythm, it also prolongs living in a state of dying from heart failure. In that regard the ICD is simultaneously a technology of life extension and dying. We explore that irony among the oldest age group -- those whose considerations of medical interventions are framed by changing societal assumptions of what constitutes premature death, the appropriate time for death and medicine's goals in an aging society. Background to the rapidly growing use of this device among the elderly is the 'technological imperative' in medicine, bolstered today by the value given to evidence-based studies. We show how evidence contributes to standards of care and to the expansion of Medicare reimbursement criteria. Together, those factors shape the ethical necessity of physicians offering and patients accepting the ICD in late life. Two ethnographic examples document the ways in which those factors are lived in treatment discussions and in expectations about death and longevity.  相似文献
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医院志愿服务的开展是缓解老龄化社会下医疗资源相对匮乏的有益措施之一,对缓解医患矛盾、节约社会成本和促进社会和谐等均起到巨大作用。医院志愿服务的组织管理及保障体系在我国均处于初级阶段,探索出一套适合国情的医务社会工作及医院志愿服务管理体系至关重要。在老龄化社会背景下对我国医院志愿服务发展的现状及主要问题进行分析,提出医院志愿服务发展的建议。  相似文献
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日本长期护理保险制度以基层政府为保险人,以全部老年人群和部分非老年人群为被保险人,费用通过"政府+社会+个人"的方式实行分摊,支付通过机构、社区和居家等进行细分。自建立以来,制度的保障水平不断提高,预防的作用不断受到重视,社区养老的地位不断凸显,和相关产业的联动不断加强。但与此同时,伴随着制度的运行成本不断增长,制度的持续发展也面临转型压力。我国护理保障制度建设在借鉴日本有益经验的同时,也应该尽力避免其不足之处。  相似文献
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