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A fehér bottól a robotikáig - A gyógyászati segédeszközök társadalombiztosítási támogatórendszerének képességszemléletű vizsgálata
Abstract
A disszertáció célja annak körüljárása, hogy miként jellemezhető a társadalombiztosítási rendszeren keresztül támogatott gyógyászati segédeszközök hozzáférhetősége Magyarországon, a felhasználók választási szabadsága szempontjából. A feltáró elemzés elméleti kerete az Amartya Sen nevéhez kötődő képességszemlélet (Capability Approach), a jóllét és a fejlődés normatív elmélete, ami a fejlődést az emberek képességeinek és arra való tényleges lehetőségeinek – szabadságainak – bővülésében látja, hogy olyan életet éljenek, amilyet okkal tartanak értékesnek.
A segédeszköz elosztást amentén vizsgáltam, hogy az mennyiben személyre szabott, és mennyiben bővíti a felhasználók tényleges lehetőségeit a számukra értékesnek tartott, jó életre: a segédeszközhöz jutás folyamatában mennyiben jelennek meg az érintettek véleményei, értékei, hangja, a „semmit rólunk nélkülünk” elv, milyen garanciákat vállal a jogalkotó és a folyamatban résztvevő többi szereplő annak érdekében, hogy az érintettek tudatában legyenek a valódi választási lehetőségeiknek.
A kutatás során – szociálpolitikai alapelveken, nemzetközi tapasztalatokon, három európai tanulmányúton és a képességszemléleten alapulva – elemzési indikátorrendszer készült. A szakirodalom áttekintésén és a jogszabályelemzésen túl, a támogatórendszer gyakorlati működését szakértői és érintetti interjúk (n=52) segítettek feltárni.
Magyarországon nincs nemzeti stratégia vagy program, ami bizonyos mértékben biztosítéka volna a támogató technológia hozzáférhetőségének. Több mint ötven jogszabály érinti a gyógyászati segédeszközöket, ezek ugyanakkor kevésbé védik a felhasználókat. A jogalkotó elsődleges célja, hogy megelőzze a túlköltekezést. A gyógyászati segédeszközök mellől elmaradnak a kapcsolódó szolgáltatások, ami nem csak az egyén szintjén teremt problémát, és eredményezi sok esetben az eszközök kihasználatlanságát, hanem csökkenti a gazdaságilag racionális működés valószínűségét is. A támogatott gyógyászati segédeszközök rendszerének jelenlegi működésében az akadályozottság orvosi-medikális modelljének jegyei fedezhetők fel: a szakemberek dominanciája mellett az érintettek valódi részvétele, és valódi választási szabadsága esetleges.
Kulcsszavak: Támogató-segítő eszközök és technológia; asszisztív megoldások; képességszemlélet, a fogyatékosság, egészség és jóllét emberi fejlődés modellje
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A tanulmány az önálló életvitelt támogató-segítő eszközök és technológia fogalmát igyekszik tisztázni. A magyar jogszabályokban a támogató-segítő eszközök megnevezése (gyógyászati segédeszközök) és tartalma elavult, nem követi a nemzetközi trendeket és irányelveket, aminek egyik következménye, hogy az állami-társadalom-biztosítási-támogatással elérhető eszközök listája jelentős elmaradásban van a piaci kínálathoz képest; ez egyik közvetett gátja az eszközök hozzáférhetőségének.
One of the strengths of a capability account of wellbeing is that it allows us to theoretically and empirically analyze at a quite practical level why certain things matter to people - such as their housing, their jobs, and their friendships. A capability account of wellbeing is also very well suited to understand the importance of place for wellbeing. Some dimensions of wellbeing are constitutively place-related, such as “feeling at home”. Other dimensions of wellbeing are affected by what the places and locations in which we live mean to us. Taken together, we call them “place-based capabilities”. Using a capability account of wellbeing allows us to use social scientific research to investigate the role of social, economic, demographic, political, ecological and technological processes on wellbeing. This paper illustrates this by investigating the role of recent technologies in enabling and expanding capabilities. On the one hand, technological change has dramatically expanded those capabilities. On the other hand, the use of those technologies has unintended consequences for other capabilities. The conceptual as well as empirical relationships between (place-based) capabilities and technology is therefore a complex one.
Notions such as wellbeing, freedom, and social justice are integral to evaluating social progress and developing policies. One increasingly influential way to think about these concepts is the capability approach, a theoretical framework which was pioneered by the philosopher and economist Amartya Sen in the 1980s.
In this book Ingrid Robeyns orientates readers new to the capability approach through offering an explanation of this framework. Wellbeing, Freedom and Social Justice also endeavors to resolve historical disputes in the literature and thus will be equally engaging to those familiar with the field. The author offers a novel and illuminating account of how the capability approach can be understood in a variety of academic disciplines and fields of application. Special attention is paid to clarifying misunderstandings that have been caused by different disciplinary assumptions and the interpretive consequences they have for our consideration of the capability approach.
Robeyns argues that respecting the distinction between the general capability approach, and more specific capability theories or applications, helps to clear up confusion and misinterpretation. In addition, the author presents detailed analyses of well-known objections to the capability approach, and also discusses how it relates to other schools of analysis such as theories of justice, human rights, basic needs, and the human development approach.
Wellbeing, Freedom and Social Justice offers an original and comprehensive account of the field. The book will appeal to scholars of the capability approach as well as new readers looking for an interdisciplinary introduction.
For advocates of the rights of persons with disabilities, particularly persons with mental disabilities, the human right to live in the community as an equal member is seen to be central and, often, even as the basis for all other human rights. Yet, despite its articulation in human rights law in the Convention on the Rights of People with Disabilities (CRPD), foundational issues about the right remain undertheorized and unclear. This paper brings to bear the capabilities approach, a normative framework about human well-being, social development and social justice, to this central concern in disability rights, mental health ethics, and international human rights law: protecting and respecting a person's right to live in a community as an equal. We argue that this human and moral right is best conceptualized as a capability to live in the community as an equal member. The capabilities approach provides this capability with a strong ethical framework and conceptual resources to guide reasoning and its practical realization.
Tanulmányom az emberi jogi narratíva kritikai elemzése a fogyatékos emberek mozgalmának szempontjából. Az empirikus adatokra épülő
kutatás annak járt utána, hogy miként látják az autista és értelmi fogyatékos emberek érdekvédelmében dolgozók az emberi jogokat. A kutatást az Egyesült Királyságban és Magyar-
országon folytattam, résztvevői hivatásos érdekvédők, szülő-érdekvédők és értelmi sérült
vagy autista érdekvédők voltak.
Purpose: This is a position paper describing the elements of an international framework for assistive technology provision that could guide the development of policies, systems and service delivery procedures across the world. It describes general requirements, quality criteria and possible approaches that may help to enhance the accessibility of affordable and high quality assistive technology solutions.
Materials and methods: The paper is based on the experience of the authors, an analysis of the existing literature and the inputs from many colleagues in the field of assistive technology provision. It includes the results of discussions of an earlier version of the paper during an international conference on the topic in August 2017.
Results and conclusion: The paper ends with the recommendation to develop an international standard for assistive technology provision. Such a standard can have a major impact on the accessibility of AT for people with disabilities. The paper outlines some the key elements to be included in a standard.
• Implications for Rehabilitation
• Assistive technology is a key element in rehabilitation, but many people have no access to affordable AT solutions. The recommendations in the paper aim to inform policies, systems and service delivery procedures on how to improve access to AT across the world.
The Sustainable Development Goals (SDGs) have placed great emphasis on the need for much greater social inclusion, and on making deliberate efforts to reach marginalized groups. People with disabilities are often marginalized through their lack of access to a range of services and opportunities. Assistive products can help people overcome impairments and barriers enabling them to be active, participating and productive members of society. Assistive products are vital for people with disabilities, frailty and chronic illnesses; and for those with mental health problems, and gradual cognitive and physical decline characteristic of aging populations. This paper illustrates how the achievement of each of the 17 SDGs can be facilitated by the use of assistive products. Without promoting the availability of assistive products the SDGs cannot be achieved equitably. We highlight how assistive products can be considered as both a mediator and a moderator of SDG achievement. We also briefly describe how the Global Cooperation on Assistive Technology (GATE) is working to promote greater access to assistive products on a global scale.
Mindenki ismer olyan helyi gazdaságfejlesztési projekteket, amelyek eredménye erősen megkérdőjelezhető. Ilyenek a sebtében felhúzott irodaházak, amelyek aztán üresen konganak, vagy a kialakított öntözőrendszer, amelyet a helyi lakosság lerombol. Vannak olyan fejlesztési projektek is, amelyek hatása összetettebb: felépül ugyan a bevásárlóközpont, de elszívja a belvárosi kereskedők forgalmát, felépül az ipari park, azonban nem teremt új munkahelyet.
Ezekből a jól ismert jelenségekből kiindulva, disszertációmban olyan kérdésekre próbálok meg választ találni: hogyan ítélhető meg egy helyi gazdaságfejlesztési projekt sikeressége, miért sikerülnek félre egyes helyi gazdaságfejlesztési projektek, és mit tehetnek a helyi szereplők, hogy sikeressé tegyék ezeket a projekteket?
Dolgozatom kiindulópontja a helyi gazdaságfejlesztés elmélete. A Világbank meghatározása szerint: „a helyi gazdaságfejlesztés célja az adott térség gazdasági teljesítményének és valamennyi ott élő életminőségének javítása” (Swinburn et al. 2006). Erre épül a helyi gazdaságfejlesztés versenyképesség alapú stratégiája, mely szerint a helyi gazdaságfejlesztés célja az életminőség növelése, eszköze a versenyképesség, alapja pedig a helyi vállalatok versenyelőnyeinek a megerősítése (Bajmócy 2011).
E megközelítés több hiányossággal is küszködik. Először: semmit nem mond arról, hogy mit jelent a helyi lakosok számára az életminőség, vagy jól-lét, holott a közgazdaságtan másik részdiszciplínája – a jóléti közgazdaságtan – részletesen elemzi az életminőség, illetve a jó élet fogalmát. Másodszor: egyértelmű pozitív kapcsolatot feltételez a reáljövedelem növekedése (vagy újabban: a globális versenyben való helytállás képessége) és a jól-lét között, noha azt az ökológiai közgazdaságtan erősen megkérdőjelezi.
E két hiányosságot kiküszöbölendő, disszertációmban először a jól-lét fogalmának igyekszem szubsztantív meghatározását adni, és e fogalomra alapozva próbálom felépíteni a helyi gazdaságfejlesztés stratégiáját. Az általam kiválasztott jól-lét koncepció az Amartya Sen nevéhez köthető képességszemléletből ered, mely szerint az emberi jól-lét az emberek számára elérhető tényleges lehetőségekből tevődik össze (Sen 1999).
Ezt követően a seni képességszemlélet alapján egy elemzési keretet állítok fel. Ennek segítségével egyrészt lehetővé válik helyi gazdaságfejlesztési projektek értékelése, másrészt rá tudunk mutatni arra, mely társadalmi, gazdasági, környezeti tényezők játszanak közre egy helyi gazdaságfejlesztési program kivitelezése során.
4
Disszertációm újdonságértékét a következőkben látom:
(1) A képességszemléletnek elenyésző a magyar szakirodalma, ezért újdonságértékű a téma magyar nyelvű szakirodalmi összefoglalója. A magyar szakirodalom terminológiája sok esetben pontatlan, nehézkes, néhol egyenesen félrevezető. Ezért disszertációmban arra is kísérletet teszek, hogy tisztázzam az elmélet kulcsfogalmait és világos magyar terminológiát állapítsak meg.
(2) Ahogy említettem: a helyi gazdaságfejlesztés versenyképesség alapú modelljeinek szakirodalma nem reflektál más közgazdasági tudományterületek eredményeire az emberi jól-léttel kapcsolatban. Ezért disszertációmban újdonságértékű, hogy megpróbálom összehangolni az eddig egymásra nem reflektált szakirodalmakat.
(3) Disszertációmban olyan esettanulmányokat dolgozok fel, melyek alacsony jövedelmű országok helyi fejlesztéseit elemzik a képességszemlélet szemszögéből. Habár ezek az esettanulmányok a képességszemlélet fogalmi eszköztárát használják, részben eltérő módszereket alkalmaznak, és nem veszik figyelembe egymás eredményeit. Ennélfogva az esettanulmányok metaelemzése a helyi döntéshozatal számára is releváns lehet. Amennyire tudom: az esettanulmányok metaszintű összevetését még senki nem végezte el.
(4) A képességszemlélet szakirodalmában igen gyakori az alacsony jövedelmű országokról szóló elemzés, de tudtommal még senki nem alkalmazta a képességszemléletet magasabb jövedelmű országok helyi gazdaságfejlesztési projektjeinek elemzésére. Így a disszertációmban előadott elemzési keret és annak empirikus alkalmazása is új eredménynek tekinthető.
Over time, the meaning of disability has been understood in a variety of ways. The way in which disability is understood is important because the language people use to describe individuals with disabilities influences their expectations and interactions with them. For physical education teachers, philosophical orientation in regard to disability discourse can influence how they treat and interact with students with disabilities in their classes. Most recently, the medical and social models have been the two prominent models of disability discourse. The purpose of this article is to provide an overview of the medical and social models of disability discourse by comparing, contrasting, and critiquing the models. Further, we present practical examples using different hypothetical scenarios involving the same student with disabilities to depict how a teacher with a medical model orientation compared to a teacher with a social model orientation would interact and work with a student with a disability in physical education.
Background:
This study was an extension of research which began in the Umbria region in 2009.
Aim:
To investigate the extent to which assistive technology (AT) has been abandoned by users of the Italian National Health Service (ULHS) and the reasons for this.
Design:
Observational study.
Setting:
Users who received a hearing device (HD) or mobility device (MD) by ULHS between 2010 and 2013.
Population:
749 out of 3,791 ULHS users contacted via telephone completed the interview: 330 (44.06%) had a HD and 419 (55.94%) a MD.
Methods:
Data were collected using a specially developed telephone interview questionnaire including the Italian version of the Quebec User Evaluation of Satisfaction with AT (QUEST 2.0) and Assistive Technology Use Follow-up Survey (ATUFS).
Results:
134 users (17.9%) were no longer using their assigned AT device within seven months of issue and 40% of this group reported that they had never used the device. Duration of use (for how long the AT device was used before abandonment) and satisfaction with service delivery did not predict AT abandonment. People who received a HD where more likely to abandon their device (22.4%) than those who received a MD (14.4%).
Conclusions:
Abandonment may be due to assignment of inappropriate devices or failure to meet user needs and expectations. These findings are consistent with previous data collected by Federici and Borsci in 2009. Utility of AT in use, reasons of abandonment, and importance of device and service satisfaction for the use or non-use of an AT are presented and discussed.
Clinical rehabilitation impact:
AT abandonment surveys provide useful information for modelling AT assessment and delivery process. The study confirms the relevance of person centredness approach for a successful AT assessment and delivery process.
The UN Convention on The Rights of Persons with Disabilities is said to manifest the paradigm change from the medical to the social model of disability. This paper argues that it goes beyond and creates the human rights model of disability.
This article sheds light on the public policy situation for persons with severe disabilities in Chile by analyzing the Ministry of Health “Home-Based Care Program for Persons with Severe Disabilities.” The article further advocates for the relevance of the Capability Approach (CA) in the assessment of public policy for persons with disabilities and intends to illustrate a link between a real policy and basic concepts of the CA providing a model of content analysis for public policy through the lens of the CA. We present a content analysis, focused on underlying intentions of agency, freedom, well-being, and achievement based in the official text of the Chilean program. Then we examine this content under original categories and matrices based on the work of Sen, to ultimately reveal how a current Chilean policy falls short of fully addressing the diagnosed situation of its target population and highlights areas for improvement. Not only does the program lack coherence and compliance with Chilean laws and international standards, but it also lacks connections with important concepts for persons in situations of dependency such as agency and freedom.
The Matching Person & Technology (MPT) assessment process is a set of person-centered measures, all of which examine the self-reported perspectives of adult consumers regarding strengths/capabilities, needs/goals, preferences and psychosocial characteristics, and expected technology benefit. There are separate measures for general, assistive, educational, workplace, and healthcare technology use; in Ireland, the measures were used to assess outcomes of assistive technology (AT) provision for (a) people throughout the country participating in a new localized AT service delivery process and (b) students transitioning from secondary education. There are companion provider forms so that consumer-provider shared perspectives can be assessed and to ensure that the matching process is a collaborative one; the Irish version assumes collaboration from the start. Each measure can be used when evaluating a person for technology use and as person-centered, ideographic, outcomes measure. The measures have been determined to have good reliability and validity.
This study evaluates whether the International Classification of Functioning, Disability, and Health (ICF) framework provides a useful basis to ensure that key user needs are identified in the development of a home-based arm rehabilitation system for stroke patients. Using a qualitative approach, nine people with residual arm weakness after stroke and six healthcare professionals with expertise in stroke rehabilitation were enrolled in the user-centered design process. They were asked, through semi-structured interviews, to define the needs and specification for a potential home-based rehabilitation device to facilitate self-managed arm exercise. The topic list for the interviews was derived by brainstorming ideas within the clinical and engineering multidisciplinary research team based on previous experience and existing literature in user-centered design. Meaningful concepts were extracted from questions and responses of these interviews. These concepts obtained were matched to the categories within the ICF comprehensive core set for stroke using ICF linking rules. Most of the concepts extracted from the interviews matched to the existing ICF Core Set categories. Person factors like gender, age, interest, compliance, motivation, choice, and convenience that might determine device usability are yet to be categorized within the ICF comprehensive core set. The results suggest that the categories of the comprehensive ICF Core Set for stroke provide a useful basis for structuring interviews to identify most users needs. However some personal factors (related to end users and healthcare professionals) need to be considered in addition to the ICF categories.
The purpose of this paper is to indicate a framework for exploiting the potential role of assistive technology (AT) in supporting care and participation of people with disabilities and elderly people through appropriate service delivery systems (SDS). The paper is based on the findings of the AAATE/EASTIN workshop Service Delivery Systems on Assistive Technology in Europe (held in Copenhagen on May 21-22, 2012, under the patronage of the Danish EU Presidency), on the roadmaps indicated by the previous HEART Study published in 1995 by the European Commission, and on a consensus process within the Board of the AAATE (Association for Advancement of Assistive Technology in Europe) and the EASTIN Association (European Assistive Technology Information Network). The first chapter Background) discusses the reasons why a position paper on this issue was deemed useful; it also summarises the key themes of the Copenhagen workshop and recalls the HEART Study. The second chapter (The scope of an AT SDS), discusses the concept of assistive solutions-intended as individualised interventions providing users with appropriate environmental facilitators (AT products, personalised environmental modifications, personal assistance) to overcome disability and enable participation in all aspects of life-and the mission of a SDS-ensuring that all people with disabilities can access appropriate assistive solutions that are able to support autonomy in their life environment. The paper also points out that AT service delivery policies should be well coordinated with accessibility policies i.e. those related to infrastructural interventions ensuring that the mainstream environment, products and services are usable by all people, including those with reduced function or who depend on assistive technology. The third chapter (Basic features of an AT SDS) discusses why public SDS are needed for AT, what the main AT SDS models are, and how a SDS process can be described and monitored in terms of quality. The discussion is organised into answers to eight recurring questions: 1) Are assistive technology products going to disappear in the future, due to the embodiment of accessibility features in mainstream products; 2) Why shouldn't assistive technology products be dealt with as common consumer goods, purchased directly by users without the intermediation of service delivery systems; 3) Are there different approaches for AT service delivery; 4) When can a medical model, or a social model, or a consumer model be considered appropriate; 5) Independently of the model and the Country or Region, is it possible to identify common steps in the service delivery process; 6) How does each step influence the costs and the outcomes of the whole process; 7) How can the SDS process be monitored by quality indicators; and 8) How can information support the service delivery process. The last chapter (Some recommendations) provides a number of useful recommendations for those who are engaged in the design, development and implementation of AT SDS policies. The recommendations are clustered round the six SDS quality indicators suggested by the HEART Study: Accessibility, Competence, Coordination, Efficiency, Flexibility, User Influence.
The definition of disability is of interest to disability policymakers and analysts because it has fundamental implications for eligibility for public programs, for the scope of legislation, and for the way disability prevalence is measured. The purpose of this article is to assess how an approach developed in economics to analyze issues related to the standard of living, the so-called capability approach, may help us understand disability at the conceptual level. The article first summarizes different theoretical models of disability (the medical model, the social model, the Nagi model, and the International Classification of Functioning, Disability and Health of the World Health Organization) and then presents the main components of the capability approach. The capability approach allows researchers to analyze (a) disability at the capability level; (b) potential disability; and, at the functioning level, (c) actual disability. This framework also helps explain how disability may result from three types of factors: the individual's personal characteristics (e.g., impairment, age, race, gender), the individual's resources, and the individual's environment (physical, social, economic, political). The article explores some implications of the capability approach for analyzing the employment and the standard of living of persons with disabilities.
This paper explores the contribution of the Capability Approach of Amartya Sen and other authors to policy making in the specific case of disability policy. After reviewing existing models, their translation into action and their limitations in this regard, the paper introduces a new policy framework based on the Capability Approach. In particular, we introduce a new measure of functioning and capabilities. We investigate ways of measuring the gap between functionings, what people are able to do and be, and capabilities – the valuable practical opportunities people have and choose from. The possibility of the elaboration of such a disability indicator opens new perspectives for policy making that are of particular interest to persons with disabilities (who are often excluded from mainstream policy making because their agency is not considered by policy makers).
In this paper, we introduce a framework that is an extension of the capability approach of Amartya Sen to analyse the concept of disability in a dynamic context for the disabled person. We build a theory of “dis-capability”, according to which we define as disabled someone who has a limited capability set compared to his/her objectives, ambitions and system of values. The aim is to explain the dynamics between expectation, adaptation and creative adaptation for a dis-capabled person. In this perspective, disability represents the interweave between two pathways. While the first one, generating a condition of personal vulnerability, limits one's capability set, the second one is a pathway of creative adaptation, able to disclose new abilities, opportunities and potentialities. External capabilities emerge within such pathways. These capabilities, which rest on a close relationship between two or more individuals, significantly contribute to the construction of new capabilities. Finally, we examine some of the conditions under which external capabilities change from the direct interaction between few people to wider collective or team agency actions.
This article presents elements of a capability perspective on impairment and disability and develops in connection with it a multidimensional and relational account of disability. It suggests how a capability perspective provides new and fundamental insights into the conceptualization of impairment and disability, and in doing this, resolves the tension between natural and social causal factors evident in current discussions of disability and education. It argues that the capability approach is innovative with respect to the centrality of human diversity in assessing equality, and that the specific understanding of human diversity proposed, the democratic decisional process promoted and the normative account of disability those entail, all have the potential to take educational theory and inclusive education policies in fruitful directions.
Investigations of what increasing digital connectivity and the digitalization of the economy mean for people and places at the world's economic margins.
Within the last decade, more than one billion people became new Internet users. Once, digital connectivity was confined to economically prosperous parts of the world; now Internet users make up a majority of the world's population. In this book, contributors from a range of disciplines and locations investigate the impact of increased digital connectivity on people and places at the world's economic margins. Does the advent of a digitalized economy mean that those in economic peripheries can transcend spatial, organizational, social, and political constraints—or do digital tools and techniques tend to reinforce existing inequalities? The contributors present a diverse set of case studies, reporting on digitalization in countries ranging from Chile to Kenya to the Philippines, and develop a broad range of theoretical positions. They consider, among other things, data-driven disintermediation, women's economic empowerment and gendered power relations, digital humanitarianism and philanthropic capitalism, the spread of innovation hubs, and two cases of the reversal of core and periphery in digital innovation.
ContributorsNiels Beerepoot, Ryan Burns, Jenna Burrell, Julie Yujie Chen, Peter Dannenberg, Uwe Deichmann, Jonathan Donner, Christopher Foster, Mark Graham, Nicolas Friederici, Hernan Galperin, Catrihel Greppi, Anita Gurumurthy, Isis Hjorth, Lilly Irani, Molly Jackman, Calestous Juma, Dorothea Kleine, Madlen Krone, Vili Lehdonvirta, Chris Locke, Silvia Masiero, Hannah McCarrick,Deepak K. Mishra, Bitange Ndemo, Jorien Oprins, Elisa Oreglia, Stefan Ouma, Robert Pepper, Jack Linchuan Qiu, Julian Stenmanns, Tim Unwin, Julia Verne, Timothy Waema
A 21. század nem csak politikai és társadalmi változásokat hozott: a felgyorsuló technikai-technológiai fejlődés nyomán a gyógyászatban is egyre korszerűbb és egyre hatékonyabb eszközök, illetve módszerek állnak rendelkezésre. A rehabilitáció terén ilyen az exoskeleton vagy a bionikus művégtagok megjelenése, de szerephez jutnak a VR-rendszerek, sőt egyes telefonos applikációk is, mindezek mellett a pszichológia fejlődése is töretlen a szakterületen. Dr. Weinhoffer Judit az utóbbi két évtized tendenciáit foglalja össze kétrészes tanulmányában, amely A katona-egészségügy szerepe a rehabilitáció 20. és 21. századi fejlődésében című, a Zrínyi Kiadónál 2021-ben megjelent kötete 7. fejezetének szerkesztett változata.
Well-being, happiness, and quality of life are now established objects of social and medical research. Does this science produce knowledge that is properly about well-being? What sort of well-being? The definition and measurement of these objects rest on assumptions that are partly normative, partly empirical, and partly pragmatic, producing a great diversity of definitions depending on the project and the discipline. This book, written from the perspective of philosophy of science, formulates principles for the responsible production and interpretation of this diverse knowledge. Traditionally, a philosopher’s goal has been a single concept of well-being and a single theory about what it consists in. But for science this goal is both unlikely and unnecessary. Instead the promise and authority of the science depends on it focusing on the well-being of specific kinds of people in specific contexts. Sceptical arguments notwithstanding, this contextual well-being can be measured in a valid and credible way-but only if scientists broaden their methods to make room for normative considerations and address publicly and inclusively the value-based conflicts that inevitably arise when a measure of well-being is adopted. The science of well-being can be normative, empirical, and objective all at once, provided that we line up values to science and science to values.
A new framework for assessing the role of information and communication technologies in development that draws on Amartya Sen's capabilities approach.
Information and communication technologies (ICTs)—especially the Internet and the mobile phone—have changed the lives of people all over the world. These changes affect not just the affluent populations of income-rich countries but also disadvantaged people in both global North and South, who may use free Internet access in telecenters and public libraries, chat in cybercafes with distant family members, and receive information by text message or email on their mobile phones. Drawing on Amartya Sen's capabilities approach to development—which shifts the focus from economic growth to a more holistic, freedom-based idea of human development—Dorothea Kleine in Technologies of Choice? examines the relationship between ICTs, choice, and development.
Kleine proposes a conceptual framework, the Choice Framework, that can be used to analyze the role of technologies in development processes. She applies the Choice Framework to a case study of microentrepreneurs in a rural community in Chile. Kleine combines ethnographic research at the local level with interviews with national policy makers, to contrast the high ambitions of Chile's pioneering ICT policies with the country's complex social and economic realities. She examines three key policies of Chile's groundbreaking Agenda Digital: public access, digital literacy, and an online procurement system. The policy lesson we can learn from Chile's experience, Kleine concludes, is the necessity of measuring ICT policies against a people-centered understanding of development that has individual and collective choice at its heart.
Drawing on philosophy, political and social theory, decision-theory, economics, psychology, history and literature, Jon Elster’s classic book Sour Grapes continues and complements the arguments of his acclaimed earlier book, Ulysses and the Sirens. Elster begins with an analysis of the notation of rationality, before tackling the notions of irrational behavior, desires and belief with highly sophisticated arguments that subvert the orthodox theories of rational choice. Presented in a fresh series livery and with a specially commissioned preface written by Richard Holton, illuminating its continuing importance to philosophical enquiry, Sour Grapes has been revived for a new generation of readers. © Maison des Sciences de l’Homme and Cambridge University Press 1983.
Increasing scholarly attention has focussed on how to integrate technology within the Capability Approach (CA), yet without a consistent solution. Some describe technology as a special kind of capability input, but others consider the concept of technology to be fundamentally different from that of an ordinary input. We aim to contribute to the theoretical development of the CA by offering a consistent justification for the explicit inclusion of technology in this framework. We propose that technical objects have a ‘generative’ and a ‘transformative’ dimension through which they enable capabilities directly and affect other inputs in the attainment of valued capabilities. The objects acquire the transformative dimension from the broader technological context, which we propose as a new class of conversion factors. Using the example of mobile phones and their role in healthcare access, we demonstrate that our proposal helps to frame the analysis of the development impact of technology.
Disability studies provide the theoretical background for what we call the shift from the medical to the social model of disability. The social model of disability was developed as a critique to the medical model of disability. However, within disability studies, the social model of disability has been almost as strongly criticized as the medical model of disability. Michael Oliver, one of the founding fathers of the social model of disability, has recently called for a halt to this criticism, unless someone can come up with a better alternative. The CRPD offers such an alternative: the human rights model of disability. It is by no means the only alternative to the social model of disability (many models have been developed, among them recently the capability approach model), but the human rights model is an improvement on the social model of disability, and it is a tool to implement the CRPD.
The capability approach is one of Amartya Sen's most significant contributions to philosophy and the social sciences. His writings on the capability approach are not only of theoretical interest on their own, but also provide concepts used in his work on social choice, freedoms, and development (see the chapters by Alkire, Pettit, and Roberts in this volume). Moreover, the capability approach has practical relevance for policy design and assessment, most famously through the work of the United Nations' Human Development Reports (United Nations Development Programme 1990-2007/8). This chapter provides an overview of the conceptual and normative foundations of the capability approach and the role of agency within the approach. It puts aside the diverse ways in which the capability approach has been applied and implemented (Robeyns 2006). The chapter is divided into two parts. The first part, of which Ingrid Robeyns is the primary author, describes the main purpose of the capability approach, the concepts of functioning and capability, and the question of selecting and weighing capabilities. The second part, of which David A. Crocker is the primary author, focuses on the nature, value, and role of agency in the capability approach. Scholars and policy makers use the capability approach in a wide range of fields, most prominently in development studies and policymaking, welfare economics, social policy, and social and political philosophy. It can be employed in both narrower and broader ways.
Over the years, several studies have been performed on the subject of non-use of provided assistive technology. All of them report high rates of non-use. In this literature overview the determinants mentioned in literature that affect the degree of non-use will be discussed. They will be compared to the determinants that affect adherence with medical interventions. First, the various definitions of non-use used in literature will be compared. Next, an overview of the determinants of non-use of assistive technology will be given, categorized under personal factors, factors related to the assistive device, factors related to the user's environment and factors related to the intervention. After comparing these factors to the factors found in literature related to adherence with medical interventions, the strategies used to reduce non-adherence with medical interventions will be "translated" into the field of assistive technology provision.
There is a lack of evidence on the effects and quality of AT service delivery (ATSD). This study presents a quasi-experimental 3-months follow-up using a pre-test/post-test design aimed at evaluating outcomes of AT interventions targeting children with physical and multiple disabilities. A secondary aim was to evaluate the feasibility of the follow-up assessment adopted in this study with a view to implement the procedure in routine clinical practice. Forty-five children aged 3-17 years were included. Parents were asked to complete the IPPA for AT effectiveness; KWAZO and QUEST 2.0 for satisfaction with ATSD; SCAI for estimating the social cost of AT interventions. At follow-up, 25 children used the AT recommended. IPPA effect sizes ranged from 1.4 to 0.7, showing a large effect of AT interventions. Overall, parents were satisfied with ATSD, but Maintenance, Professional services, and AT delivery were rated not satisfactory. SCAI showed more resources spent for AT intervention compared to human assistance without technological supports. AT may be an effective intervention for children with disabilities. Issues concerning responsiveness and feasibility of the IPPA and the SCAI instruments are discussed with a view to inform routine clinical practice.
Those seeking to improve the well-being of individuals with disabilities worldwide often draw on the idea of human rights. More recently, a variety of international human rights legislation such as the Convention on the Rights of Persons with Disabilities (CRPD) has come into force worldwide. The present article aims to ground human rights of people with disabilities such as those in the CRPD in a theory of social justice called the capabilities approach (CA). This article discusses the reasons for grounding rights in a theory of justice, the links between the CA and human rights, the central concern for disability and individuals with disabilities in the CA, and seven central components of the CA.
In Reconciling the Capability Approach and the ICF, Jerome Bickenbach (2014) asks for caution in the “head-to-head comparison” of the capability approach and the International Classification of Functioning, Health and Disability (ICF). Bickenbach’s main argument is that the ICF has been misunderstood. I start with what the ICF is and how it has been used so far, then take up Bickenbach’s reactions to the major criticisms of the ICF that he identifies in the capability approach literature. Finally, I react to Bickenback’s proposal for a reconciliation.
I explore the usefulness of Martha Nussbaum's capabilities approach in regard to the UN Convention on the Rights of Persons with Disabilities (CRPD). The CRPD aims at empowering people with disabilities by granting them a number of civil and political, but also economic, social and cultural rights. Implementing the CRPD will clearly be politically challenging and also very expensive for states. Thus, questions might arise as to whether the requirements set in the CRPD can be justified from an ethical perspective. I will first investigate if Nussbaum's capabilities approach provides support for the rights claimed in the CRPD. Second, I will investigate to what extent Nussbaum's capabilities approach is a useful tool to set priorities among rights in the course of the implementation of the convention. This is an urgent question because seen realistically, it will not be possible to realize all rights at once and thus some rights need to receive greater priority than others. I will argue that the capabilities approach can be regarded as supporting the rights specified in the CRPD, but that it proves unable to guide the implementation process due to an insufficient grounding of the capabilities. Employing the capabilities approach thus leads to only limited results.
La littérature portant sur les applications de l’approche par les capabilités d’Amartya Sen et de Martha Nussbaum est abondante, mais ce n’est que récemment que certains ont soutenu l’idée que son application à l’analyse des handicaps présenterait un réel avantage par rapport aux analyses existantes, et en particulier qu’elle serait préférable au modèle du fonctionnement et du handicap que l’on trouve dans la Classification Internationale du Fonctionnement, du Handicap et de la Santé (CIF) de l’Organisation mondiale de la santé. Je soutiens dans cet article qu’une comparaison directe entre l’approche par les capabilités et la CIF doit être menée avec beaucoup de précaution, parce que la première est essentiellement une analyse théorico-politique de justice égalitaire, alors que la seconde est un modèle de système de classification pour décrire le handicap qui est explicitement neutre vis-à-vis de toute théorie de justice distributive. Néanmoins, cet article montre qu’une comparaison attentive de ces deux conceptualisations du handicap révèle des aspects saillants de convergence qui indiquent une synergie potentielle entre l’approche par les capabilités appliquée au handicap et la CIF.
This paper outlines Assistive Technology (AT) that is currently available to enable older people and carers to retain an independent lifestyle. Much of this technology is designed to aid activities within the home. In this context ‘Home’ includes sheltered housing but not hospital or residential care. We will discuss its
From a rights perspective disability has come increasingly to be seen as less a matter of personal misfortune than of societal neglect and obstruction, and as much warranting claims on the state to ensure inclusion and equality as to prosecute a duty of care. This shift resonates with other transitions within international discourse, most notably the increasing prominence of the notion of human development, which emphasises the importance of equity, freedom, and full realisation of human rights and capabilities as central to societal developmental objectives. After briefly examining apparent parallels in discourses relating to disability and to human development, the capabilities approach, upon which the concept of human development is grounded, is examined more closely and its implications for disability considered. It is argued that a capabilities approach may serve alternatively to keep disability partially hidden from view or become a powerful means for identifying the responsibilities of governments and external agencies in genuinely equalising opportunities.
This article seeks to illuminate the complementarity between the capabilities framework, developed by Amartya Sen and others, and the social model of disability. Common themes include the relationship between social barriers and individual limitations, the importance of autonomy and the value of freedom, and dissatisfaction with income as a measure of well‐being. Bringing the two approaches together has implications for analysis (for example in identifying poverty or disadvantage), and for policy, which are briefly illustrated. The article concludes that the capabilities framework provides a more general theoretical framework in which to locate the social model of disability, without compromising any of its central tenets; and the social model provides a thorough‐going application of the capabilities framework. Each can benefit from exposure to the other.