Dependence and Autonomy in Old Age
An Ethical Framework for Long-term Care

In this influential book, George Agich abandons comfortable abstractions to reveal the concrete threats to personal autonomy in long-term care.

George Agich (Author)

9780521009201, Cambridge University Press

Paperback, published 7 August 2003

218 pages
22.9 x 15.5 x 1.3 cm, 0.376 kg

'Agich's book is a revision of Autonomy and Long-term Care (1993) and the slight change of name is revealing. This book is a relatively accessible paperback for a wide audience, but it has an important and complex philosophical point: to spell out the contextual meaning of autonomy in the 'nooks and crannies' of everyday situations … Agich argues convincingly that all of us are dependent on various structures and various people at different stages in our lives. Rather than autonomy increasing from childhood to adulthood and then decreasing again into old age, we should speak about the nature of our autonomy and our dependencies changing and changing in perfectly normal ways.' Ethical Theory and Moral Practice

Respecting the autonomy of disabled people is an important ethical issue for providers of long-term care. In this influential book, George Agich abandons comfortable abstractions to reveal the concrete threats to personal autonomy in this setting, where ethical conflict, dilemma and tragedy are inescapable. He argues that liberal accounts of autonomy and individual rights are insufficient, and offers an account of autonomy that matches the realities of long-term care. The book therefore offers a framework for carers to develop an ethic of long-term care within the complex environment in which many dependent and aged people find themselves. Previously published as Autonomy and Long-term Care, this revised edition, in paperback for the first time, takes account of recent work and develops the author's views of what autonomy means in the real world. It will have wide appeal among bioethicists and health care professionals.

1. Introduction
Long-term care images
Autonomy
Autonomy and long-term care: the problem
2. The liberal theory of autonomy
Pluralism, toleration, and neutrality
The State and positive autonomy
Some problems of positive autonomy
Liberal principles in long-term care
Nursing home admission practices
The use of restraints
The perils of liberal theory
Communitarianism and the contextualist alternative
Practical implications of the debate over the foundation of ethics
Conflict and conversation
The function of rights
Limitation of rights
Paternalism and the development of persons
From paternalism to parentalism
Summary
3. Long-term care: myth and reality
Myths of old age
Nursing homes
Therapeutic relationships
Concepts of illness and disease
Models of care
The concept of a practice
Home care
Summary
4. Actual autonomy
Result-oriented theories
Action-oriented theories
The concrete view of persons
Autonomy: a developmental perspective
Narrative approaches
Dependence in human development
Sickness as dependence
Autonomy and identification
The paradox of development and problems of identification
Implications for long-term care
Summary
5. A phenomenological view of social action
Sociality and the everyday world
General Features of the social nature of persons
Space
Time
Communication
Affectivity
Summary
6. Autonomy and long-term care: another look
Social reality of Eastside
Appeal to autonomy as independence
A phenomenologically informed analysis
Lessons from Eastside
Conclusion
Bibliography
Index.

Subject Areas: Coping with old age [VFJG], Geriatric medicine [MJX], Medical ethics & professional conduct [MBDC]