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The realities and misconceptions of long-term care and the challenges it presents for the ethics of autonomy are analyzed in this perceptive work. While defending the concept of autonomy, the author argues that the standard view of autonomy as non-interference and independence has only a limited applicability for long-term care. He explains that autonomy should be understood as a comprehensiveness that defines the overall course of a person's life rather than as a way of responding to an isolated situation. Agich distinguishes actual and ideal autonomy and argues that actual autonomy is better revealed in the everyday experiences of long-term care than in dramatic, conflict-ridden paradigm situations such as decisions to institutionalize, to initiate aggressive treatments, or to withhold or to withdraw life-sustaining treatments. Through a phenomenological analysis of long-term care, he develops an ethical framework for it by showing how autonomy is actually manifest in certain structural features of the social world of long-term care. Throughout this timely work, the rich sociological and anthropological literature on aging and long-term care is referenced and the practical ethical questions of promoting and enhancing the exercise of autonomy are addressed.
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.
Among the issues confronting America is long-term care for frail, older persons and others with chronic conditions and functional limitations that limit their ability to care for themselves. Improving the Quality of Long-Term Care takes a comprehensive look at the quality of care and quality of life in long-term care, including nursing homes, home health agencies, residential care facilities, family members and a variety of others. This book describes the current state of long-term care, identifying problem areas and offering recommendations for federal and state policymakers. Who uses long-term care? How have the characteristics of this population changed over time? What paths do people follow in long term care? The committee provides the latest information on these and other key questions. This book explores strengths and limitations of available data and research literature especially for settings other than nursing homes, on methods to measure, oversee, and improve the quality of long-term care. The committee makes recommendations on setting and enforcing standards of care, strengthening the caregiving workforce, reimbursement issues, and expanding the knowledge base to guide organizational and individual caregivers in improving the quality of care.
This accessible, interactive resource book encourages front-line staff working with dementia sufferers in nursing and residential settings to examine their working practice and modify it to where appropriate to meet best practice guidelines. Packed with photocopiable training exercises, discussion points and questions to prompt care workers to reflect on their style of work, this practical training manual also provides a framework for care work in line with statutory requirements and national training standards. It can be used as a self-training guide by carers, who can work through it at their own pace or under the supervision of a colleague, or by trainers running structured courses on good practice in dementia care. It is also suitable for use as a quick reference in daily practice. This comprehensive resource will provide useful guidance for all staff working face-to-face with people with dementia, whether in nursing, day-care or residential settings.
This collection of original essays explores the social and relational dimensions of individual autonomy. Rejecting the feminist charge that autonomy is inherently masculinist, the contributors draw on feminist critiques of autonomy to challenge and enrich contemporary philosophical debates about agency, identity, and moral responsibility. The essays analyze the complex ways in which oppression can impair an agent's capacity for autonomy, and investigate connections, neglected by standard accounts, between autonomy and other aspects of the agent, including self-conception, self-worth, memory, and the imagination.
As more people live longer, the need for quality long-term care for the elderly will increase dramatically. This volume examines the current system of nursing home regulations, and proposes an overhaul to better provide for those confined to such facilities. It determines the need for regulations, and concludes that the present regulatory system is inadequate, stating that what is needed is not more regulation, but better regulation. This long-anticipated study provides a wealth of useful background information, in-depth study, and discussion for nursing home administrators, students, and teachers in the health care field; professionals involved in caring for the elderly; and geriatric specialists.
Long-term care is an increasingly important issue in many contemporary welfare states around the globe given ageing populations. This ground-breaking book provides detailed case studies of 11 EU-member states’ welfare regimes within Europe to show how welfare states organize, structures and deliver long-term care and whether there is a social investment perspective in the delivery of long-term care. This perspective is important because the effect of demographic transitions is often used as an argument for the existence of economic pressure on welfare states and a need for either direct retrenchment or attempts to reduce welfare state spending. The book’s chapters will look specifically into how different welfare states have focussed on long-term care in recent years and what type of changes have taken place with regard to ageing populations and ambitions to curb increases in public sector spending in this area. They describe the development in long-term care for the elderly after the financial crisis and also discuss the boundaries between state and civil society in the different welfare states' approaches to the delivery of care.
This book is open access under a CC BY 4.0 license. This book examines the concept of care and care practices in healthcare from the interdisciplinary perspectives of continental philosophy, care ethics, the social sciences, and anthropology. Areas addressed include dementia care, midwifery, diabetes care, psychiatry, and reproductive medicine. Special attention is paid to ambivalences and tensions within both the concept of care and care practices. Contributions in the first section of the book explore phenomenological and hermeneutic approaches to care and reveal historical precursors to care ethics. Empirical case studies and reflections on care in institutionalised and standardised settings form the second section of the book. The concluding chapter, jointly written by many of the contributors, points at recurring challenges of understanding and practicing care that open up the field for further research and discussion. This collection will be of great value to scholars and practitioners of medicine, ethics, philosophy, social science and history.
In few places in American society are adults so dependent on others as in nursing homes. Minimizing this dependency and promoting autonomy has become a major focus of policy and ethics in gerontology. Yet most of these discussions are divorced from the day-to-day reality of long-term care and are implicitly based on concepts of autonomy derived from acute medical care settings. Promoting autonomy in long-term care, however, is a complex task which requires close attention to everyday routines and a fundamental rethinking of the meaning of autonomy. This timely work is based on an observational study of two different types of settings which provide long-term care for the elderly. The authors offer detailed descriptions of the organizational patterns and routine practices that erode autonomy of the elderly. Their observations lead to a substantial rethinking of what the concept of autonomy means in long-term care. The book concludes with suggestions on how the autonomy of elderly individuals in long-term care institutions might be promoted.
In recent years, the triumph of autonomy has made paternalist interventions increasingly problematic. The value of a patient's right to self-determination and the practice of informed consent are considered supremely important in present-day health care ethics. In general, the idea of 'doctor knows best' has become more and more suspicious. This has left us with a situation in which paternalist medicine seems difficult to reconcile with respect for patient autonomy. This book offers a thorough reflection on the relationship between autonomy and paternalism, and argues that, from both theoretical and practical angles, the tension between these concepts is not as acute as it might seem. In long-term care, psychiatry, and care for the severely handicapped, the principle of respect for autonomy is particularly ill-suited. This, however, does not mean that such respect is totally irrelevant, but that it should take a different shape. Good care in those cases requires us to transcend the sharp dichotomy between autonomy and paternalism. In Autonomy and Paternalism: Reflections on the Theory and Practice of Health Care various acclaimed authors present their views on this interesting and extremely relevant debate.