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Doody's Review ServiceReviewer: Myra A Aud, PhD, RN (University of Missouri-Columbia)
Description: This book is a scholarly discussion of autonomy as applied to older adults needing long-term care. Long-term care in this case includes both institutional long-term care provided in skilled and intermediate care facilities and long-term care provided in the older adults' homes or the homes of their children. The author presents a comprehensive review of theoretical conceptualizations of autonomy and interpretations of autonomy in long-term care by healthcare providers and bioethicists. A strong case is made for looking at autonomy in the context of older adults' everyday experiences in long-term care rather than in the intense bioethical cases addressed in acute care.
Purpose: Because the author describes his goal as providing a framework for respecting autonomy in long-term care, he does not provide a detailed set of instructions on how to increase the autonomy of older adults. Instead he explores what autonomy might be in the everyday experience of older adults in long-term care. Given current concerns related to care quality in institutional and home-based long-term care, the author's discussion of autonomy in the everyday experiences of older adults is very timely.
Audience: This book would be of interest to gerontologists, bioethicists, and providers of healthcare to older adults who are interested in a philosophical discussion of autonomy. Readers looking for a set of simple instructions will be disappointed. However, graduate students will find this book a challenging read and a scholarly presentation by an expert. The author suggests that this edition would be useful for classroom use.
Features: The author discourses at length on the concept of autonomy and theoretical conceptualizations of autonomy. He also addresses long-term care as it is provided to frail older adults by professional healthcare providers in institutions such as nursing homes and by families (spouses and adult children most often) in home settings. He points out that the majority of older adults are cared for in home settings rather than in institutions. A distinction is made between the exercise of autonomy in healthcare decision making in acute care and in everyday life as experienced by older adults at home or in nursing homes.
Assessment: I found this book to be a fascinating read, one that made me pause, examine and re-examine the author's premises. I especially appreciate the author's phenomenological approach and his discussion of autonomy in the framework of four themes: space, time, communication, and affectivity and the role of autonomy in the choices of everyday life for older adults needing long-term care because of increasing frailty.