Dependence and Autonomy in Old Age: An Ethical Framework for Long-term Care / Edition 2

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To reveal the concrete threats to personal autonomy in long-term care, George Agich's book offers a framework for developing 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 (Oxford, 1993), this revised edition in paperback has wide appeal among bioethicists and health care professionals.

This book contains no illustrations.

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Editorial Reviews

From the Publisher
"This is an excellent text on an important topic. The author's empathic understanding of the issues involved in the long-term care of frail older individuals makes this book one not only of useful instruction but also of sprirtual inspiration." Leila Toiviainen, University of Tasmania, Australia, Nursing Ethics

"This book has been hailed by critics as a milestone in medical ethics...It challenges clinicians to reexamine many of the ethical principles on which they have based their interactions with patients in long-term care." New England Journal of Medicine

"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." Doody's Review Service*****5 Stars!

Doody's Review Service
Reviewer: 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.

5 Stars! from Doody
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Product Details

  • ISBN-13: 9780521009201
  • Publisher: Cambridge University Press
  • Publication date: 7/1/2003
  • Edition description: Revised
  • Edition number: 2
  • Pages: 218
  • Product dimensions: 5.98 (w) x 8.98 (h) x 0.47 (d)

Meet the Author

George Agich is Chairman of the Department of Bioethics at the Cleveland Clinic Foundation, Professor of Clinical Medicine at Ohio State University and Adjunct Professor of Philosophy at Bowling Green State University. His previous books are Responsibility in Health Care (1982), and The Price of Health (1986), and he is a member of the editorial board of The American Journal of Bioethics and other journals.
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Table of Contents

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.
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