Autonomy and Long-term CareOxford University Press, 1993 - 197 pages 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. |
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ability abstract accounts of autonomy action activities actual autonomy acute medical agent Agich argued autonomy as independence autonomy as negative autonomy in long-term baby talk basic behavior beliefs caregivers choice cognitive communitarian competence concept of autonomy concern concrete context cultural decision decisionmaking defined dependence disability discussion Eastside effect elders in long-term essential everyday world example existence experience expressivist feature frail function fundamental home care human development human persons ideal identification illness impaired implications important individuals informed consent institutional interaction involves liberal theory long-term care meaning meaningful medical ethics medicine moral negative freedom negative liberty noninterference nursing area nursing home one's parents paternalism patients phenomenological political positive practical problem professional question rational reality reflection regarding relationship requires residents respect role seems sense sick sick role significant simply social world staff structure tence Thomasma tion typically understanding values view of autonomy world of everyday