Ethical Versus Legal Issues In Family Social Care

Family members provide most of the care for other family members of all ages, and their actions illustrate the ethical values of beneficence, nonmalefic-ence, fidelity, accountability, privacy, and justice. Families, however, do not act in isolation from the larger society and other social institutions. Laws and public policy affect family caregiving. In other words, the ethics of family caring is not confined to members of the family and their views of rights and duties but operates within...

Education And Attitudes

In order to introduce a wide array of technologies, the attitudes not only of older persons, but of caregivers, researchers, industry, and the general public must be taken into account. Do these groups agree as to what types of technologies are appropriate Is the negative attitude toward all things old, including people, a deterrent An educational program to counter such negative views and attitudes needs to be instituted at a variety of levels. In particular, marketing individuals and industry...

Needs Of Dying Persons

An ethic of care for terminally ill persons must be responsive to needs. Generally, the needs of dying persons will span the needs of life itself, from physical and medical care issues to psychological and social needs and often to spiritual concerns. To focus the point, consider persons dying from cancer. Sometimes these people will have to experience the deterioration of their bodies over a period of weeks or months. Anxiety, fear, loneliness, and depression are common. Most people can expect...

Social Support Rights And Responsibilities

We begin with a brief explication of the terms ''need'' and ''right.'' Although rights language in and of itself does not adequately address the complex issues found in the provision of home care services, it cannot be avoided when clients, agencies, and staff are attempting to determine the legitimacy of certain claims, requests, and demands. Rights language, however, will be tempered with the language of relationships and responsibilities. A need is defined as a necessity, a lack of something...

Health And Health Care

Elderly ethnic minorities generally have greater health problems than their white counterparts. Moreover, minorities tend to have chronic disability at an earlier age than nonminorities (Hawkins & Kildee, 1990). Forty-one percent of elderly Latinos viewed themselves to be in poor or fair health, compared with 29.9 of all elderly (C. Lopez & Aguilera, 1991). Elderly Latinos also have disproportionately higher rates of disability than non-Latinos. Elderly minorities of color face serious...

Public Policy

In the area of public policy, Kapp (1991) indicates that there should be little external monitoring of family caregiving relationships ''society cannot legislate lovingkindness'' (p. 11). However, some families are dysfunctional, and thus elder-abuse and neglect laws seek to prevent harm where ethical considerations for nonmaleficence are inoperative. Public policy addressing elder mistreatment must not simply punish but also address issues of autonomy and support for families. One public...

Family Social Caregivers

Families provide nearly 80 of the in-home care for older relatives with chronic impairments (U.S. Senate Special Committee on Aging, 1992). The primary forms of assistance to older family members are social, emotional, and financial support, instrumental activities such as meal preparation, shopping, housework, and transportation, personal care (e.g., bathing, dressing, and feeding), and help with accessing social service agencies. Care is principally provided by a single individual, the...

The Hospice Movement

Borrowed from a medieval term referring to wayside inns for pilgrims and other travelers needing help and assistance, hospice represents a variety of programs to assist and care for terminally ill patients. Much of the inspiration for the hospice movement in North America, which began in the 1970s, came from programs developed in Great Britain, especially at St. Christopher's Hospice under the direction of Dr. Cicely Saunders (Davidson, 1985 Zimmerman, 1986). Often working outside the...

Minority Elderly Data Inadequacies

There is a lack of sufficient research data on minorities of color. We do not know enough about their perceptions about their own health, how often they are bedridden or otherwise restrictively limited, or the financial influence on such limitations. Most epidemiological studies of minority elderly focus on broad racial comparisons instead of actual ethnic, ecological, or social factors that may affect the health or the delivery of health care of the minority elderly (e.g., the relationship of...

Summary

Acceleration in technological advances, coupled with increases in the aging population, has led to an unavoidable convergence of these two major societal trends. What the blend can look like is largely dependent upon attitudes toward the elderly and the appropriate utilization of technologies in areas such as home health care, education, work retirement schemes, and adaptive lifestyles. As the population continues to age, it is likely that increasing numbers of those aged 85 or older will face...

Principles Of Research Ethics

This chapter examines ethical issues associated with geriatric research. The research discussed in this chapter generally falls under the umbrella of clinical research. This includes research about medical care, as well as psychiatric and psychosocial aspects of health and health care. Few of the issues described are unique to geriatrics. Rather, most topics discussed are common to clinical research in general. The chapter briefly reviews some of the historical development of contemporary...

Preventing Promoting And Maintaining

Preventive medicine commonly speaks of primary and secondary prevention. Primary prevention seeks to ''prevent the onset of a disease.'' Secondary prevention ''aims to identify an established disease in a presymptomatic stage in order to cure or prevent its progression'' (Rubenstein, 1996-1997, p. 48). While some primary preventive measures (e.g., those aimed at preventing hypertension or diminishing certain cancer risk factors) are quite effective, medical prevention in mental health is more...

The Spiritual Dimension

The spiritual core can be considered the deepest center of the person. Here the person is open to the transcendent dimension and it is here where he or she experiences ultimate reality. Spirituality is composed of those attitudes, beliefs, and practices that enable us to reach out toward that part of reality that is transcendent. According to L. A. Burton (1992), there are basic assumptions with regard to spirituality (1) Tillich calls it ''the existential awareness of non- being.''...

Balancing The Ideal And The Practical Normative Goals For Mental Health And Aging

As the previous discussion has made clear, a robust normative vision for mental health and aging takes seriously the cultural, social, and other limits that older people experience in their efforts to lead personally meaningful and socially significant lives. To the extent possible, a broad social strategy is a critical vector in facilitating these ends. At one step removed from this large social vision, prevention is the desirable approach for those conditions for which we understand, at least...

Implications Of Preventive Ethics For Longtermcare Policy And Planning

The preventive-ethics approach to long-term-care decision making that we have proposed here has important implications, still fully to be identified and explored, for public policy and for institutional practice and planning. Public policy and institutional practice and policies can sometimes function synergis-tically as a source of unnecessary and ethically suspect impediments to preventive ethics. For example, many hospitals have attempted to shorten length of stay for Medicare beneficiaries...

Current Longtermcare Policy And Legislation In The United States

In long-term care, as in other aspects of U.S. health care delivery, ''form follows funding'' (R. L. Kane & R. A. Kane, 1990, p. 416). Because U.S. long-term-care policy and financing are decentralized, categorical, and limited (Benjamin, 1992), there is no long-term-care system but a fragmented array of different programs and many gaps in what is needed, especially outside of institutions. The following facts regarding long-term-care financing are key to comprehending what we must frankly...

Prolong Life Or Forgo Lifesustaining Treatments

The confluence of the factors of greater life expectancy, causes of death precipitating longer periods of disability and dying, and removal of death and dying from the home and the care of families to institutions have produced an unprecedented need to rebuke the unbridled use of life-sustaining technologies. As ethical debate has arisen over the last three decades, two opposing approaches have been used to treat dying patients either to prolong life or allow patients to die by refusing...

Practical Stepwise Preventiveethics Approach To Longtermcare Decision Making

Preventive ethics eschews theoretical, a priori resolution of the ambiguous and complex process of long-term-care decision making (Chervenak & Mc-Cullough, 1991). Preventive ethics takes a prospective approach to ethical conflict in the decision-making process. The preceding analysis of the ethical dimensions of long-term-care decision making and their implications for practice makes it possible to describe a preventive-ethics approach to long-term-care decision making. This...

Responsibility Of The Individual

When we talk about ethics and the rights of individuals, we must not fail to discuss the individual's responsibility. It is the patient's responsibility to inform others of his or her decisions. A living will provides an excellent way of doing this. It allows individuals to state a preference for no heroic measures. However, because it is uncertain whether or not health professionals must carry out the terms of the living will, some states have enacted natural-death acts. The only patients...

Conclusion Policy Recommendation

''Social intervention is any act, planned or unplanned, that alters the characteristics of another individual or the pattern of relationships between individuals'' (Kelman & Warwick, 1978, p. 3). This includes such macrolevel phenomena as public policy, national planning, military intervention in the affairs of other nations, and technical assistance. It also covers microlevel phenomena such as psychotherapy, neighborhood security watch programs, sensitivity training, and experiments done...

Proxy Designation Clause

If you wish, you may use this section to designate someone to make treatment decisions if 23. you are unable to do so. Your Living Will Declaration will be in effect even if you have 25. I authorize the following person to implement my Living Will Declaration by accepting, 26. refusing, and or making decisions about treatment and hospitalization 29. If the person I have named above is unable to act on my behalf, I authorize the following 33. I have discussed my wishes with these persons and...

Ethics Aging And Mental Health

To reflect about mental health, ethics, and aging is also to ask, what is the territory for such reflection For the past decade, as ethicists have considered aging and gerontologists and geriatricians have deepened their interest in and knowledge about biomedical ethics, ethics has tended to focus on bracketed moments when individuals must make decisions. In this thinking, ethics became a ''decision-procedure for resolving conflict-of-choice situations'' (Hauerwas & Burrell, 1977, p. 8)....

Future Needs And Resources Of Family Caregivers

The family will continue to be the primary source of physical, social, emotional, and financial support for its members. Demographic changes such as increased life expectancy, the large baby-boom cohort, and fewer age peers suggest that there will be more older family members to be cared for by fewer younger family members. Although caregiving in aging families brings to mind images of younger members providing care for older members, care tends to flow from older to younger members as well....

Types Of Family Social Care

The family as a social institution functions as the primary source of physical, social, emotional, and financial support for its members. Provision of various types of care flows back and forth between generations. For married couples, a spouse is the primary source of care. However, adult children care for parents or grandparents aging parents provide assistance or care to developmentally disabled adult children siblings help each other with housekeeping and transportation and grandparents...

The Disabled Older Adult

Aging does bring with it decline, to a greater or lesser degree depending upon the person. But even in this state the Scriptures tell us that we are not alone. ''Even to your old age and gray hairs I am he, I am he who will sustain you. I have made you and I will carry you. I will sustain you and I will rescue you'' (Isa. 46 4). This Scripture gives the gift of hope. The Scriptures also give a basis for value that is independent of productivity. Feeling valued by God can give a person enough...

Research Population And Setting

Ethical issues also arise from the population being studied and the setting in which the study is being conducted. Certain settings may have a greater likelihood of raising concerns about coercion or the ability of subjects to provide informed consent. Coercion issues arise when there is the possibility that the setting in which the research will take place will make subjects reluctant to refuse participation in research. In part, these concerns stem from the Nazi era when defendants at the...

Raceethnicity And Family Social Care

The preceding discussion highlights general patterns of caregiving. However, there are subcultural differences. For example, multigenerational households are more prevalent among African American, Latino, and Asian families (R. W. Beck & S. H. Beck, 1989 Tennstedt et al., 1993). Social support and various types of assistance are exchanged within these extended-family households (Sil-verstein & Waite, 1993 Speare & Avery, 1993). Although such households may be formed on the basis of...

Technology And Longterm Care

The health of the caregivers and the health of the care receiver must be jointly considered. What benefits the caregiver can result in less staff turnover. For example, the technology that can be employed for patient lifting and moving may not be immediately perceived as having such a beneficial effect, but the reciprocal nature of the provision and the receipt of care is too often lost. The incorporation of technology into long-term-care settings thus plays a dual role that enhances the...

Retirement

Ethnic-minority elderly face serious financial problems. Since most have worked at relatively low-paying jobs or are forced to exit the work force before retirement age for health reasons, they are likely to receive minimum or near-minimum benefits when they retire. This results in high rates of poverty and near poverty. Many elderly minorities have incomes so low that they cannot survive without assistance from families and friends. Latino elderly have typically worked hard throughout their...

Ethical Issues in Aging Synthesis and Prospects for the Twentyfirst Century

Handbooks lay a presumptuous claim to a place for themselves in the scholarly literature. Whereas most publications have limited aims and short shelf lives, works in this genre claim to represent the state of the art at least as defined by the field's leading practitioners. ''One of the few generalizing influences in a world of overspecialization'' (Encyclopaedia Britannica, 1985, Vol. 21, p. 555), handbooks are designed to render in-depth, topical analyses of nearly all the important facets of...

Scope Of Ethical Issues Addressed In This Chapter

G, a 79-year-old widowed, white woman, has been admitted to the short-stay unit of a comprehensive geriatric health care center after discharge from the hospital for hip replacement. She has been discharged to the short-stay unit as part of a contract arrangement between the hospital and the geriatric health care center. Her care plan includes postsurgical follow-up, physical therapy, and planning for the future. Her medical problems include mild heart failure and moderate visual...

Power Of Decision Making

The individual makes the decision when he or she is cognitively intact. The family, guardian, or agent designated by a durable power of attorney for health care makes the decision when the individual is not cognitively intact. If the family is not in agreement, medical staff will do what is least likely to result in a malpractice suit. If no family and or friends exist to aid in the decision, the medical profession's views will have precedence. Decisions when the patient has cognitive problems...

Who Becomes The Decision Maker For The Judgment Impaired

In the traditional progression of decision making, the presumption is that the family comes first. The individuals biologically closest or whomever the individual is most closely associated with are thought to be in the best position to reflect the wishes of the patient. Decision making is usually a shared process rarely is it advisable that surrogates should operate in isolation. Understandably, physicians because of their expertise play an important role in shaping decisions. Patients and...

Ethical Issues in the Quality of Care

With the passage of Medicaid and Medicare legislation in the 1960s, quality-assurance systems received a focus of attention in the health care delivery system that had never before existed. Initially, quality-assurance activities were concentrated in hospitals, but they have now expanded into ambulatory care, primary care, long-term-care settings, and community and public health care programs. Even in the present period of debate regarding health care reform, every health care initiative, no...

Implications For Practice

The preceding ethical analysis underscores ambiguity and its management as central ethical themes of long-term-care decision making, in sharp contrast to acute-care decision making. Long-term-care decisions introduce ambiguity by contradiction or the threat of contradiction among the values, hopes, and identities in the moral lives of elders and those who care for them. These ambiguities shape housing and financial decisions, as well as decisions about what care is needed and who can, will, or...

Concepts Of Mental Health

Because health is a complex concept, efforts to ''define'' mental health can be diffuse and ambiguous. Moreover, formal definitions are one thing operational usage is another. In practice, mental health has often been construed minimally as the absence of mental illness. In the prevailing biomedical model, a second distinction has existed between health as the absence of illness and health as the absence of disease. In this view, illness is a condition of, and is suffered by, persons, while...

Conclusions On Death Dying And Ethnicity

Death, as part of the life process, affects every individual and culture. It produces anxiety and is disruptive to social dynamics. Each culture has its own beliefs, norms, and rituals about death and dying. Funerals function to provide people an outlet to commiserate and grieve together. This seems necessary in order to get on with life and alleviate the disruption caused by the departure of a group member. There is a general attitude in the dominant culture to deny and avoid the topic of...

Modernization Approach To Aging And Ethnicity

Immigration during the latter half of the nineteenth century and the early twentieth century consisted largely of people from societies that were less industrialized and less modernized than the United States (Italians, Mexicans, Puerto Ricans, Polish, and Irish). While it is true that in some cases, the country of origin was in the process of urbanizing and industrializing, most immigrants came from the agricultural peasant regions of these countries (Markides & Min-del, 1987). Most Italian...

The Ethics Concepts

While some of the contributors to this handbook would disagree, in my view it is better to see the seven concepts in a balanced perspective rather than as a hierarchy. If they are viewed in this way, there is a blending or an integration rather than competition. This in no way does away with the tension between right and responsibility and the positional distance between autonomy and accountability. As we have seen in the contributors' discussions of the issues and dilemmas that emerge when we...

Tanya Fusco Johnson

Library of Congress Cataloging-in-Publication Data Handbook on ethical issues in aging edited by Tanya Fusco Johnson. p. cm. Includes bibliographical references and index. ISBN 0-313-28726-0 (alk. paper) 1. Aged Care Moral and ethical aspects. 2. Aging Moral and ethical aspects. I. Johnson, Tanya F. HV1451.H35 1999 174'.2 dc21 98-8235 British Library Cataloguing in Publication Data is available. Copyright 1999 by Tanya Fusco Johnson All rights reserved. No portion of this book may be...

Ethics In Aging

This handbook follows a growing number of writings on ethics in aging, and we are indebted to their authors for the breadth of ethical issues they have addressed and their insights in charting a course for resolution. Many writers, including those who have contributed to this volume, have moved this field of ethics in aging to a higher level of understanding, and we wish to acknowledge their pioneering efforts, especially those of the many who are unnamed. Illustrative of the more well-known...

Recognition Response And Access In Specific Circumstances

Recognizing a mental health problem is critical to obtaining or providing timely and effective responses to the problem. Societal recognition of problems, as previously noted, is also crucial in assuring access to care. Striving, both as individuals practitioners, family members, and elders themselves and as a society, to maximize recognition of genuine problems, provide appropriate access to care, and thus relieve suffering and minimize harm to the elders affected is a pivotal, shared moral...

Racial Mortality Crossover Phenomenon

There is a notable exception to lower life expectancy for African Americans compared to whites 75 to 80 years of age. At this point, a convergence occurs whereby African Americans have more expected years remaining than whites (Wing, Manton, Stallard, Harnes, & Tyroler, 1985 Manton, 1980). We call this the racial mortality crossover phenomenon. There are also racial crossover patterns in death from heart disease and certain types of cancer (National Center for Health Statistics, 1980)....

Analytical Strategies Models And Paradigms

Analytical strategies, models, and paradigms can be used to explore and suggest answers for some of these ethical questions as well as provide a basis for decision making. A number of ethical models or paradigms can be applied to situations involving the provision of care by family members. Some models focus on the consequences of the behavior (teleological theory), while others suggest that consequences alone may not determine the rightness or wrongness of an action (deontological theory)...

Ethics In The Multicultural Multidisciplinara Setting

As the contributors to this handbook point out over and over, we live in a multicultural society. Along with aging being a triumph of the twentieth century, we can also claim credit for great strides in human rights and the respect for persons of differing classes, color, cultures, and creed. In addition, we have recognized the value in seeing the individual in context and with a variety of needs, biological, psychological, social and cultural. The holism in clear. We cannot view an emotional...

Shrinking Of The World

Older individuals tend to use less and less of what can be termed the total environment. This gradual restriction often begins when the person leaves the world of work at retirement. A second point at which there is a reduced level of participation in the outside world occurs when the individual experiences the onset of a chronic illness. Further restrictions are put into play as the individual ages and sensory deficits, such as vision or hearing losses, become more intensified. Such physical...

Ethical Issues And Conflicts For Service Providers

Professional and agency providers of health and human services are expected, as part of their fiduciary or trust relationship (Frankel, 1983) with the older persons they serve, to respect and promote their clients' legal rights. In fulfilling this function, ethical dilemmas are bound to materialize. For descriptive purposes, we shall examine the contexts of guardianship and elder abuse and neglect. Guardianship is a legal relationship, authorized by a state court, between a ward (the person...

Spiritual Needs Of Older Adults Versus Younger Adults

Each developmental stage presents us with unique opportunities and challenges. As children, we are, for the most part, taken care of by adults. Our basic survival needs are met in addition to our need for love and nurture. As we enter into adolescence, we begin to formulate our own belief systems and attempt to separate ourselves from our parents or guardians. Young adulthood has us pursuing our dreams, entering our career paths, and marrying and having children. When middle age approaches, we...

Case Studies

Younger Family Members Caring for Older Adult Children The provision of care by younger family members for older members may lead to the discussion of a number of ethical issues as well as produce ethical dilemmas when two or more ethical values clash. The following case study of adult children caring for older parents is useful for elaborating some of the ethical issues and dilemmas associated with this type of family social care. Case 1 Martha is 75 years old and lives alone in the house...

Fear Of Crime

It was true that the neighborhood had changed. Freshly painted houses had been replaced by houses with boarded windows and vacant lots. The corner store was less a hangout for children coming home from school than for young men peddling drugs. Fences were decorated with graffiti, and abandoned cars dotted the streets. Most of the neighbors that George had known so well during his working years had left the city long ago for sprawling suburbs or the rural landscape beyond. Only a few remained,...

Communicative Ethics In Decision Making

''Communicative ethics'' is a systematic method for making ethical decisions. This approach to ethical decision making is described by the German social philosopher Juirgen Habermas 1990 . In recent years, Habermas has used the phrase ''discourse ethics.'' However, we will use communicative ethics because the word conveys a better sense of this process how and what we communicate when we must make ethical decisions in a group setting. Communicative ethics reminds us of the importance of the...