Ethical Issues in Family Care

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Jennifer Crew Solomon

Families tend to create enduring patterns of reciprocal support between older and younger members. Family social care is provided both by younger family members for older family members and by older people for younger. The focus of social care is providing assistance that increases a person's competence and mastery of the environment, rather than increasing his or her dependence (Hooy-man & Kiyak, 1996). From a life-course perspective, social care begins with nurturing and socializing the young for participation in society. At the other end of the life course, social care provides assistance with tasks of daily living and personal care in cases of extreme disability. The specific type of assistance is determined by the family member's functional ability, living arrangements, and the gender of both caregiver and receiver. A discussion of ethical issues related to family social care must take into account different types of assistance, family structure, gender, age, and racial/ethnic characteristics of caregivers and receivers.

Bound up in these family caregiving contexts are ethical values, issues, and dilemmas. Ethical values (e.g., autonomy, beneficence, justice, fidelity) provide a basis for deciding what a person in a particular situation morally ought to do. A number of ethical issues arise when these values are applied to situations involving the provision of social care by family members. For example, what is the level of cognitive development required for a person to function autonomously? Ethical dilemmas are created by conflicts between ethical values. Should an older person be allowed to continue handling his or her own finances (autonomy) in spite of consistent money mismanagement (nonmaleficence)? In other words, should a person be protected from harm that results from his or her own bad decisions?

This chapter begins with a discussion of the wide range of assistance provided by family members to other family members and the characteristics of both caregivers and receivers. This is followed by a presentation and analysis of scenarios that illustrate how ethical considerations for autonomy, privacy, beneficence, justice, fidelity, nonmaleficence, and accountability apply to family social care provided by adult children for parents, older parents for adult children with developmental disabilities, and grandparents for grandchildren.

Ethical principles not only provide a basis for examining particular types of caregiving by family members but are woven into policies and legislation that influence behavior more broadly and impact U.S. society in general. Thus analytical strategies, models, and paradigms are presented as a basis for decision making on issues related to family social care. This includes assessing how well U.S. society addresses the needs of family caregivers and receivers; recommending improvements in policy, practice, and research; and making projections about the future needs and resources of family caregivers and receivers.

A discussion of ethical models illustrates the complexity of implementing decisions based on various ethical values. At the theoretical level, the ethical value of autonomy, for example, may be applied to all persons involved in the family. In practical terms, one family member's decision-making rights often impinge on those of another family member. Jamison (1995) warns that our society has placed increasing emphasis on autonomy to the extent that it becomes ''almost pure hedonism'' and is not balanced with ''qualities of altruism and benevolence'' (p. 43). Moreover, the family is also a moral community with certain rights and responsibilities, and therefore, family autonomy should not be ignored (High, 1991). Placing ethical values within the context of an ethical model not only highlights complexity but also provides criteria for deciding between alternative ethical decisions.

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