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.
Industry Reviews
"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."--The New England Journal of Medicine
"Agich addresses [the provider's responsibility to respect the patient's autonomy] richly and comprehensively in this new book...Valuable."--Elder Express, Newsletter of the Office of Geriatric Medicine and Gerontology, Wright State University School of Medicine
"A well-written exploration of how to think about improving the quality of life for long-term care patients."--Choice
"An excellent work. It is an intelligent analysis of some of the realities that confront this serious problem in our aging society....Should be required reading for researchers, clinicians, ethicists, and philosophers on issues related to the care of the elderly."--Lawrence Lapalio (Loyola Univ Medical Center), Doody's Journal
"The most important contribution to the maturation of our thinking about autonomy that has yet been offered. Those who labor in long-term care or who are responsible for an interface with long-term care will be rewarded, but so too will a broad audience of health professionals and ethicists. The clear, sometimes lyrical writing makes the reading easy. The message is very important."--Annals of Internal Medicine
"Intellectually important, revelatory, and suggestive, offers insights that must be the basis on which real reform is crafted."--Martha Holstein, Medical Humanities Review
"For persons serving on ethics committees of short- or long-term care facilities, this volume will provide useful food for thought and a springboard from which to reassess authonomy in light of a model much more grounded in the developmental interdependence of our families and our care-giving institutions."--Psychiatric Services
