Hostname: page-component-78c5997874-dh8gc Total loading time: 0 Render date: 2024-11-11T02:51:02.748Z Has data issue: false hasContentIssue false
  • English
  • Français

Autonomy and Advance Directives

Published online by Cambridge University Press:  29 November 2010

Elisabeth Boetzkes
Elisabeth Boetzkes
Affiliation:
McMaster University
Get access Rights & Permissions [Opens in a new window]

Abstract

In this paper it is argued that the voluntariness of decisions by older adults concerning future levels of health care should be viewed with scepticism, since such decisions are made in contexts of broad coercion. Broad coercion exists where there are asymmetries of power and dependency between groups, where social expectations unduly influence decisions, or where negative stereotyping results in low self esteem. Parallel cases, where broad coercion is acknowledged, are presented. Rather than conclude that older adults can never make voluntary decisions, however, it is suggested that scepticism may be removed by establishing the authenticity of the desires behind their health care choices. Three theories of authentic desire are examined and found inadequate, but a fourth alternative – the “autobiographical approach,” which requires us to uncover the personal metaphors of life and aging of older adults – is found to be more promising.

Résumé

L'auteur de cet article soutient que la prise de décisions par les aînés à propos de la nature future des soins de la santé qui leur sont destinés devrait être accueillie avee scepticisme étant donné qu'elle se produit dans un contexte de coercition prononcée. Une telle coercition existe quand il y a déséquilibre des pouvoirs et une dépendence entre les groupes, quand les attentes sociales influencent excessivement les décisions et quand les stérérotypes négatifs résultent en une faible estime de soi. Des cas parallèles, caractérisés par une coercition prononcée, sont présentés. Plutôt que de conclure que les aînés ne peuvent jamais prendre volontairement de décisions, l'auteur suggère d'éliminer ce scepticisme en établissant l'authenticité des désirs motivant leurs choix en matière de soins de santé. Trois théories de désirs authentiques sont examinées, puis considérées inadéquates, mais une quatrième, soit « l'approche autobiographique, » qui exige que nous révélions les métaphores personnelles de la vie et du vieillissement des aînés, est jugée plus prometteuse.

Keywords

Advance DirectivesAutonomyAuthenticityVoluntarinessAgeism.Volontésautonomieauthenticitébénévolatâgisme.
Type
Articles
Information
Canadian Journal on Aging / La Revue canadienne du vieillissement , Volume 12 , Issue 4: The Humanities in Gerontology Numéro spécial: Les sciences humaines en gérontologie , Winter/hiver 1993 , pp. 441 - 452
Copyright
Copyright © Canadian Association on Gerontology 1993

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Advance Directives Seminar Group. (1992). Advance Directives: Are They An Advance? Canadian Medical Association Journal, 146(2), 129–143.Google Scholar
Chipperfield, Judith G., & Havens, Betty. (1992). A Longitudinal Analysis of Perceived Respect among Elders: Changing Perceptions for some Ethnic Groups. Canadian Journal on Aging, 11(1), 15–30.CrossRefGoogle Scholar
Corea, Gena. (1985). The Mother Machine. New York: Harper and Row.Google Scholar
Daniels, Norman. (1992). Cost Containment, Justice, and Provider Autonomy. In Munson, Ronald (Ed.), Intervention and Reflection (4th ed.) (p. 611). Belmont, CA: Wadsworth.Google Scholar
Foner, Nancy. (1985). Old and frail and everywhere unequal. Hastings Center Report, 15(2), 27–31.CrossRefGoogle ScholarPubMed
Foot, Philippa. (1983). Euthanasia. In Narveson, Jan (Ed.), Moral Issues, Toronto: Oxford University Press.Google Scholar
Gert, Bernard. (1972). Coercion and Freedom. In Pennock, J. Roland & Chapman, John William (Eds.), Coercion. Chicago: Atherton.Google Scholar
Glass, J. Conrad Jr, & Trent, Curtis. (1980). Changing Ninth-Graders' Attitudes Toward Older Persons. Research on Aging, 2(4), 499–512.CrossRefGoogle Scholar
Hume, David. (1977). An Inquiry Concerning Human Understanding. (1st ed.) Indianapolis: Hackett.Google Scholar
Kenyon, Gary. (1992). Why is Ageism a Serious Problem and What Can Be Done about It? Canadian Journal on Aging, 11(1), 2–5.CrossRefGoogle Scholar
Kenyon, Gary M., Birren, James E., & Schroots, Johannes J.F. (Eds.). (1991). Metaphors of Aging in Science and the Humanities. New York: Springer Publishing Company.Google Scholar
Luxton, M., & Rosenberg, H. (1986). Through the Kitchen Window: The Politics of Home and Family. Toronto: Garamond Press.Google Scholar
Moen, Elizabeth W. (1979). What Does Control Over Our Bodies Really Mean? International Journal of Women's Studies, 2(2), 129–143.Google Scholar
Moody, Thomas E. (1989). Liberal Conceptions of the Self and Autonomy. In Sturba, James & Peden, Creighton (Eds.), Freedom, Equality and Social Change. Lewiston: Edwin Mellen Press.Google Scholar
Morgan, Kathryn Pauly. (1989). Of Woman Born? How Old-Fashioned! — New Reproductive Technologies and Women's Oppression. In Overall, Christine (Ed.), The Future of Human Reproduction (pp. 70–71). Toronto: The Women's Press.Google Scholar
Rawls, John. (1971). A Theory of Justice. Cambridge, MA: Harvard University Press.CrossRefGoogle Scholar
Robertson, John. (1991). Second Thoughts on Living Wills. Hastings Center Report, November.CrossRefGoogle ScholarPubMed
Schonfield, David. (1982). Who is Stereotyping Whom and Why? Gerontologist, 22(3), 267–272.CrossRefGoogle ScholarPubMed
Singer, Peter. (1992). Justifying Voluntary Euthanasia. In Munson, Ronald (Ed.), Intervention and Reflection (4th ed.). Belmont, CA: Wadsworth.Google Scholar