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Autonomy and Advance Directives

Published online by Cambridge University Press:  29 November 2010

Elisabeth Boetzkes
Elisabeth Boetzkes
Affiliation:
McMaster University
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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

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