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.
