Elders and the Quest for Their Autonomy

By Cohen, Elias S.; Wilson, Keren Brown | Aging Today, September/October 2003 | Go to article overview

Elders and the Quest for Their Autonomy


Cohen, Elias S., Wilson, Keren Brown, Aging Today


It has taken well over 20 years to begin to shift the care of people with chronic illness or disability away from institutional solutions to various communitybased options. Currently, about 800,000 Medicaid beneficiaries receive home and community-based services ("Report Criticizes Federal Oversight of State Medicaid," The New York Times, July 7, 2003). Approximately half are 65 and older, compared with over 1 million Medicaid clients living in licensed nursing homes and other institutional settings who are mostly age 65 or older. Ironically, for all of the advocacy efforts on behalf of older people, the most significant developments resulting in this shift to home and community-based solutions have occurred in the field of developmental disabilities.

The U.S. General Accounting Office (GAO) study reported by The New York Times attacked the level of care in nursing facilities and questioned the quality of community-based care. This report should focus professionals in aging, particularly those who manage care, on the complexities of delivering care in any setting. The GAO investigation ought to force the field to recognize that the methods tried to date have not achieved the principal aim of care: that it be of high quality, respond to the needs of people with disability, offer long-term economic and programmatic efficiency, andabove all-vindicate the fundamental right of individuals to flourish regardless of age, disability, race, gender or other category of group identity.

Regardless of what the most passionate advocates may assert, there are no magic bullets: not injunctions against institutional care, not policies that attach money to individuals needing care, not draconian regulation and enforcement, not an endless number of waiver-based programs, not compassionate paternalism, and not reform of guardianship statutes and public-guardianship programs.

Vindicating the moral and legal right to autonomy, self-determination and the ability to direct one's own care is complex. Autonomy and what it means is poorly understood. Fundamentally, it involves economics. Society assumes the well-to-do can more easily take advantage of these rights than the poor because mobilizing the economic assets needed for independent living in the setting of one's choice can be daunting. Think of the challenges facing those with few resources as they seek accessible, affordable and appropriate housing, transportation, medical and nursing care, personal assistance, and social or psychological support. Moreover, the health and service system has only begun to understand the nature of chronic disability well enough to make the changes necessary to help people with disabilities overcome the physical and social barriers to full participation in society.

The sense of a right to flourish, to determine one's destiny, requires a strong appreciation of one's worth, a feeling of optimism and a belief that people with disabilities are able to engage positively with the world around them. The exercise of autonomy will fail, though, to the extent that either individuals with disabilities or those hoping to assist them deny the capacity for engagement with and pleasure in their daily lives.

In recent years, ethicist Bart J. Collopy and others have discussed the need to distinguish the complex elements of autonomy involved in helping older people who need assistance. For example, people may find their executional autonomy, the ability to execute physical tasks, severely compromised. Quadriplegia, cognitive impairments and other afflictions get in the way of carrying out one's decision to act. However, decisional autonomy may persist undiminished or only somewhat diminished even for those with dementia or other cognitive impairments, who may still play a role in making decisions about their lives and care. Decisional autonomy deserves no less respect than executional autonomy.

Furthermore, understanding autonomy requires a sophisticated appreciation of liability issues, safety and the limits of parens patriae (literally, government acting as parent) to those with compromised capacity. …

The rest of this article is only available to active members of Questia

Sign up now for a free, 1-day trial and receive full access to:

  • Questia's entire collection
  • Automatic bibliography creation
  • More helpful research tools like notes, citations, and highlights
  • Ad-free environment

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Default project is now your active project.
Project items

Items saved from this article

This article has been saved
Highlights (0)
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

Citations (0)
Some of your citations are legacy items.

Any citation created before July 30, 2012 will labeled as a “Cited page.” New citations will be saved as cited passages, pages or articles.

We also added the ability to view new citations from your projects or the book or article where you created them.

Notes (0)
Bookmarks (0)

You have no saved items from this article

Project items include:
  • Saved book/article
  • Highlights
  • Quotes/citations
  • Notes
  • Bookmarks
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited article

Elders and the Quest for Their Autonomy
Settings

Settings

Typeface
Text size Smaller Larger Reset View mode
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Full screen

matching results for page

Cited passage

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited passage

Welcome to the new Questia Reader

The Questia Reader has been updated to provide you with an even better online reading experience.  It is now 100% Responsive, which means you can read our books and articles on any sized device you wish.  All of your favorite tools like notes, highlights, and citations are still here, but the way you select text has been updated to be easier to use, especially on touchscreen devices.  Here's how:

1. Click or tap the first word you want to select.
2. Click or tap the last word you want to select.

OK, got it!

Thanks for trying Questia!

Please continue trying out our research tools, but please note, full functionality is available only to our active members.

Your work will be lost once you leave this Web page.

For full access in an ad-free environment, sign up now for a FREE, 1-day trial.

Already a member? Log in now.