Ebook Etikan dan Hukum Keperawatan : TAKING CARE ; Ethical Caregiving in Our Aging Society

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Taking Care: Ethical Caregiving in Our Aging Society is a report of
the President’s Council on Bioethics, which was created by
President George W. Bush on November 28, 2001 by means of
Executive Order 13237 and renewed on September 23, 2003 by
means of Executive Order 13316.
The Council’s purpose is to advise the President on bioethical
issues related to advances in biomedical science and technology. In
connection with its advisory role, the mission of the Council
includes the following functions:
• To undertake fundamental inquiry into the human and
moral significance of developments in biomedical and
behavioral science and technology.
• To explore specific ethical and policy questions related to
these developments.
• To provide a forum for a national discussion of bioethical
issues.
• To facilitate a greater understanding of bioethical issues.
Among the several topics mentioned in the executive order as
deserving of possible Council attention are ethical issues
surrounding the end of life. Several of those issues are the subject
of this report.
Taking Care addresses the ethical challenges of caregiving in our
rapidly aging society, with special attention to the care of people
with dementia. Our purpose is to provide a humanly rich account
of the caregiving dilemmas—social, familial, and personal—and to
offer some important ethical guidelines for the care of persons who
can no longer care for themselves.
There is no question that we are on the threshold of a “mass
geriatric society,” a society of more long-lived individuals than ever
before in human history. For this great gift of longer and healthier

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life for ourselves and our loved ones we are, and should be,
enormously grateful. No sensible person would wish to return us to
a time—not that long ago—in which the diagnosis of uncontrolled
diabetes meant certain death within a month or two, in which
women commonly died giving birth, children often died of
smallpox and polio, and nothing could be done for tuberculosis,
syphilis, and other deadly infectious diseases. Old age today is—for
the most part and for most people—much better than it used to be:
millions of Americans are staying healthy and active well into their
seventies and eighties, and some deep into their nineties. By
historical standards, it is a wonderful time to be old.
At the same time, however, there are good reasons to be
concerned about the human and moral shape that a mass geriatric
society will take, especially if the “price” many people pay for the
gift of added years of healthier life is a period of protracted debility,
dementia, and dependence stacked up at the end before they
eventually die. Such a reshaping of the lifecycle will create
enormous challenges for nearly every family and for the entire
society. The economic challenges facing Social Security, Medicare,
and Medicaid are more or less well known. A looming crisis of
long-term care for the incapacitated has received less attention,
partly because we prefer to avert our gaze, largely because we lack
an adequate human and ethical understanding of this issue.
Socially, we have preferred to place our hopes in programs that
promote healthy aging and in scientific research seeking remedies
for incapacitating diseases like Alzheimer’s. Insofar as we do
approach the topic of long-term care, we worry mainly about
numbers and logistics: How many will need it? Who will provide it?
How will we pay for it? The ethical questions of what the young
owe the old, what the old owe the young, and what we all owe each
other do not get mentioned. Neither do the questions of social
support for the caregivers or a good end of life for us all.
In the meantime, millions of American families, more each
decade, already face the difficult task of caring for frail and
incapacitated elders, often entirely on their own with very little
social support. And millions more, “the worried well,” live
anxiously, dreading the prospect that the curse of untreatable
dementia and disability will descend on them before a cure arrives,
to ruin their final years, deplete their savings, and burden their
loved ones with the obligation to care for them. Their generalized

P REFACE │xix
anxiety often focuses on end-of-life decision-making, commonly
expressed in a fear that others will impose life-sustaining treatments
on them when they are too demented to choose for themselves or
too diminished to benefit from the intervention.
Largely in response to these anxieties of the worried well, our
society has embraced the idea of advance directives, especially living
wills, in which individuals try to determine in advance how they
wish to be treated should they become incapacitated. This approach
to the dilemmas of caregiving gives major ethical weight to personal
autonomy and choice and personal pride in self-sufficiency. But in
so doing, it deliberately ignores the truth of human interdependence
and of our unavoidable need for human presence and care, especially
when we can no longer take care of ourselves. The moral emphasis on
choosing in advance needs to be replaced with a moral emphasis on
caring in the present. The moral emphasis on independence needs
to be supplemented with a moral commitment to serve the lives of
those we love, regardless of their disabilities. A culture of caregiving
requires moral support from an ethics of care.
In the first chapter of this report (“Dilemmas of an Aging
Society”), we offer a sociological overview of aging in America and
inquire into the special challenges of aging well in modern times.
We pay special attention to the growing prevalence of Alzheimer’s
disease and other forms of dementia, and the implications this has
for caregivers and the larger society. Although this chapter offers
no proposed ethical guidelines, it presents a human picture that
should inform policymakers in their efforts to encourage, support,
and sustain dignified long-term care for the American people, and
in settings that preserve the humanity of those who receive care and
those who give it.
In the second chapter (“The Limited Wisdom of Advance
Directives”), moving from the social picture to the personal one, we
offer a practical and ethical critique of relying on living wills as the
best and most human approach to dealing with the problems of
incapacitated persons. At the same time, we endorse both the
appointment of surrogate decisionmakers and the practice of
advance care planning that encourages families to discuss and plan
together how best to care for their loved ones.
In the third and fourth chapters, moving from critique to
positive analysis and guidelines, we offer a constructive inquiry into
ethical caregiving. In the former (“The Ethics of Caregiving:

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General Principles”), we explore the general ethical principles and
moral boundaries involved, emphasizing the importance of seeking
the present welfare of the patient and of serving the life that the
person still has, regardless of disability and frailty. In the latter
(“Ethical Caregiving: Principle and Prudence in Hard Cases”), we
show—through analyses of a series of very difficult clinical cases—
how principle and prudence can collaborate in finding the best care
possible for persons entrusted to our care. In both chapters we
acknowledge how hard it can be to provide constant care for those
who can no longer speak for or stand by themselves; and we
recognize how painful it can be to see loved ones lose their most
treasured human capacities, including the capacity to recognize the
people with whom they have long shared a life. Yet before such loss
and in the face of such difficulty, loving care and principled
prudence are all the more required, if we are to answer the call
never to betray or abandon, always to serve as best we can.

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Ketersediaan

E2100087

610.73 ROB T

Tersedia

Informasi Detail

Judul Seri

-

No. Panggil

610.73 ROB T

Penerbit

Washington DC : The President’s Council on Bioethics., 2005

Deskripsi Fisik

xvii, 333 Hlm

Bahasa

English

ISBN/ISSN

-

Klasifikasi

610.73

Tipe Isi

-

Tipe Media

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Tipe Pembawa

-

Edisi

-

Subjek

Ethical Caregiving in Our Aging Society

Info Detail Spesifik

Label Merah Hijau - Etika dan Hukum Keperawatan

Pernyataan Tanggungjawab

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