Health Care Analysis

, Volume 25, Issue 1, pp 72–89 | Cite as

Ageism and Autonomy in Health Care: Explorations Through a Relational Lens

Original Article
First Online:

Abstract

Ageism within the context of care has attracted increasing attention in recent years. Similarly, autonomy has developed into a prominent concept within health care law and ethics. This paper explores the way that ageism, understood as a set of negative attitudes about old age or older people, may impact on an older person’s ability to make maximally autonomous decisions within health care. In particular, by appealing to feminist constructions of autonomy as relational, I will argue that the key to establishing this link is the concept of self-relations such as self-trust, self-worth and self-esteem. This paper aims to demonstrate how these may be impacted by the internalisation of negative attitudes associated with old age and care. In light of this, any legal or policy response must be sensitive to and flexible enough to deal with the way in which ageism impacts autonomy.

Keywords

Ageism Autonomy Care Health care Decision-making Older persons Relational autonomy Self-relations 
This is a preview of subscription content, log in to check access.

References

  1. 1.
    Aintree University Hospitals NHS Foundation v James [2013] UKSC 67.Google Scholar
  2. 2.
    Anderson, J., & Honneth, A. (2005). Autonomy, vulnerability, recognition and justice. In J. Christman & J. Anderson (Eds.), Autonomy and the challenge to liberalism: New essays (pp. 127–149). Cambridge: Cambridge University Press.CrossRefGoogle Scholar
  3. 3.
    Becker, G. (1994). The oldest old: Autonomy in the face of frailty. Journal of Aging Studies, 8(1), 59–76.CrossRefPubMedGoogle Scholar
  4. 4.
    Benson, P. (1994). Free agency and self-worth. Journal of Philosophy, 91(12), 650–668.CrossRefGoogle Scholar
  5. 5.
    Benson, P. (2000). Feeling crazy: Self-worth and the social character of responsibility. In C. Mackenzie & N. Stoljar (Eds.), Relational autonomy: Feminist perspectives on autonomy, agency and the social self (pp. 72–93). Oxford: Oxford University Press.Google Scholar
  6. 6.
    Biggs, S., & Haapala, I. (2013). Elder mistreatment, ageism and human rights. International Psychogeriatrics, 25(8), 1299–1306.CrossRefPubMedGoogle Scholar
  7. 7.
    Black, K. & Dobbs, D. (2014). Community-dwelling older adults’ perceptions of dignity: Core meanings, challenges, supports and opportunities. Ageing and Society, 34(8), 1–22.Google Scholar
  8. 8.
    Bright, L. (1999). The abuse of older people in institutional settings: Residents’ and carers’ stories. In N. Stanley, J. Manthorpe, & B. Penhale (Eds.), Institutional abuse: Perspectives across the life course (pp. 191–204). London: Routledge.Google Scholar
  9. 9.
    Butler, R. (1975). Why survive? Being old in America. New York: Harper and Row.Google Scholar
  10. 10.
    Buzgová, R., & Ivanová, K. (2011). Violation of ethical principles in institutional care for older people. Nursing Ethics, 18, 64–78.CrossRefPubMedGoogle Scholar
  11. 11.
    Carr, H. (2012). Rational men and difficult women—R (on the application of McDonald) v. Royal Borough of Kensington and Chelsea [2011] UKSC 33. Journal of Social Welfare and Family Law, 34(2), 219–230.CrossRefGoogle Scholar
  12. 12.
    Charles, S. (2010). How should feminist autonomy theorists respond to the problem of internalized oppression? Social Theory and Practice, 36(3), 409–428.CrossRefGoogle Scholar
  13. 13.
    Charpentier, M., & Soulières, M. (2013). Elder abuse and neglect in institutional settings: The resident’s perspective. Journal of Elder Abuse and Neglect, 25, 339–354.CrossRefPubMedGoogle Scholar
  14. 14.
    Christman, J. (2004). Relational autonomy, liberal individualism, and the social constitution of selves. Philosophical Studies, 117, 143–164.CrossRefGoogle Scholar
  15. 15.
    Clough, B. (2014). What about us? A case for legal recognition of interdependence in informal care relationships. Journal of Social Welfare and Family Law, 36(2), 129–148.CrossRefGoogle Scholar
  16. 16.
    Clough, B. & Brazier, M. (2014). Never too old for health and human rights. Medical Law International. August 20, 2014. doi: 10.1177/0968533214547557
  17. 17.
    Code, L. (1991). What can she know? Feminist theory and the construction of knowledge. Ithaca: Cornell University Press.Google Scholar
  18. 18.
    Cracknell, R. (2010). The ageing population. London: House of Commons Library Research. http://www.parliament.uk/documents/commons/lib/research/key_issues/Key-Issues-The-ageing-population2007.pdf. Last accessed August 11, 2014.
  19. 19.
    Cuddy, A. J., et al. (2005). This old stereotype: The pervasiveness and persistence of the elderly stereotype. Journal of Social Issues, 61(2), 267–285.CrossRefGoogle Scholar
  20. 20.
    Department of Health. (2009). Ageism and age discrimination in primary and community care in the United Kingdom. London: Centre for Policy on Ageing.Google Scholar
  21. 21.
    Department of Health. (2009). Ageism and age discrimination in social care in the United Kingdom. London: Centre for Policy on Ageing.Google Scholar
  22. 22.
    Department of Health. (2009). Ageism and age discrimination in secondary health care in the United Kingdom. London: Centre for Policy on Ageing.Google Scholar
  23. 23.
    Department of Health. (2012). Long term conditions compendium of information (3rd ed.). London: Department of Health.Google Scholar
  24. 24.
    Department of Health. (2014). Methodology for estimating “Wider Societal Benefits” as the net production impact of treatments. http://www.nice.org.uk/Media/Default/About/what-we-do/NICE-guidance/NICE-technology-appraisals/DH-Documentation-for-Wider-Societal-Benefits.pdf. Last accessed October 28, 2014.
  25. 25.
    DL v A Local Authority & Others [2012] EWCA Civ 253.Google Scholar
  26. 26.
    Donnelly, M. (2010). Healthcare decision-making and the law: Autonomy, capacity and the limits of liberalism. Cambridge: Cambridge University Press.CrossRefGoogle Scholar
  27. 27.
    Dunn, C. (2012). The effect of ageing on autonomy. In H. Lesser (Ed.), Justice for older people (pp. 51–63). Amsterdam: Rodopi.Google Scholar
  28. 28.
    Dworkin, G. (1988). The theory and practice of autonomy. Oxford: Oxford University Press.CrossRefGoogle Scholar
  29. 29.
    Equality and Human Rights Commission. (2011). Close to home: An inquiry into older people and human rights in home care. London: EHRC.Google Scholar
  30. 30.
    Faulkner, L. R. (1982). Mandating the reporting of suspected cases of elder abuse: An inappropriate, ineffective and ageist response to the abuse of older adults. Family Law Quarterly, 16, 69–91.Google Scholar
  31. 31.
    Fineman, M. A. (2004). The autonomy myth: A theory of dependency. London: The New Press.Google Scholar
  32. 32.
    Fineman, M. A. (2013). Equality, autonomy and the vulnerable subject in law and politics. In M. A. Fineman & A. Grear (Eds.), Vulnerability: Reflections on a new ethical foundation for law and politics (pp. 13–27). Farnham: Ashgate.Google Scholar
  33. 33.
    Flynn, E. (2013). Making human rights meaningful for people with disabilities: Advocacy, access to justice and equality before the law. The International Journal of Human Rights, 17(4), 491–510.CrossRefGoogle Scholar
  34. 34.
    Foster, C. (2013). Autonomy in the medico-legal courtroom: A principle fit for purpose? Medical Law Review, 22(1), 48–63.Google Scholar
  35. 35.
    Friedman, M. (2003). Autonomy, gender, politics. Oxford: Oxford University Press.CrossRefGoogle Scholar
  36. 36.
    Garnett, M. (2014). The autonomous life: A pure social view. Australasian Journal of Philosophy, 92(1), 143–158.CrossRefGoogle Scholar
  37. 37.
    Gilligan, C. (1993). In a different voice. Cambridge: Harvard University Press.Google Scholar
  38. 38.
    Govier, T. (1993). Self-trust, autonomy and self-esteem. Hypatia, 8(1), 99–120.CrossRefGoogle Scholar
  39. 39.
    Greenberg, J., et al. (2004). Ageism: Denying the face of the future. In T. Nelson (Ed.), Ageism: Stereotyping and prejudice against older persons (pp. 27–48). Cambridge: MIT Press.Google Scholar
  40. 40.
    Harding, R. (2012). Legal constructions of dementia: discourses of autonomy at the margins of capacity. Journal of Social Welfare and Family Law, 34(4), 425–442.CrossRefGoogle Scholar
  41. 41.
    Herring, J. (2009). Older people in law and society. Oxford: Oxford University Press.CrossRefGoogle Scholar
  42. 42.
    Herring, J. (2013). Forging a relational approach: Best interests or human rights? Medical Law International, 13(1), 32–54.CrossRefGoogle Scholar
  43. 43.
    Ho, A. (2008). Relational autonomy or undue pressure? Family’s role in medical decision-making. Scandinavian Journal of Caring Sciences, 22(1), 128–135.CrossRefPubMedGoogle Scholar
  44. 44.
    Hoagland, S. (1988). Lesbian ethics: Toward new value. Palo Alto, California: Institute of Lesbian Studies.Google Scholar
  45. 45.
    Holroyd, J. (2009). Relational autonomy and paternalistic interventions. Res Publica, 15(4), 321–336.CrossRefGoogle Scholar
  46. 46.
    Joint Committee on Human Rights. (2007). The human rights of older people in healthcare: Eighteenth report of session 2006–07, vol 1—report and formal minutes. London: The Stationery Office.Google Scholar
  47. 47.
  48. 48.
    Kohn, N. A. (2009). Outliving civil rights. Washington University Law Review, 86(5), 1053–1115.Google Scholar
  49. 49.
    Kohn, N. A., et al. (2013). Supported decision-making: A viable alternative to guardianship. Penn State Law Review, 117(4), 1111–1157.Google Scholar
  50. 50.
    LBL v RYJ and VJ [2010] EWHC 2665 (COP).Google Scholar
  51. 51.
    Lloyd, L., et al. (2014). Identity in the fourth age: Perseverance, adaptation and maintaining dignity. Ageing and Society, 34(1), 1–19.CrossRefGoogle Scholar
  52. 52.
    London Borough of Redbridge v G & Others [2014] EWCOP 17.Google Scholar
  53. 53.
    London Borough of Redbridge v G & Others [2014] EWCOP 485.Google Scholar
  54. 54.
    Mackenzie, C. (2014). Introduction: What is vulnerability and why does it matter for moral theory? In C. Mackenzie, W. Rogers, & S. Dodds (Eds.), Vulnerability: New essays in ethics and feminist philosophy (pp. 1–29). Oxford: Oxford University Press.Google Scholar
  55. 55.
    Mackenzie, C. (2014). The importance of relational autonomy and capabilities for an ethics of vulnerability. In C. Mackenzie, W. Rogers, & S. Dodds (Eds.), Vulnerability: New essays in ethics and feminist philosophy (pp. 33–59). Oxford: Oxford University Press.Google Scholar
  56. 56.
    Mackenzie, C., & Rogers, W. (2013). Autonomy, vulnerability and capacity: A philosophical appraisal of the mental capacity act. International Journal of Law in Context, 91(1), 37–52.CrossRefGoogle Scholar
  57. 57.
    Mackenzie, C., & Stoljar, N. (Eds.). (2000). Relational autonomy: Feminist perspectives on autonomy, agency and the social self. Oxford: Oxford University Press.Google Scholar
  58. 58.
    Mackenzie, C., & Stoljar, N. (2000). Autonomy Reconfigured. In C. Mackenzie & N. Stoljar (Eds.), Relational autonomy: Feminist perspectives on autonomy, agency and the social self (pp. 3–31). Oxford: Oxford University Press.Google Scholar
  59. 59.
    MacKinnon, C. A. (1983). Feminism, marxism, method, and the state: Towards feminist jurisprudence. Signs, 8(4), 635–658.CrossRefGoogle Scholar
  60. 60.
    Naffine, N. (1990). Law and the sexes: Explorations in feminists jurisprudence. London: Allen and Unwin.Google Scholar
  61. 61.
    National Institute for Health and Care Excellence. (2014). Consultation paper: Value based assessment of health technologies. http://www.nice.org.uk/Media/Default/About/what-we-do/NICE-guidance/NICE-technology-appraisals/VBA-TA-Methods-Guide-for-Consultation.pdf. Last accessed October 28, 2014.
  62. 62.
    Nedelsky, J. (1989). Reconceiving autonomy: Sources, thoughts and possibilities. Yale Journal of Law and Feminism, 1, 7–36.Google Scholar
  63. 63.
    Nedelsky, J. (2011). Law’s relations: A relational theory of self, autonomy and law. Oxford: Oxford University Press.Google Scholar
  64. 64.
    Nelsen, P. (2010). Oppression, autonomy and the impossibility of the inner citadel. Studies in Philosophy and Education, 29(4), 333–349.CrossRefGoogle Scholar
  65. 65.
    Nursing and Midwifery Council, Case 83A0008E, 27 March 2008.Google Scholar
  66. 66.
    Nursing and Midwifery Council, Case 09E0079C, 14 February 2013.Google Scholar
  67. 67.
    Oshana, M. (1998). Personal autonomy and society. Journal of Social Philosophy, 29(1), 81–102.CrossRefGoogle Scholar
  68. 68.
    Pathare, S. & Shields, L. S. (2012). Supported decision-making for persons with mental illness: A review. Public Health Reviews, 34(2), 1–40.Google Scholar
  69. 69.
    Pattinson, S. D. (2002). Undue influence in the context of medical treatment. Medical Law International, 5(4), 305–317.CrossRefPubMedGoogle Scholar
  70. 70.
    Perkins, M. M., et al. (2012). Relational autonomy in assisted living: A focus on diverse care settings for older adults. Journal of Aging Studies, 26, 214–225.CrossRefPubMedPubMedCentralGoogle Scholar
  71. 71.
    Phelan, A. (2008). Elder abuse, ageism, human rights and citizenship: Implications for nursing discourse. Nursing Inquiry, 15(4), 320–329.CrossRefPubMedGoogle Scholar
  72. 72.
    R (McDonald) v Royal Borough of Kensington & Chelsea [2011] UKSC 33.Google Scholar
  73. 73.
    R (Nicklinson & Anor) v Ministry of Justice [2014] UKSC 38.Google Scholar
  74. 74.
    Re C [1994] 1 All ER 819.Google Scholar
  75. 75.
    Re T (Adult: Refusal of Medical Treatment) [1993] Fam 95.Google Scholar
  76. 76.
    Schwarz, A. W. (2007). Autonomy and oppression: Beyond the substantive and content-neutral debate. Journal of Value Inquiry, 39, 443–457.CrossRefGoogle Scholar
  77. 77.
    Sherwin, S., & Winsby, M. (2010). A relational perspective on autonomy for older adults residing in nursing homes. Health Expectations, 14, 182–190.CrossRefPubMedPubMedCentralGoogle Scholar
  78. 78.
    Skirbekk, H., & Nortvedt, P. (2014). Inadequate treatment for elderly patients: Professional norms and tight budgets could cause “Ageism” in hospitals. Health Care Analysis, 22, 192–201.CrossRefPubMedGoogle Scholar
  79. 79.
    Stoljar, N. (2000). Autonomy and the Feminist Intuition. In C. Mackenzie & N. Stoljar (Eds.), Relational autonomy: Feminist perspectives on autonomy, agency and the social self (pp. 94–111). Oxford: Oxford University Press.Google Scholar
  80. 80.
    Thornton, J. E. (2002). Myths of ageing or ageist stereotypes. Educational Gerontology, 28, 301–312.CrossRefGoogle Scholar
  81. 81.
    United Nations General Assembly Resolution A/RES/67/139. (2012). Towards a comprehensive and integral legal instrument to promote and protect the rights and dignity of older persons. Google Scholar
  82. 82.
    Vasil, L., & Wass, H. (1993). Portrayal of the elderly in the media: A literature review and implications for educational gerontologists. Educational Gerontology, 19(1), 71–85.CrossRefGoogle Scholar
  83. 83.
    Verkerk, M. (1999). A care perspective on coercion and autonomy. Bioethics, 13(3/4), 358–368.CrossRefPubMedGoogle Scholar
  84. 84.
    Wilińska, M., & Cedersund, E. (2010). “Classic Ageism” or “Brutal Economy”? Old age and older people in the polish media. Journal of Aging Studies, 24(4), 335–343.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  1. 1.CSEP, School of LawUniversity of ManchesterManchesterUK

Personalised recommendations