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Freedom, Dependency, and the Care of the Very Old
Author(s) -
Thomasma David C.
Publication year - 1984
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.1984.tb00892.x
Subject(s) - autonomy , dependency (uml) , quality of life (healthcare) , medicine , quality (philosophy) , process (computing) , personal autonomy , function (biology) , freedom of choice , social psychology , nursing , psychology , law , epistemology , computer science , philosophy , software engineering , evolutionary biology , political science , biology , operating system
Difficulties exist in making treatment decisions for the very old and dependent patient. In the years to come, these difficulties will increase. It is argued that such persons should not be abandoned to their “rights” as autonomous persons; yet quality of life judgments should also be avoided except in limited circumstances. Since aging is a process of becoming more dependent, the author proposes a dependency rule, by which greater responsibility for treatment decisions falls on care‐givers as a person's dependency increases. In place of quality of life judgments he suggests a medical indications policy, if the latter includes restoration of some affective function. Five kinds of freedom are proposed, of which only some are lost in chronic illness and old age. Finally, it is suggested that life itself involves greater interdependence than the autonomy criterion itself can allow. The author focuses on the problem of dependency in the aged and the role an increase in this dependency plays, with corresponding loss of personal autonomy, in quality of life judgments. These, in turn, form the basis for treatment decisions.