Abstract
Ethics and the Elderly: The Challenge of Long-term Care by Sarah M. Moses discusses the challenges and ethics of providing long-term care and support to the elderly and examines two current models of care from a Christian viewpoint. It had the potential to be an interesting addition to the literature, but this reviewer found it exceptionally difficult to read.
Despite its limitations, this book is clearly well-researched and referenced and can be a valuable contribution to an uncommonly addressed field. Ethics and the Elderly appears to be largely derived from the author’s doctoral thesis, and the book’s writing style, being that of a doctoral thesis, limits its readability. Much time is spent at the beginning and end of each chapter as the author describes at length what she “will do” in that chapter and then again reviewing what she “has done” at the end. The use of APA-style citations throughout the paper is distracting, with a huge number of in-line author names, titles, and page numbers in parentheses (instead of the endnote style, as is common to traditional texts). This unfortunately makes reading this book feel choppy and disjointed; it was a struggle to complete. Finally, the use of first person (“I,” “we,” “us,” vs. “this author” or “one”) in formal writing is unusual and causes the book to feel more like an opinion paper or doctoral thesis and less like the well-researched informative text that it could be.
That being said, there is some good information in the text. Writings and background from the Catholic Church (“Church” in the book) and other Christian sources (“church”) are examined in this extensively referenced text, which also uses statistical and financial data from governmental and other secular sources. This book is useful to a specifically Catholic readership: frequently and throughout the book, there are references to the guidelines of the US Conference of Catholic Bishops, the document Gaudium et spes from Vatican Council II, writings of the Pontifical Council for the Laity of the Roman Catholic Church, writings of the US Catholic bishops, papal writings and archives, and the Catholic tradition.
The author reviews the problem of aging, the increasing number of persons over the age of sixty-five, and the unique challenges of not only providing adequate care but also providing acceptable and desirable care and continues to introduce the ethical challenges to providing this care. For instance, she cited the different issues posed by aging persons with physical disabilities but without decline in mental capabilities, as opposed to others with mental disabilities who maintain physical strength. There are additional and unique challenges and care needs and dilemmas, of course, posed by those who, with age, decline significantly both cognitively and physically; elders who retain both cognitive and physical faculties have different needs in a community, as well. These latter situations are not specifically addressed, which is a significant shortcoming.
The author also proposes that it is not enough to simply provide more nursing home institutions and caregivers, in order to create a “place” within which to put the anticipated increasing population of frail elderly. She discusses ethical dilemmas related to the costs of such care, its overall desirability and acceptability to a society, and the limited number of actual caregivers for such a population, both from a licensed medical perspective as well as via family and friends. Her premise is this: “just care of the elderly cannot be measured merely in terms of amounts of material and financial resources, but whether the care is provided in such a way as to foster the dignity of older people as persons who retain agency even in the midst of frailty and disability” (p. 35).
One of the ways to foster dignity is a “Green House” home, a small homelike environment where a small group of ten to twelve elders who need specialized care or supervision can live together in private rooms with a shared or communal great/living room and kitchen/dining room. Caregivers, known as shahbaz, nurture relationships and participate actively in the day-to-day lives of residents. The goal is to create a true home with access to the outdoors and which is part of the local neighborhood. The Green House model of care is a secular model, begun by a geriatrician, Dr. William Thomas, and promoted throughout the United States as an alternative to traditional nursing home care.
A second approach is found in the Community of Sant’Egidio, which is used as another example of elder care. The community began in Rome in 1968 and is a worldwide movement of over 60,000 laypeople, based on prayer, solidarity, ecumenism, and dialogue, and directed toward service to the poor. Its origins lie in the “lay spiritual renewal of the Catholic Church’s Vatican II reforms” (p. 58), and although communities are officially recognized within the Roman Catholic Church, members are of many (predominantly Christian) faiths and of all ages. Members are laypeople who have chosen to associate together toward a goal, but who have traditional jobs, lives, and families, and do not live together. In general, this outreach is based on developing friendships with the elderly, enabling them to remain at home when possible through direct assistance, and provides companionship in institutions (which decreases isolation and marginalization in that population). The author also discusses some less common practices used by Sant’Egidio communities whereby congregate care is provided. Elder members of the community are likewise encouraged to contribute their skills and knowledge, as able, to help others in the community.
The author examines the examples of the elderly in the Bible and engages in an interesting and educational analysis of biblical references and teachings on the role of the aging and elderly. This analysis is used to justify or explain religious ethics and ethical imperatives to care for this population and the background from which this should be approached. She then addresses the roles of the Church and Christian tradition in empowering discipleship in a community and in fostering communities “in which persons practice mutual love…in support and care for one another…for a life of service as disciples” (p. 116). The author makes the important point that all persons in a community, including the elderly, can and should contribute and have respect for the contributions they can offer. She emphasizes that a just society is measured by its ability to provide care for its elderly, and indeed, this is a social responsibility and the church should focus its efforts on educational awareness initiatives, direct/indirect provision of care, and just allocation of public resources. Successful communities providing long-term care for the elderly do so in ways which “promote dignity, equality, mutuality, and enables meaningful participation in the community” (p. 148), and the author provides examples.
The book concludes with a thoughtful analysis of “whether or not we are willing to marshal the energy, creativity, and resources to make age a blessing and not a curse” (p. 170). An extensive twenty-two-page bibliography concludes this text in case further details are desired by a reader.
Despite its flaws, Ethics and the Elderly would be appropriate reading for students of philosophy, religion, ethics, and gerontology, though it is not, as written, suitable for a more general audience. It provides a valuable perspective on how care for elders is currently delivered, suggests ways in which it could be better, and offers uniquely Christian/Catholic background and guidance for how to proceed.