Care Home Ethics

Abstract

In this chapter, we reflect on the ethics of caring for older people in residential care, a complex but underdiscussed field. One of the central questions we address is that of what constitutes a good reason for intervening in the life of another. This issue is something of a classic, being central to politics and ethics, but what is written about such issues on the grand scale often seems lacking when applied to specific contexts. In this chapter, we will explore the general questions concerning the moral boundaries in caring for older people that are raised in the context of residential care.

How should we respect the autonomy of the old when they, sometimes by their own admission, need assistance with living? What exactly does a change in status from private to communal residence imply in terms of the rights of the individual resident and the duties and obligations of the institution? Does the mere fact that a person recognizes their reduced independence in some areas of their life represent sufficient reason to assume consent for others to direct and control it? What intuitions form the basis of our moral duty of care in this context and do those intuitions withstand scrutiny? Are there instances when this same moral duty of care requires us to allow people to choose the nature and timing of their own ending?

In addressing these questions, we explore the ethical underpinnings of the regulative principles for the care of older people and the intuitions that inform them. We also offer a moral rule of thumb to guide us in judging the fine line between justified and unjustified intervention in the lives of others. To focus our discussion, we begin with a case.