Moral Discourse and Public Policy in Aging: Framing Problems, Seeking Solutions, and “Public Ethics”

Abstract

RÉSUMÉDes approches humanistes sont essentielles pour explorer les principales politiques touchant la gérontologie et la gériatrie. Cet article décrit comment l'approche de « l'éthique publique, » c'est-à-dire l'examen des principales valeurs sous-tendant et orientant le procédé d'élaboration des politiques publiques, peut nous faire davantage comprendre les politiques ayant trait au vieillissement. Pour illustrer cette analyse, des exemples tirés d'une étude comparative entre le Canada et les États-Unis sont fournis. Parmi les éléments analysés, on trouve d'abord les principales valeurs sociales formant la toile de fond de cette étude, particulièrement l'opposition entre l'individualisme et le collectivisme. Ensuite, la définition et la résolution des problèmes reposent à la fois sur les faits et les valeurs. Elles impliquent une discussion sur les facteurs sociaux intervenant dans la « crise » du vieillissement, notamment la polarisation des gens en groupes d'âge et la rationalisation des ressources destinées aux soins de la santé. Finalement, la nature du débat public et du discours moral, en qualité de procédé guidant l'élaboration de politiques publiques, est étudiée, et les répercussions quant à l'importance des valeurs dans l'élaboration de nouvelles politiques à venir sont également considérées. Le procédé d'élaboration des politiques publiques, notamment la manière dont il relève les défis associés à une population vieillissante, en dit long sur la cohésion et l'intégrité sous-jacentes de notre société et sur le degré d'humanisme que l'on trouve au sein des principales politiques et institutions sociales.

Age Discrimination and Early Retirement Policies:

“…Our general conclusion, reflecting the distinct histories of the two societies, is that Canada has a greater collectivist public policy, while U.S. policy reflects a stronger commitment to individual rights. This position is consistent with the view held by others that Canada has a more communitarian orientation, as reflected in its national health care system (Clark, 1993;Lipset, 1990 must not be allowed to monopolize jobs, but must make room for younger workers. In the United States, the greater concern for the rights of individuals is illustrated by both legislative actions and judicial interpretations.…”

Addressing the ageing workforce: a critical examination of legal policy objectives and values in the United Kingdom

“…This analysis highlights the importance of considering how values are embedded in policy documents, and shape and influence policy outcomes in different substantive areas (though see Dean 2010: 45–6). While some studies have explicitly considered the values inherent in particular policy discourses (in relation to ageing in the USA and Canada, see Clark 1993; in relation to health policy, see Giacomini et al 2001), this has not extended to ageing law and policy in the UK. While Bernard and Phillips have argued that ‘an explicitly articulated value base’ is ‘crucial to the establishment of this new policy agenda for ageing in tomorrow's Britain’ (2000: 34), no UK government has developed a vision or coherent strategy to address ageing (Select Committee on Public Service and Demographic Change 2013: 8), and legislative and policy interventions remain piecemeal and reactive in nature ( see Bernard and Phillips 2000: 40).…”

“…Therefore, a focus on individual choice could rationalise and justify limited government intervention and a minimal governmental role. Clark (1993: 487) has noted the significant impact of ‘the cultural context of the continuum between individualism and collectivism’ in ‘defining policy problems and their solutions’. If ageing is defined in individualistic terms, this will have dramatic implications for how society (and government) ‘defines a moral obligation to enhance the quality of life of older persons’ (Clark 1993: 487).…”

“…Clark (1993: 487) has noted the significant impact of ‘the cultural context of the continuum between individualism and collectivism’ in ‘defining policy problems and their solutions’. If ageing is defined in individualistic terms, this will have dramatic implications for how society (and government) ‘defines a moral obligation to enhance the quality of life of older persons’ (Clark 1993: 487). By defining ageing as an individual matter, UK government documents have minimised the moral case for intervening to protect and enhance individual wellbeing, shifting the risks associated with ageing to the individual ( see Estes 2001: 194).…”

Quality of Life, Values, and Teamwork in Geriatric Care: Do We Communicate What We Mean?

“…Moreover, because of differentials in power between the professional and the patient, the professional's definition of need, or the "problem" to be "solved," usually takes precedence over that of the client. The person who controls the definition of the problem simultaneously defines the range of options available to solve it (Clark, 1993) -an insight having both clinical (Dill, 1993) and public policy relevance (Aronson, 1992;. In other words, recipients of clinical care and public policies must have genuine input into the basic construction of need and the concepts used to describe it, or else consumers will be prevented from effective dialogue and discussion regarding the important outcomes of the needs assessment process.…”