On paternalism, autonomy and best interests: Telling the (competent) aged‐care resident what they want to know

Abstract

This paper has been derived from a review of literature from a recent qualitative study that explored the meaning of truth-telling within the care provider-aged resident dyad in high-level (nursing home) care of elderly people. In the literature reviewed here, paternalism (as benevolent decision-making in another's best interests) is critically analysed. Autonomy is then described and its function in promoting health is underscored. Furthermore, this paper specifically challenges nurses to consider their capacity to really know another's best interests--particularly in the nursing home. Finally, a very simple recommendation is proposed for determining and managing the (competent) aged-care resident's informational disclosure preferences: ask them.

Autonomy at the end of life: life-prolonging treatment in nursing homes—relatives’ role in the decision-making process

“…Lack of respect for the elderly in western society may represent general grounds for the fact that the paternalistic attitude of the relatives does not encounter resistance even from healthcare professionals, which may be due to these staff members’ lack of ethical skills 9 45 46. There is a need for routines as well as a written guide on the issue of limiting the life-prolonging treatment of patients who are not competent to give consent 18…”

The meaning of nursing-home: ‘Waiting to go up to St. Peter, OK! Waiting house, sad but true’ — An Australian perspective

“…Autonomy, argued for here, is about giving the nursing-home resident the opportunity to be self-determining and maintaining control over the decisionmaking element of their care. I have recommended elsewhere that this can be achieved by care staff utilising a 'psychological registration sheet' that notes what information is given and reactions to it to improve communication with residents (De Valck andVan de Woestijne, 1996 andTuckett, 2006). The nursing-home that claims to have as its primary focus 'the resident' ought to take seriously the residents' health and therefore the residents' autonomy.…”

Commentary: Disclosure in Oncology—To Whom Does the Truth Belong?

“…These principles can come in conflict with one another and may be accorded relative weights in different situations. Autonomy specifically comes from the Greek auto ("self") and nomos ("rule" or "governance") and mandates respect for the patient as an independent actor who has the right to information and to the opportunity to make his or her own medical decisions [15].…”