Paternalism versus autonomy: Are they alternative types of formal care?

Abstract

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The field of aging shows an extraordinarily high variability, usually classified as pathological, normal, and successful aging (Rowe and Kahn, 1987). Some of these ways of aging require certain amount of care, from successful aging promotion to pathological intensive assistance. Moreover, care of older adults is a broad, complex, and heterogeneous field in which an older person interacts with other persons, mainly family members and/or professionals (that is, caregivers) in a specific context, receiving goods, such as health or social care, welfare, and/or protection support when needed or other less defined types of goods, such as health education, social support or a variety of shared recreational activities. The type of care or social interactions provided by the caregiver depends on the care required by the older adult s physical, psychological or social conditions in interaction with the caregivers knowledge, abilities of care and views of aging taking place in an institutional or natural environment. In this complex human situation, two main perspectives of care have been called: paternalist vs. person centered or autonomist, being usually considered antagonist ways of care (Brownie and Nancarrow, 2013). As emphasized by Gallagher (1998), paternalist care is characterized by a dominant attitude of superiority, We know, you don t, usually is being expressed by caregiver through overprotection over the care recipient. Conversely,modern social and health caremanagement, froman equalitarian position, includes the patient in the decision making process, under the assumption that the patient is able to participate in the decision making process of care (see also Rodriguez-Osorio and Dominguez- Cherit, 2008), not only as new managerial way to considering patient, as a client, but in order to obtain or reinforce client/patient autonomy (Langer and Rodin, 1976; Pavlish et al., 2011; Bercovitz et al., 2019). It has been emphasized that these two apparently polar orientations can be compatible in the care context (Perry and Applegate, 1985), because they depend on the characteristics of the subject of care: cognitive and physical functional conditions, state of consciousness and understanding, legal situation, etc. Here we will discuss to what extent these two types of care could be and must be compatible depending on certain individual care-recipient characteristics.