Ethics in an Aging Society
Harry R. Moody
Johns Hopkins University Press, Baltimore
1992, 288 pp., $40
In the preface Harry R. Moody informs readers that Ethics in an Aging Society is a compilation, at least in part, of a number of articles and speeches he had given previously. The format both enhances and detracts from the book's content. One benefit is that Moody covers a spectrum of topics dealing with ethical issues in late life. Unfortunately, readers will find a bit of discontinuity in the flow of the subject matter from one chapter to another. As a result, they may feel a sense of disconnectedness.
Moody introduces readers to the new language of ethics and the elderly. Terms such as "negotiated consent" (a physician-patient discussion on treatments and their expected outcomes) and "communicative ethics" (communication in ethical decision making) help enlighten the often complex situations encountered in decision making at the end of life. Moody emphasizes that issues such as nursing home placement and withholding or withdrawing treatments could be handled better than they currently are by using these tools. Decisions for the elderly are difficult not so much because the issues are inherently difficult but rather because communication is lacking among patient, family, professional care givers, and healthcare team members. Moody provides an excellent discourse on how to better communicate and negotiate when making decisions at the end of life.
Another strength of this book is the chapter, "The Long Good-Bye: The Ethics of Nursing Home Placement." Moody's emphasis on professional gerontology and case management adds new insights to the ethical issues of nursing home placement, which have long gone unnoticed. This chapter should be required reading for all levels of nursing home personnel.
Ethics in an Aging Society has a number of weaknesses stemming from the fact that it is a distillation of earlier works. Many chapters are deeply ingrained in philosophy. For readers unfamiliar with the philosophers or schools of thought to which Moody refers, the content is lost. On the other hand, Moody's heavy use of vernacular language in some chapters is distracting and dilutes his message. For this reason it is difficult to determine the book's appropriate audience.
Another weakness of the book is that Moody glosses over the critical role of the physician in decision making. His explanation of advance directives is also inadequate. In addition, most of the material in the book was published before the implementation of the Omnibus Budget Reconciliation Act of 1987 guidelines for nursing home reform. Some of the problems he cites (e.g., restraint use) are addressed in new nursing home regulations.
Nevertheless, Ethics in an Aging Society is a good attempt at examining a range of topics from long-term care to rationing to rational suicide. I believe the book is a useful resource for particular areas of interest such as nursing home placement and consent in the nursing home setting.
Nancy W. Hooyman, MD
Chief, Division of Geriatric Medicine
St. John's Mercy Medical Center
St. Louis