Department of Philosophy



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The Department of Philosophy Colloquium Series presents

Katherine Wayne (Ottawa)

"Defusing the threat of the old with pragmatic bioethics"

THURSDAY, November 9th, 2017

Note change of room: Chernoff Hall, Room 117 @ 4:00 p.m.

In both popular media and professional circles, Canada's aging population is frequently portrayed as an impending crisis, as a burden and threat to a health care system struggling with limited resources. Yet this crisis narrative tends to obscure rather than expose genuine barriers to effective and sustainable health care planning, partly because its content and authority draw heavily from systemic ageism and ableism in health care. Subverting that authority demands critical scrutiny of widely applied normative approaches to health care challenges. In this paper, I make a case for why and how two concepts that are foundational to these approaches – namely autonomy and vulnerability – should be de-prioritized and refined in health care ethics and policy discourse and practice. Effective and ethically informed health care planning for older persons will, I argue, shift significant attention away from autonomy concerns, and toward the good of agency and the harms of compromised agency. I begin the paper with an overview of the crisis narrative and its effects on older persons and healthy aging discourse. I then set out to show how the concept of autonomy and the principle of respect for autonomy are—in their common presentations in applied bioethics, and in their functions of delineating and navigating ethical conflicts and challenges raised in relevant scenarios—unlikely to be reliably and meaningfully guiding. I outline and defend the positive dimension of my proposal through consideration of how compromised agency creates high-risk vulnerability, which eventually results in poor health outcomes and intensified resource demands. Moreover, re-directing focus to facilitating and restoring agency in order to reduce high-risk vulnerability, rather than establishing greater means of evaluating, preserving, and enhancing autonomy in the context of broadly constraining age-based vulnerability, could be multiply advantageous. I explore how implementing such a shift would be likely to, for instance: circumvent unproductive rehearsals of autonomy vs paternalism debates, encourage desirable innovations in health care, and foster clearer communication among normative theorists, health care practitioners and researchers, and policy makers. 


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