December 10, 2022

Viewing Covid deaths in nursing homes through a feminist lens

Society needs take personal relationships more into account

Feminist bioethics may be good lens through which to assess how we care for the elderly, especially in the Covid-19 pandemic. In an article in the journal Bioethics Jennifer Parks and Maria Howard argue that (at least in the United States), personal relationships were regarded as less important than physical health indicators. As a consequence, many elderly gave up on life.

They cite another article from The Hastings Center Report:

With great expense and effort, we organized deaths with ventilators for America’s oldest people. We thought the ethical imperative was to get a ventilator for everyone. The real need was to provide care that helped. We can save more lives and make unavoidable deaths less painful if we will learn at last this simple lesson.

Parks and Howard contend that our society has forgotten that the self is essentially social. This is an interesting and controversial idea which runs against the liberal current which has dominated political philosophy in the Anglosphere since the 17th Century. For social contract theorists like Hobbes, Locke and Rousseau, each man was a kind of self-sufficient Robinson Crusoe. They write:

… the self is essentially social, meaning that who one is, one’s identity, is derived from socialization processes, the relationships into which a person is born, and the relationships and identities that define one personally and socially. Under this view, we do not become autonomous despite our relationships with others but because of them. … liberal theories that understand selves as primarily independent and self-sufficient ignore the relational nature of who we are and how our social situation informs our self-concepts.

This has very practical consequences for plans for dealing with nursing homes:

Whether we should forsake the mental health of the old in the fight to protect their physical health is a question that we think deserves closer scrutiny. An increasing number of studies indicate that the impact of isolation, loneliness, and lack of human contact has deadly implications, especially for the elderly experiencing degrees of dementia. As our relational ethics framework suggests, humans suffer deeply from that lack; and this is exacerbated for our elders who may rely heavily on others to hold their identities and sense of self in place…

Since the beginning of the pandemic, the value of “life at any cost” has prevailed in nursing homes; but this may be a value judgement that not all residents share. The benefits of allowing for limited visitation might outweigh the risks of exposure to the virus that this visitation brings. This is especially true when such visits allow elders to plan end of life care with their loved ones in face-to-face discussions about advance care planning.

Michael Cook is editor of BioEdge

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