10/07/2009

The virtues and vices of dependent older people by William May

"In The Virtues and Vices of Aging,- an elegant essay written over twenty years ago --William F. May contextualizes his discussion by reminding us of the power imbalance between older patients and health professionals. He observes that caregivers who unwittingly display their health and youth are "like a bustling cold front that moves in and stiffens the landscape." They cannot see that their vocation depends on patients, which compounds the power imbalance, and obscures the moral the significance of reciprocal dependency.

Writing across the boundaries of psychology, ethics, and theology, May warns against the common confusion of infirmity with moral failure. He emphasizes that virtues do not emerge automatically with age; rather, they "grow only through resolution, struggle, perhaps prayer, and perseverance."42 May begins with four virtues appropriate to later life: Courage, Public Virtue, Humility, Patience. One needs Courage to rise to the occasion of loss and the certainty of death. Aquinas defined courage as "firmness of soul in the face of adversity."43 Courage requires "keeping one's fears, one's dislikes, one's laziness under control for the sake of the good as well as one's own good."44 Public virtue requires older people (as well as others) to temper pursuit of self-interest for the sake of the common good.

Care-givers and care receivers alike need the virtue of humility. Humility restrains the arrogance of care-givers' power, even as it removes the sting of humiliation from those assaulted by disease and disability. Like humility, Patience, is a desireable response to anger, frustration, and bitterness; but patience, on May's account, is not a form of passivity or detached Stoic endurance. "Patience is purposive waiting, receiving, willing; it demands a most intense sort of activity." For May, the moral is never far from the spiritual: "precisely when all else goes out of control, when panic would send us sprawling in all directions. . . . [patience] requires us once again to become centered in the deepest levels of our lives as purposive beings."45

Drawing from the Benedictine tradition, May adds three more virtues: simplicity, benevolence, and integrity. The aged pilgrim learns to travel light, to cast off the extraneous and embrace the path to God. "Benevolence opposes the tightfistedness of avarice, not with the empty-handedness of death but with the open-handedness of love."46 May sees integrity not as a particular virtue of old age but as an all-inclusive virtue that binds all other virtues together in a unity of character.

Character is a moral structure that has integrity when it is at one with itself. Integrity requires a re-collection of the self which is not fragmented or dispersed. Creating a unity of inner and outer, word and deed, depends upon the spiritual work of autobiography. In Augustinian terms, one can commune with God only after the disciplined work which yields integrity, which itself rests on conviction of forgiveness for sin. May also believes that integrity in old age requires that one's death be framed in a context of transcendent meaning or ultimate concerns. These however, are not mere abstractions but rather patterns of ritual and behavior woven into the fabric of everyday life.

To Erikson's rather vague definition of wisdom, May adds three additional virtues originating in medieval Christianity. Integrity and wisdom are made possible by prudence, which consists of the temporal virtues of memoria, docilitas, and solertia. A person who resists nostalgia and regret--as well as the temptation to airbrush her past--earns the virtue of memoria. In contast, many contemporary approaches to psychotherapy, life review, and life story work, are not so much interested in the historical truth as in achieving a narrative truth which may enable a person to achieve a healing that comes from new meanings of old events. Docilitas does not connote the meanings of docility; rather it "signifies a capacity to be silent," to be alert, attentive to the present moment. Solertia is a characteristic of those who "learn to sit loose to life;" it signifies openness to the future, readiness ready for the unexpected.

The Stoic grounds wisdom on rational self-mastery and detachment. The Biblical tradition on the other hand, grounds wisdom "through a primordial attachment . . . to the divine love [which] sustains, but also orders and limits all other attachments and fears. In the Christian tradition, attachment to God makes possible the virtues of nonchalance and courtesy. Nonchalance signifies the capacity to take life's gifts and assaults in stride; courtesy is the capacity to "deal honorably with all that is urgent, jarring, and rancourous."47 The evils and tragedies of life are understood to be "real but not ultimate." Love rather than death has the last word. Hilaritas is the final virtue handed down by the Benedictine monks. Or in common parlance, humor is a "saving grace," allowed by the capacity to see life's experience from a more spacious perspective.

May aptly criticizes academic ethicists who focus chiefly on moral dilemmas and provide critical guidelines to professionals. It has been over twenty years since he since he observed that ethics "does not offer much help to patients facing the ordeal of fading powers. [The aged] need guidelines for action, to be sure, but more than that they need strength of character in the face of ordeals."

Source and full article see: http://www.bioethics.gov/background/cole.html

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