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The realities and myths of long-term care and the challenges it poses for the ethics of autonomy are analyzed in this perceptive work. The book defends the concept of autonomy, but argues that the standard view of autonomy as non-interference and independence has only a limited applicability for long term care. The treatment of actual autonomy stresses the developmental and social nature of human persons and the priority of identification over autonomous choice. The work balances analysis of the ethical concepts associated with autonomy with discussion of the implications of the ethical analysis for long term care. A central chapter involves a phenomenological analysis of four general features of everyday experience (space, time, communication, and affectivity) and explores their practical implications for long term care. This work concludes with a discussion of the advantages associated with a phenomenologically-inspired treatment of actual autonomy for the ethics of long-term care.

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CHOICE Review

Medical ethicist Agich (Southern Illinois Univ.) successfully argues that the usual definition of autonomy as "freedom to be left alone to exercise ... individual freedom of action or choice" must be further refined in the long-term care setting. Persons are in a nursing home precisely because their ability to exercise choice and act independently are reduced by illness or inability to perform. Agich's point is that for the typical, already "compromised," nursing home patient, autonomy comes in meaningful relationships of everyday living, not in the everyday dramatic decisions associated with hospitalizations. The nursing home, he argues, must not just allow freedom of choice, but actively develop a framework of "positive expectations on the part of everyone involved," such as talking, walking, and watching. According to Agich, nursing homes are "anything but communities or homes; little or nothing is done to foster, or even to permit, meaningful relationships or associations to develop." His writing is characteristically heavy with the jargon of medical ethicists. A well-written exploration of how to think about improving the quality of life for long-term care patients. Advanced undergraduate through professional. J. E. Allen; University of North Carolina at Chapel Hill

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George J. Agich is at Southern Illinois University.