Medical Discourse: The Crucial Role of Social Networks in Healthcare Decisions for the Elderly and Disabled
In a thought-provoking editorial published in the American Journal of Bioethics, Volume 21, Issue 11 (2021), Kevin Mintz, PhD and David Magnus, PhD, delve into the complex relationship between frailty, social support, and the allocation of scarce resources, particularly in the Intensive Care Unit (ICU).
Dominic JC Wilkinson argues that frailty, a condition that measures physiological and physical vulnerability, should be considered as a factor in the allocation of scarce resources in the ICU. Wilkinson's argument, however, does not account for how inequalities in social capital and resources might contribute to some patients being determined as frail, not others.
Wilkinson's clinical frailty scale does not assess disability itself, but rather the level of social support a patient may have, such as the prevention of complete mobility loss by a home healthcare worker. This suggests that a patient's level of frailty can be influenced by their level of social support.
On the other hand, many patients with intellectual impairments lack trustworthy and interdependent relationships, making them vulnerable to abuse and neglect. This lack of relationships and social networks can be another barrier specifically to supported decision-making.
The Covid-19 pandemic has exacerbated the extent of social isolation for people with intellectual disabilities, especially those who are institutionalized. Institutionalization can contribute to higher levels of self-reported social isolation for individuals with intellectual disabilities.
Lack of robust social networks for people with intellectual disabilities is reflected in empirical studies on loneliness and social isolation within this population. This can be a significant barrier to supported decision-making and surrogate decision-making for these patients.
Andrew Peterson, Jason Karlawish, and Emily Largent propose a framework for supported decision-making for adults with mild cognitive impairments within the context of disability rights. However, this framework assumes the existence of a preexisting support network, which may exclude those with Alzheimer's and other intellectual disabilities who are socially isolated.
Moreover, proposals like Wilkinson's may increase inequity as ICU resources are targeted to the socio-economically better off, who are likely to be less frail. This raises ethical questions about justice in the allocation of scarce resources, especially considering that socially disadvantaged patients are more likely to need critical care during the Covid-19 pandemic.
Both articles discuss the ethical questions in medical decision making for people with disabilities and older adults, focusing on respecting their dignity and autonomy. However, they overlook the ethical challenges arising from inequalities in social support for aging patients with significant disabilities.
The authors of the recommending articles in issue 21, volume 11 of the American Journal of Bioethics and their publication dates are not provided in the available search results. Shakespeare (1995) offers a relevant perspective, suggesting that one's overall health and wellbeing is influenced by access to social supports and resources as much as a particular diagnosis. This underscores the importance of considering social support when making decisions about the allocation of scarce resources.
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