The realities of long-term care call for a refurbished, concrete concept of autonomy that systematically attends to the history and development of persons and takes account of the experiences of daily living.

Similar ethical difficulties are present in the clinical practice of both physicians and nurses, with important differences in access and use of ethics support services. A need for systematic ethics educational activities was identified. Inclusion of individual ethics consultants in Croatian healthcare ethics support services is strongly advised.

The ethical discussion of facial allograft transplantation (FAT) for severe facial deformity, popularly known as facial transplantation, has been one sided and sensationalistic. It is based on film and fiction rather than science and clinical experience. Based on our experience in developing the first IRB approved protocol for FAT, we critically discuss the problems with this discussion, which overlooks the plight of individuals with severe facial deformities. We discuss why FAT for facial deformity is ethically and surgically justified despite its negative portrayal in the media.

Dependence and autonomy in old age : an ethical framework for long-term care / George J. Agich.-2nd edn., rev. p. cm. Previously published as: Autonomy and long-term care. Includes bibliographical references and index. ISBN 0 521 00920 0 (paperback) 1. Aged-Long-term care-Moral and ethical aspects. 2. Autonomy (Psychology) in old age. 3. Autonomy (Philosophy) I. Agich, George J., 1947-Autonomy and long-term care. II. Title. RC954.3 .A44 2003 174 .2-dc21 2002031406 ISBN 0 521 00920 0 paperback Contents Preface vii 1 Introduction Long-term care images Autonomy Autonomy and long-term care: the problem 2 The liberal theory of autonomy Pluralism, toleration, and neutrality The state and positive autonomy Some problems with positive autonomy Liberal principles in long-term care The perils of liberal theory Communitarianism and the contextualist alternative Practical implications of the debate over the foundation of ethics Conflict and conversation The function of rights Limitations of rights Paternalism and the development of persons From paternalism to parentalism Summary 3 Long-term care: myth and reality Myths of old age Nursing homes Therapeutic relationships Concepts of illness and disease Models of care The concept of a practice Home care Summary v vi Contents 4 Actual autonomy Result-oriented theories Action-oriented theories The concrete view of persons Autonomy: a developmental perspective Narrative approaches Dependence in human development Sickness as dependence Autonomy and identification The paradox of development and problems of identification Implications for long-term care Summary 5 A phenomenological view of actual autonomy Sociality and the world of everyday life General features of the social nature of persons Space Time Communication Affectivity Summary 6 Autonomy and long-term care: another look Social reality of Eastside Appeal to autonomy as independence A phenomenologically informed analysis Theories of autonomy Final thoughts References Further reading Index

ABSTRACT. This paper discusses the importance of Richard M. Zaner's work on clinical ethics for answering the question: what kind of doing is ethics consultation? The paper argues first, that four common approaches to clinical ethics -applied ethics, casuistry, principlism, and conflict resolution -cannot adequately address the nature of the activity that makes up clinical ethics; second, that understanding the practical character of clinical ethics is critically important for the field; and third, that the practice of clinical ethics is bound up with the normative commitments of medicine as a therapeutic enterprise.