Dr. Masami Takahashi
Office: 307-A, x-2884

This course is designed to encourage future gerontologists to critically examine and reflect upon their own and others' values and ethical principles as these relate to the opinions and actions of old people toward themselves and others, and of younger people toward elders individually and as a group. Through readings, films, and discussions the class will become familiar with common ethical issues faced by older people, by the professionals serving them, the organizations and communities of which they are part, and the aging nation. Students will consider how equally well informed and concerned people of all ages frequently hold very different positions on virtually every issue that involves the elderly singly or as a class. Members of the course will also participate in small working groups to design and present ethics project proposals.

The elderly, their loved ones, caregivers, advocates, service providers, and the society as a whole, through its government, often are forced to make difficult choices in situations where age is a major consideration or the primary one. At such times, it is important that those in decision-making or influential roles be fully aware of the principles concerning the value of life and the worth of every human being that will be expressed through particular attitudes, judgment, and actions toward individuals of other ages and toward specific age groups. As a family members, friends, professionals, and citizens, all gerontologists need to be highly sensitive and well-informed about ethical issues that older adults commonly face and those affect them. This course is therefore required of all students in the M.A. in Gerontology Program.

By the end of this course, students will:
 

1. form and defend opinion on whether and in what ways the ethical questions that elders must address are comparable to and/or different from those of younger people;
 

2. use correctly the specialized vocabulary of the field of ethics and aging;
 

3. describe the salient features of the ancient religious traditions and more recent religious and secular ethical thought that directly and indirectly shape individuals' thinking and popular opinion about intergenerational equity, duty, and care at each level (individual, institutional, and societal);
 

4. explain the heightened interest over the past several decades in questions of ethics that involved old people;
 

5. examine the personal values and ethical principles they themselves have previously brought to their personal and professional relationships with older individuals and groups of elders, identify their sources, compare their personal beliefs with the ethical assumptions informing current social policy affecting older people;
 

6. reconsider and articulate the position they have to come to hold after examining the values and principles they formerly used to address ethical issues involving older adults;
 

7. identify the major public debates centering on issues affecting the elderly in our aging society and provide a critical analysis of the explicit and implicit values embedded in an editorial or journal article dealing with controversial subjects;
 

8. develop and defend a position on whether social policy and biomedical ethics should or should not be different for individuals and groups at different stages of life at a given time;
 
 

Moody, H. R. (1996). Ethics in an aging society. Baltimore, MD: Johns Hopkins University Press.
 

Smith, G. P. (1996). Legal and healthcare ethics for the elderly. Washington, DC: Taylor & Frasncis.
 
 

This course will be taught in a combination of graduate seminar plenary discussions and work in groups to simulate the kinds of professional activities gerontologists engage in throughout their careers. Students are expected to:
 

1. CLASS PARTICIPATION Attend all classes in their entirety, complete all assignments punctually, and contribute actively in class and group discussions. Each student must select one or two articles from the syllabus and lead class discussion on assigned date (15% of final grade).
 

2. CLASS ASSIGNMENTS See the course schedule below (20% of final grade).
 

3. MID-TERM PRESENTATION Present ethics project in a preferred format. The presentation must specify why the ethics topic is important to investigate and include an in-depth literature review and a summary analysis of what is known in the field pertaining to the chosen topic. Focus on the current status (e.g., pros and cons of a particular public policy) and briefly suggest future research direction. 10-15 page/group paper must also be submitted by November 3, 1999 (25% of final grade).
 

4. FINAL RESEARCH PAPER (40% of final grade) Expand the line of research that you are already engaged in as a member of the project team. Discuss deficiencies of status quo regarding ethical issues of this specific population of older adults. Suggest concrete steps to improve their lives as well as our society as a whole (10-15 pages). Due on or before December 15, 1999.
 

Page requirement excludes title page, abstract, tables and figures, and references.

All written assignments must be typed and follow the APA format.
 

9/1 Introduction

Course Overview

Class Project Brainstorming
 

Class assignment #1: Due 9/15

Conduct an informal interview with one older adult (60+ years of age) and another individual whose line of work intersects with older adult population. Ask them what their concerns are which are relevant to aging issues (e.g., living environment, transportation, crime, public policy, healthcare, media portrayal of older adults, etc.). Remember, it is always better to prepare a set of specific questions beforehand in order to obtain maximum amount of information in an interview session. Briefly describe who they are and what their ethical concerns are in two or three concise paragraph(s). Bring a copy for each member of the class (1-2 pages).
 

9/8 Psychological theories of aging
 

Chinen, A. B. (1984). Modal logic: A new paradigm of development and late-life potential. Human Development, 27, 42-56.
 

Erikson, E. H. (1959). Growth and crises of the healthy personality. Psychological Issues, 1, 50-100.

Kramer, D. A., Kahlbaugh, P. E., & Goldston, R. B. (1992). A measure of paradigm beliefs about the social world. Journal of Gerontology, 47(3), 180-189.
 

Labouvie-Vief, G., Hakim-Larson, J. Devoe, M., Schoeberlein, S. (1989). Emotions and self regulation: A life span view. Human Development, 32, 279-299.

(Suggested Readings)

Labouvie-Vief, G. (1982). Dynamic development and mature autonomy. Human Development, 25, 161-191.
 

Sinnott, J. D. (1994). Development and yearning: Cognitive aspects of spiritual development. Journal of Adult Development, 1(2), 91-99.
 

9/15 Paradigms of aging: Myths and realities.
 

Film: 48 Hours, Caring for mom and dad.
 

Binstock, R. H. (1990). The aged as scapegoat. The Gerontologist, 23(2), 136-143.
 

Crockett, W. H. & Hummert, M. L. (1990). Perceptions of aging and the elderly. In Psychology and aging (pp. 217-242).

Clark, P. G. (1991). Ethical dimensions of quality of life in aging: Autonomy vs. collectivism in the United States and Canada. The Gerontologist, 31(5), 631-639.
 

Palmore, E. B., & Maeda, D. (1985). Respect for the elders. The honorable elders revisited (pp. 81-99). Durham, NC: Duke University Press.

Moody, Ch1., Ethics in an aging society: Old answers and new questions.

Moody, Ch2., Bioethics and geriatric health care.

Smith, Ch1., Aging as a phenomenon.
 

(Suggested Reading)

Hummert, M. L., Garstka, T. A., Shaner, J. L., & Strahm, S. (1994). Stereotypes of the elderly held by young, middle-aged, and elderly adults. Journal of Gerontology, 49(5), 240-249.
 
 
 

Class assignment #2: Due 9/29

Form a 2-4 person project team with similar interests. As a group, select a general topic and divide it into several subcategories (which will eventually be assigned as the Final Research Project to each member). A topic could be either theoretical or applied (e.g., intervention/outreach program) on any subjects discussed in class, in your readings, or based on your personal observations (e.g., topic raised in interview from Assignment #1), as long as it is related to the issues of ethical treatment of the elderly. Write a 3-5 page project proposal as a group.
 

9/22 Decision making risk, choices, and responsibilities.

Fitting, M. D. (1984). Professional and ethical responsibilities for psychologists working with elderly. The Counseling Psychologist, 12(3), 69-78.
 

Jecker, N. S. (1990). The role of intimate others in decision making. The Gerontologist, 30(1), 65-71.
 

Selig, S., Tomlinson, T. & Hickey, T. (1991). Ethical dimensions of intergenerational reciprocity: Implications for practice. The Gerontologist, 31 (5), 624-630.
 

Shaw, W. S., Patterson, T. L. Semple, S. J., Grant, I., Yu, E. S. H., Zhang, M. y., He, Y., & Wu, W. y. (1997). A cross-cultural validation of coping strategies and their associations with caregiving distress. The Gerontologist, 37 (4), 490-504.
 

Moody, Ch3., Ethical dilemmas of Alzheimer's disease.

Smith, Ch2., A full or limited right of access to healthcare services.

Smith, Ch3., Healthcare financing.
 

(Suggested Reading)

Clarke, E. J., Preston, M., Raksin, J., & Bengtson, V. L. (1999). Types of conflicts and tensions between older parents and adult children. The Gerontologist, 39(3), 261-270.
 

9/29 Resource allocation and healthcare rationing.
 

Silverstein, M., & Parrott, T. M. (1997). Attitude toward public support of the elderly. Research on Aging, 19(1), 108-132.
 

Zweibel, N. R., Cassel, C. K., & Karrison, T. (1993). Public attitudes about the use of chronological age as a criterion for allocating healthcare resources, The Gerontologist,33(1),74-80.
 

Moody, Ch9., Should we ration health care on grounds of age?

Moody, Ch10., Generational equity and social insurance.

Moody, Ch11., Intergenerational solidarity.

Smith, Ch4., Economic efficiency, prioritizing, and rationing.
 

10/6 Older adults' participation in decision making.
 

Fry, S. T. (1991). Health care and decision making. In N. S. Jecker (Ed.), Aging and ethics (pp.171-186). The Human Press.
 

High, D. M. (1990). Old and alone: Surrogate health care decision-making for the elderly without families. Journal of Aging Studies, 4(3), 277-288.
 

Kapp, M. B. (1991). Health care decision making by the elderly: I get by a little help from my family. The Gerontologist, 31(5), 619-623.
 

Maule, A. J., Cliff, D. R., & Taylor, R. (1996). Early retirement decisions and how they affect later quality of life. Ageing and Society, 16, 177-204.
 

Moody, Ch8., From informed consent to negotiated consent.

Smith, Ch5., Autonomy, competency, and guardianship paternalism.

Smith, Ch6., Informed and negotiated consent.
 

10/13 Caring for the elderly: Ethical treatment of long-term care residents.

Castle, N. G., & Fogel, B. (1998). Characteristics of nursing homes that are restraint free. The Gerontologist, 38(2), 181-188.
 

Wolf, R. S., & Li, D. (1999). Factors affecting the rate of elder abuse reporting to a state protective services program. The Gerontologist, 39(2), 222-228.
 

Moody, Ch5, The long good-bye: The Ethics of nursing home placement.

Moody, Ch6, Ethical dilemmas in the nursing home.

Smith, Ch9, Nursing home industry.

Smith, Ch10, Ethical and legal rights of long-term care residents.
 

Class assignment #3: Due 10/20

Describe an "ideal" physical environment (e.g., home, neighborhood, community, etc.) for a specific group of older adults. Discuss what their needs are and what types of accommodation they require (1-2 pages).
 

10/20 Physical environment and quality of life issues.
 

Cohen-Mansfield, J. Werner, P. (1998). The effects of an enhanced environment on nursing home residents who pace. The Gerontologist, 38(2), 199-208.
 

Lawton, M. P. (1977). The impact of environment on aging and behavior. In J. Birren and K. W. Schaie (Eds.), Handbook of the psychology of aging (pp. 276-301). NY: Van Nostrand Reinhold.
 

More to come
 

10/27 Decision rights of older patients: Treatment/nontreatment preferences, living wills, and advance directives.
 

Glick, H. R., Cowart, M. E. & Smith, J. D. (1996). Implementation and impact of the Patients Self-Discrimination Act: Preliminary survey and proposal for change. Journal of Applied Gerontology, 15(1), 38-56.
 

Uhlmann, R. F., Pearlman, R. A., & Cain, K. C. (1988). Physicians' and spouses' predictions of elderly patients' resuscitation preferences. Journal of Gerontology, 43(5), M115-M121.
 

Smith, Ch7, Advanced directives.

Smith, Ch8, Complexities in treatment and nontreatment decisions.
 

11/3 Mid-term presentation (Group paper due).
 

11/10 Suicide: Death with dignity.
 

Humphry, D. (1992). Rational suicide among the elderly. In A. A. Leenaars, R. W. Maris, J. L. McIntosh, & J. Richman (Eds.), Suicide and the older adult (pp. 125-129). NY: Guilford Press.
 

Kaplan, M. S., Admek, M. E., & Geling, O. (1996). Sociodemographic predictors of firearm suicide among older white males. The Gerontologist, 36(4), 530-533.
 

McIntosh, J. L. (1992). Epidemiology of suicide in the elderly. In A. A. Leenaars, R. W. Maris, J. L. McIntosh, & J. Richman (Eds.), Suicide and the older adult (pp. 15-35). NY: Guilford Press.
 

Moody, Ch4, "Rational suicide" on grounds of old age?

Moody, Ch7, Acts of intervention.

Smith, Ch11, Death with dignity.
 

11/17 Ethics in conducting research with older adults.
 

Cassell, C. K. (1985). Ethical issues in research in geriatrics. Generations(Winter), 45-48.
 

Reich, W. T. (1978). Ethical issues related to research involving elderly subjects. The Gerontologist, 18(4), 326-337.
 

Rosnow, R. L. (1997). Hedgehogs, foxes, and the evolving social contract in psychological science: Ethical challenges and methodological opportunities. Psychological Methods, 2(4), 345-356.

Films (Controversial experiments by Milgram and Zimbardos).

11/24 Ethics in conducting research with older adults (cont.).
 

Past controversial psychological studies:

Milgram (1969).

Zimbardo (1972).

12/1 Gerontology Club meeting.

Spiriuality in aging (Chaplain Jan mcCabe, Ravenswood Hospital Medical Center).
 

12/8 Where do we go from here? Addressing the needs of a diverse and growing aging population.
 

Slusher, M. P., Mayer, C. J., Dunkle, R. E. (1996). Gays and Lesbians Older and Wiser (GLOW): A support group for older gay people. The Gerontologist, 36(1), 118-123.
 

Post, J. A. (1996). Internet resources on aging: Seniors on the net. The Gerontologist, 36(5), 565-569.
 

Smith, Ch12, The future.
 

12/15 Finals Week.