Frailty's Place in Ethics and Law: Some Thoughts on Equality and Autonomy and on Limits and Possibilities for Aging...

Consideration of ethical and legal themes relating to frailty must engage with the concern that frailty is a pejorative concept that validates and reinforces the disadvantage and vulnerability of aging adults. In this chapter, we consider whether a greater focus on frailty may indeed be part of the solution to the disadvantages that aging adults face in achieving equality and maintaining their autonomy within systems that have used their frailty to deny them equality and autonomy. First, by examining equality both as an ethical norm and as a requirement for protections against discrimination, we raise questions about the grounds on which health providers and health systems can be required to give equal concern and respect to the needs of frail older persons. Second, we explore autonomy and identify the tension between meaningful self-determination and prevailing ethical and legal norms associated with informed choice. Third, we argue that a proper understanding of frailty is essential within both of these themes; it respects equality by enabling health providers and systems to identify and address the distinct care needs of aging adults and helps to align informed choice theory with appropriate processes for decision-making about those needs.