Political tensions between ethical codes, complexity and inequality within ageing

While welfare retrenchment, alongside any rigid ‘McDonaldised’ components of care management in UK adult social work, offers a contrast to the more complex needs of older service users, such tensions nevertheless frequently reverberate in other components of care. One area where any discursive friction remains just as pronounced is within the broad, and often ideologically fixed, universal statements embedded within professional ethical frameworks. Codes of ethics within welfare professions such as social work have expanded significantly since the 1970s, and indeed represent an essential trait within competitive labour market attempts to gain full professional status. At one level, they offer an opportunity to establish basic norms and standards of behaviour, while providing a framework within which a distinct professional identity may be established. Evidence, however, that social workers follow or are fully aware of ethical codes remains weak, and adherence is likely to vary significantly at the level of active agency (Congress, 2010). Moreover, codified moral frameworks are regularly contradictory or ambiguous — not least due to their tendency to draw from contrasting moral theories, which can offer mixed messages to social workers. Ties to wider public understandings of morality within codes also often remain unclear (Banks, 2004), and other critics have highlighted the individualising and conservative nature of mainstream ethical codes. For example, codes can be overtly didactic if applied within challenging fields of welfare such as social work or nursing, and in their eagerness to create the ‘totalising category of professional’, such frameworks can quickly render the social worker ‘an individual subject of correction’ (Rossiter et al., 2000; Baines, 2013).

Any distance between front-line social work practices and ethical codes can run even deeper in work with older people. This includes that core paradigms embedded in such codes contain ageist undertones. For example, utilitarian principles remain central to most codes but in seeking to maximise the happiness of an inevitably younger majority, priority is subsequently given to the young, healthy, able-bodied and employed. Indeed, this standpoint reiterates in much social policy and law. Kilner (1996: 125), for example, has noted the negative impact of the utilitarian way of thinking upon social policies and professional practices for older people. This includes the strong emphasis placed on ‘youth and productivity’, and lack of inherent protections ‘against how badly a person or group can be treated’, especially if they are assumed to lack economic viability. The other core paradigm embedded within social work codes remains Kant’s widely embraced deontological perspectives, built around the human capacity to reason. Wilmot (1997: 17) stresses the likely exclusion of associated ‘universal rights’ for people with dementia — or other age-related disabling conditions — in Kant’s terms. This is due to any limited cognitive capacity on behalf of the ill, and likelihood that such users or patients will struggle to count as a ‘reasoning being’. In prioritising reason and objectivity, deontological frameworks also readily promote professional age-related categorisation, a modernist principle arguably intended to meet the capricious needs of the capitalist economy and labour market (Phillipson, 1982). In addition, the control of emotions is encouraged through Kant’s discursive moral framework: largely detached responses echoed in much professional training which may prove insensitive or even unattainable within much social work with older people. Examples include unpredicted casework scenarios affecting loneliness, debt, bereavement, or during safeguarding investigations. In such instances ‘natural’ emotional labour may prove decisive or indeed may be anticipated by relatives, colleagues or other people directly involved in care. Such tensions are only likely to become more pronounced within expanding and increasingly diverse demographic communities.

The prevalence of risk-averse practices, work intensification, de-skilling and bureaucracy in adult social work add further potential strains within morally acute welfare terrains. Such trends have been prevalent for many years now, including within the UK and wider Western economies such as Canada and Australia (Baines, 2013). Together such instrumentalism and labour rationalisation undermines numerous claimed principles embedded within professional ethical codes. This includes many of the Fabian, humanist and other European Enlightenment aspirations which lie at social work’s popular ethical and political core (for example, to promote social justice, user emancipation, anti-discriminatory values, and so forth). In offering universal guidance through fixed or even static statements in a changing world of‘multiple realities’, or a now deeply fragmented consumer-led ‘industry’ of social care, ethical codes and statements are perhaps doomed to fail regardless of acceptance or regular application. Petrie (2009: 3), for example, has claimed that the British Association of Social Work's Code of Ethics is ‘too grandiose’ and ‘too detailed’, as well as lacking validity due to over ambition and abstract idealism: ‘In common with many welfare policies of the UK government in recent years, [this code] could be described as an amalgam of a “blue skies” wish list and tick-box template and in attempting to cover everything achieves little’.

Bioethics and ageing

The more recent rise of bioethics, or principle-based ethics, within welfare-related research and practice raise further concerns. This paradigm originating in medicine links to ongoing policies in the UK which promote health and social care integration, including as part of greater levels of‘evidence-based’ and ‘trans-professional’ practice (Carey and Green, 2013; Carey, 2016). As a powerful paradigm drawn from clinical and biomedical discourses, bioethics provides a different set of problems for social work, due not least to its much narrower, and indeed often isolated epistemological focus, that regularly repels non-science based or inductive theory’ (Estes and Binney, 1989). With a resilient focus upon the application of hard-science, deductive analysis and binary reasoning, bioethics not only extenuates many of the problems encountered within utilitarian and Kantian frameworks discussed earlier, but also marginalises tacit understanding of structural inequality or diversity, including their influences upon ageing or within care (Carey and Green, 2013; Zielinska, 2015). Indeed, clear links have been drawn between bioethics and neo-liberal policies, due not least to special priority being given in each hegemonic discourse to consumer and market-led constructs such as ‘autonomy’ or ‘rational choice’.

Estes et al. (2003: 94—96) note that within bioethics a seductive but hazardous hegemonic fusion of universally prioritising expertise and pedagogy sits alongside a stress upon free-market welfare. Each power-based force combines to push complex and changing ageing-related needs closer towards interpretations which can only be resolved through deductive biomedical frameworks. Priority for patients or service users subsequently moves from economic, symbolic or inter-personal inequalities commonly experienced, towards the application of overtly ‘general moral principles’ which fail to adequately recognise the interactive dialogue and ‘legitimizing discourses’ that shape and sustain inequitable relationships between the doctor as patient and patient as rational consumer within inequitable discursive settings such as the hospital or clinic. The strong priority given to objective knowledge and expertise mean also that the significant power held over patients or service users is such that the human qualities of each including those embodying difference or social class are marginalised through a sophisticated professional hegemony that leads to intense forms of institutional objectification. As Estes et <1/. (2003: 96) conclude: ‘Interactions take on a Buberian “1—it” quality, whereby the humanity of the other is not seen, except as a thing like material, subject to manipulation and control’. Whilst such stances are open to personal political reinterpretation for the professional at the level of agency, any such radical ideological stance can appear unsettling at a time when reports of neglect or abuse against older people in a variety of UK health and social care settings continue to prevail or indeed rise (for example, Care Quality Commission, 2013a, 2013b).

Alternative paradigms for ageing: post-structural, critical and indigenous ethics

A number of established or emerging paradigms have challenged the apparent elitism or homogenising complacency of professional ethical codes, and more generally institutionalised forms of morality. Three examples are offered. Although often contrasting, ideologically converging elements of such alternative perspectives may together provide us with a foundation upon which to build a more sustained and viable set of moral principles more suited to moral substance, ethical recalcitrance or sincere forms of support for ever more diverse ageing communities.

The first example remains what has been loosely termed ‘postmodern ethics’ and a questioning of the logocentric bias inherent within Western philosophy and related sources of knowledge. These include many points, but of particular interest for social work remain a challenge to the pervasive ideals of autonomy and rational agency precariously built around the binary-inducing principles of reason, truth and seemingly unequivocal logic. This includes an associated scepticism felt towards seemingly ‘deviant’ others, especially forms of agency which drift away from the hetero-normative and young ‘white’ Western male. Crude logocentric emphasis placed upon emotion-free professionalism, learned knowledge, discursively embedded and taken-for-granted truth-based assumptions within grand narratives are again challenged. Examples include that ageing represents ‘naturalized decline’ and predictable dependency requiring interventions through the application of rigorous scientific knowledge. Such political cultures include the dismissal of experiential lay knowledge and opinions (unless carefully controlled), lead to implicit distrust of deviant otherness while discursively inscribing a ‘dualism between self and other’ (Рорке, 2003: 302). Postmodern and post-structural approaches instead propose alternative ways of conceptualising ageing subjectivities including challenging normative prescriptions. This suggests a more fluid ethics based on an explicit recognition of power and domination, relative freedom, openness, creativity and difference, as well as the validity of so called ‘lay’ perspectives.

Also, fundamental to such critical moral stances remains a unifying theme that ageing is not a social problem or risk to be dealt with purely by technical, bureaucratic or medical solutions, but a dynamic multicultural, political and social assemblage of tacit experiences and events embedded with meaning at a personal level, or within diverse moral communities and social spaces. Dannefer and Settersten (2010: 3), for example, note how associated life-course perspectives represent a significant departure ‘from the conventional practice of thinking about age in normative terms’, to one in which recognition is given to growing older as ‘shaped by a host of factors that cumulate in individuals over decades of living’. Here the changing identity of the ageing person is understood as part of an ongoing life-span which enmeshes many stages and influences, from the biological and psychological to the cultural, material and social.

Related post-structural interpretations of ethics seek also to challenge ‘post-welfare’ policy around ageing. This includes any increased risk-averse surveillance techniques offered by attachment or systems theory yielding ‘care managers’ or health workers, alongside the cursory but probing and insensitive use of technologies of care such as assessments of need or risk assessments, which seek to locate, measure, evaluate, instruct or move the ageing body trapped in the apparent ‘black hole’ of an increasingly demoralising fourth age (Gilbert and Powell, 2010; Higgs and Gilleard, 2015). Governance theories, inspired by Foucault (1986) and Rose (1996), offer another canon of debate. Within what Dean (2010: 20) has termed ‘the arena of the government of the self, ethics persevere in wider discourses, knowledge and power relations; and are disseminated in institutions and increasingly abrupt and didactic engagements with professionals. They also offer an epistemological framework through which to stimulate the capacity of citizens to reflect and monitor themselves, to be more reflexive, empowered and autonomous. As Gilbert and Powell (2010: 7) surmise:

Individuals, incited by discourse, engage in reflective processes where they speak the truth about themselves, gain self-knowledge, and then act on that self-knowledge in an ethic of self-formation producing the self-managing individual central to neo-liberal rule. . . Techniques of self-assessment, counselling, reflection and professional supervision all provide examples.

Normative and professional ethics in these terms become more about instilling the personal capacity of elders to gain control — to empower the reflexive ageing self — including to rely much less upon state support.

Although fascinating and clearly of relevance to critical interpretations of ageing and ethics, one sustained criticism made against such eclectic perspectives remains their limited recognition of macro-structural or materialist influences. These include in relation to poverty, inequality, social class, and their central association with later-stage ageing, such as by inculcating ‘structured dependency’ (Walker, 2009). In the UK, older people now account for nearly 60 per cent of local authority spending on social services, a reflection of both demographic pressures and ‘widening inequalities in later life’ (Milne et al., 2014: 9). Indeed, the casualisation of employment and reduced access to pensions and fragmented social and health care services in the UK are intensifying further already established forms of age-related inequality and exclusion (Phillipson, 2013).

Anti-essentialist ethics which query a rationale for generating truth claims and constructing static foundations for morality may overstate the capacity of welfare professionals to instil autonomy among older people while promoting political nihilism. Understandably perhaps, adult social workers may argue that they require guidance, direction, and insight from which to make crucial moral judgements, typically at short notice. They may be somewhat perplexed at endless debates about the use of language or the importance of managing identities, and contest that it is material inequalities and forms of structural exclusion that have the greatest impact on older clients or the local communities which they serve. In relation, Singer (1993) has argued that ethics and normative moral theory are too often ‘poverty blind’; a point of contention in a welfare profession such as social work which represents the most class-specific and increasingly rescinded or punitive instrument of the welfare state (for example, Phillipson, 1982; Jones and Novak, 1999). In relation, Shapiro and Stefkovich (2005) have detailed the ‘ethic of critique’ to prioritise not merely critical analysis, but as a theory-based means in which to foreground and confront structural and material inequalities through applied ethics. This is alongside appreciation through ethics of disadvantage and oppression including tacit attempts to promote equal relations. Here recognition is also given to minority needs, policy, history' and, crucially, the redistribution of power and material needs as a central component of ethical teaching, research and practice.

Another example of a counter-hegemonic set of moral principles remains what have been coined ‘indigenous ethics’. The non-codified and eclectic moral insights of indigenous people in the Majority World seemingly benefit from a lack of ‘epistemological corruption’ of Western logocentric ideals, alongside any situated priority given to the values of seemingly white male dominant elites. They are, it seems, not trapped in western realist discourses, and can offer a greater degree of respect for more visible older people. Indeed, elders remain central to many indigenous cultures, as does recognition of other minority issues and needs. Castellano (2004: 101), for example, details the principal role of Canadian Aboriginal Elders within their local communities, including as part of teaching:

When Aboriginal Peoples speak about maintaining and revitalising their cultures, they are not proposing to go back to igloos and teepees and a hunter-gatherer lifestyle. They are talking about restoring order to daily living in conformity to ancient and enduring values that affirm life . . . The persons who are most knowledgeable about physical and spiritual reality, the teaching and practice of ceremonies, and the nuances of meaning in Aboriginal languages are Elders. Elders typically have been educated in the oral tradition, apart from the colonizing influence of the school system. They enjoy respect as sources of wisdom because their way of life expresses the deepest values of their respective cultures.

Indigenous values provide a political challenge to the associated positivist stress upon ‘subjects’ within present day instrumental professional cultures, including any related obsession with formality’, objectivity, measurement, evidence or various corrupting business principles such as a concomitant narrow understanding of social relations, assets or medically framed ‘needs’. Within tight narrated boundaries set by bureaucratic managerial hegemonies, the marginalisation of trust, spirituality' and meaningful representation is more likely to flourish. Indeed, Popke (2003: 312) claims that many indigenous belief systems can sustain an ideological challenge to modernisation alongside ever reductive consumerist notions of development or progress, such as through a ‘kind of “situated” commitment to community’ that offers ‘a powerful source of solidarity for [older] subaltern groups seeking to confront the worst excesses of neoliberal globalisation’.

 
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