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The Oration: Ageing And Disability: Toward A Unifying Agenda

From: Australian Disability Review
Creator: Irving Kenneth Zola (author)
Date: 1988
Publication: Australian Disability Review
Source: Available at selected libraries

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The conquering aspect of technology has a counterpart in the passivity of the recipients of care. Early models of medical care went so far as to claim that passivity was a necessary condition of good care (Szasz & Hollender 1958). Eventually this became a self-fulfilling prophecy, with patients as well as professionals believing that experts had to take complete responsibility for solving problems because helpless patients lacked the capacity and the will to handle and solve their own problems. Medical care based on this approach raises exaggerated expectations (a seed-bed for malpractice suits) and undermines the capacity of individuals to draw on their own resources when they most need them; when faced with frustrating, long-term, often intractable problems. It is thus no great surprise that people who learn to normalise and routinise their situations do far better, for example, in dealing with many of the problems of hemodialysis in end-stage renal disease (Gerhardt & Brieskorn-Zinke 1986).


There are other even more subtle ways in which the use of technology has gone and is going too far; putting an individual's very integrity at stake. There is very little understanding of what happens when bodily parts and functions are replaced by equipment; it is not an unmixed blessing. It has been found in recipients of transplants and skin grafts that the physiological body rejects parts it feels are alien. So, too, the psychosocial person rejects parts he or she feels are alien and often experiences profound feelings of distrust, anger, depression, and even suicide. Thus, it is not at all clear what it means for someone to put on braces or strap on prosthetic limbs as part of his or her daily routine. The adjustment may become more serious, if not psychosis-producing, as people become internally attached to and thus dependent on machines, such as pacemakers or kidney dialysis machines.


Still another problem may exist in the over-technicalisation of 'care', such as in the invention of robots or the training of chimpanzees to service, dress, and feed people with quadriplegia. As Cavalier (1987) points out, professionals automatically assume that it is good to reduce a person's 'dependency' on others. Recently, I saw where such an assumption indeed affected the very integrity of the individuals 'being helped'.


In long-term care institutions one of the least cost-efficient activities is the feeding (and to a lesser extent, the grooming) of the residents. There was initial rejoicing when a set of machines reduced this 'unpleasant' and time-consuming' activity to manageable proportions. Within a month, however, there was a wholesale rebellion which took much effort for the residents to literally and figuratively articulate; namely, that this cost-effective method eliminated almost entirely the major time during which residents were directly attended to, one of the few times they experienced genuine touching and physical intimacy and thus one of the few times they felt recognised and recognisable as human beings.


Cost-effectiveness is, of course, not the only push to replace human interaction with machines. Part of the appeal of machines and animals is the intimacy people may perceive is easier to share with them. But there may be a long-term loss from this short-term gain. I did not accidentally use the term 'care' when introducing this thought. According to Webster's dictionary, care involves painstaking or watchful attention, regard coming from desire or esteem, a person that is an object of attention, anxiety or solicitude.


The point is simple; that giving medical care or personal care, is not merely a technical task. On the contrary, it is quite personal. Thus to objectify this care by replacing a human being with a machine or an animal can only lead to the further objectification of the individual receiving care.


Finally, the continuing technical focus (despite lip service to the contrary) of medical education has had implications for the social and emotional distance necessary for physicians and therapists to treat their patients. An emphasis on diseases, pathology, specific organs, and specific techniques helps create a 'separation' that once was quite functional. When there was no anaesthesia and death was a common outcome of serious illness and hospitalisations, the conditions and the treatments that occupied physicians' time were of relatively short duration. Because care took less time, this impersonality might also have been of less concern to patients. Though the circumstances that produced this distancing have long since passed, the educative process that brought it about still remains in a time when it is no longer functional. Distance gets in the way of dealing with long-term pain, with chronic loss, and with a dying process that may go on for years.


While there is little doubt that technology can enhance the lives of all of us -- both those with a disability and those temporarily without one -- we must be particularly careful lest the element that is being replaced is part of the essence of what is a human being and a human relationship.

Personal Support Services: Who will deliver them and how?

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