Moral decision making by elderly women caregivers: a feminist perspective on justice and care

The purpose of this study was to describe the moral decision making of elderly women caregivers caring for an incapacitated spouse or partner. A feminist ethical framework was used to examine caregivers' justice and care concerns when making a difficult decision in situations of moral conflict. A qualitative, descriptive design was used to explore caregivers' perceptions of the benefits and sacrifices of caregiving, the nature of moral conflict, and justice and care reasoning in making difficult decisions. Ten caregivers with diverse backgrounds were interviewed twice. Narratives of moral decision making were analyzed using a theoretically based guide for reading narratives of moral conflict and choice. Although the elderly women caregivers interviewed in the study used both justice and care reasoning to make difficult decisions about caregiving, 5 of the 10 participants demonstrated a predominance of justice reasoning. This finding differs from the predominance of care orientation described by younger women in previous studies. The predominance of a justice orientation in the older women in this study may reflect the context of the moral conflicts described and the influences of age, culture, and experiences of marginalization. The closeness of the caregiver-care recipient relationship influenced the caregivers' perceptions of benefits and sacrifices in caregiving and framing of the moral conflict in terms of justice and care. The majority of the caregivers identified religious and cultural beliefs that fostered a sense of moral obligation to provide care for the spouse or partner. Although caregivers used both justice and care reasoning, they were vulnerable to self-sacrifice and had difficulty balancing care of self with care of the care recipient. A clarification of the integration of justice and care reasoning was described. Nurses and nursing students can examine their own moral decision making using the concepts of justice and care reasoning and apply these concepts in direct care and counseling to enhance caregivers' awareness of caregiving options. Understanding the moral content of caregivers' decisions would assist policy makers in providing services that are compatible with the values and needs of caregivers and their families. The influence of age, culture, and marginalization on women's moral decision making is an area in need of further research.