ORCHESTRATING SOCIAL CHANGE: AN IMPERATIVE IN CARE OF THE CHRONICALLY ILL

ABSTRACT. The ethical challenges of caring for the chronically ill are of increasing concern to nurses as they attempt to create humanitarian environ-ments for long-term care. This article suggests two ethical perspectives to guide the agenda of the nursing profession to achieve social change in the care of the chronically ill and aging. First, a reemphasis on the public duties of the profes-sions is recommended which extends beyond serving the interests of the nursing profession to recognizing the need to serve the common good. Second, the limitations of the autonomy paradigm are explored and the foundation for the development of a new moral paradigm is analyzed in terms of its ' potential usefulness in addressing ethical problems of chronic illness. Several initiatives that nursing must undertake to facilitate the emergence of this paradigm are proposed. Key Words: aging and chronic illness, autonomy paradigm, common good, experience-based paradigm, nursing ethics Although severe chronic illness affects millions of Americans, the ethical dimensions of chronic illness and the challenges of caring for these vulnerable populations have only recently surfaced as issues in the field of bioethics. Jennings et al. (1988, p. 1) assert that although chronic care settings lack the high drama of acute care settings, the practical and ethical dilemmas of chronic care are no less important. However, it is not clear that practicing health care professionals, oriented towards cure of disease, recognize and are prepared to cope with the ethical and financial implications of a coherent approach to care of persons with chronic illness. Nurses, for example, are often in a unique position to nurture and interpret the values of health, knowledge, freedom of informa-tion, and equity in the distribution of health care benefits and to advocate for the translation of these values into humanitaria