Trust in family relationships : the elderly person and the female family caregiver

Elderly people and their family caregivers lack a much needed ethical framework for working through moral conflicts. Often, moral conflicts that arise in the home care setting center around the tension between respecting the elderly person's autonomy and protecting the family caregiver from harm. The family caregiver, who is most often female, is vulnerable to harm due to the strains of trying to accomplish the tasks from competing responsibilities to her immediate family, her job and her dependent elderly relatives. Additionally, the female family caregiver often feels tension from the societal pressure to assume this role. There are currently no guidelines to offer family caregivers and their elderly relatives to help them think through these moral issues. After reviewing the current demographic trends in the sixty-five year old and over population to show how widespread this situation has become, I propose that an ethical framework based on trust will provide moral guidance for family members. I define a trusting relationship and argue that people have a moral obligation not to betray the trust of others in a trusting relationship. I develop the idea of what it means to betray trust based on combining elements of Annette Baler's framework of trust with an understanding of vulnerability as a social phenomenon that is derived from outside the dyadic trusting relationship. I claim that both the elderly person and the family caregiver have an obligation not to betray each other's trust if they have developed such a trusting relationship. This model can serve to guide families and health care providers in discussions about the moral responsibilities of the elderly person to her family caregiver and the family caregiver to her elderly relative.