Trust and choice in aged care

Introduction .5

Decision-making and choice are help up as

Sociological approaches to choice focus on its social rather than psychological aspects, which are
based in meaning rather than in mental operations. On the one hand, for a choice to be meaningful
the future must appear as open, and pathways must be seen to be undetermined and contingent
upon the action taken by agents. On the other hand, choices appear as expectations about action
which themselves limit the openness of the future. By connecting probable outcomes to particular
actions, expectations reduce world complexity and define what is possible in a legible and therefore
actionable way. Without any such expectations we would be paralysed by noise of an indeterminate
reality. Consequently, choices reduce the complexity of the world by framing the future in
accordance with expectational pathways that are the scope of anticipated outcomes of agency.

Agents enact expectations in the choices they make throughout social life. These settle into shared
institutions which, in turn, define what pathways for action are available to them and others as
further choices. Institutions are “cognitive, normative, and regulative structures and activities that
provide stability and meaning for social behaviour” (Scott 1995). Institutions give consistency and
security to choices, but also present barriers to formulating and making choices that fall outside of
what is widely accepted and expected across society. Institutions become coercive when future
possibilities are closed and there is no choice but to conform to the institutional pathway.

Aged care has often been depicted as a coercive institution. This idea has been prevalent in both the
mass media and in academia. Hence during the 1970s and 1980s, researchers used Goffman’s (1961)
concept of the “total institution” to describe care homes as places where “inmates” were coerced
into conforming to rigid, bureaucratic procedures which threatened to strip them of their autonomy
and self-identity and re-socialise them into docile dependants (see Swain & Harrison 1979;
Townsend 1981). Subsequent work has challenged this somewhat monolithic perspective for failing
to account for the impact of corporeal ageing on structuring choice (Cavalli, Bickel & Lalive d’Epinay
2007), underappreciating the often subtle ways in which choices are framed, supported and enacted
within aged care contexts , and underestimating the

, we call this coercion. When agents need to decide between different pathways, we call this a
choice. When agents make a decision based on the expectation that

Aged care is a contemporary institution. People have

An institution is a

Choices can lead to disappointment.

Aged care is a

Phenomenologically, choices appear within a horizon of possibilities as points in time when later
developments are contingent upon undetermined actions. Choices are constructs of meaning
because they involve the attribution of outcomes to actions
Choices are not ex nihilo expressions of subjective will. They are possibilities that appear within a
horizon of affordances and constraints defined by one’s social milieu and context. Karl Weick
argues.

Care and trust 1.2

Levels of trust 1.2

Media portrayal and public trust 1.2

Conclusion .2