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Paternalism, Family Duties, and My Aunt Maude

Steven H. Miles, MD
JAMA. 1988;259(17):2582-2583. doi:10.1001/jama.1988.03720170058035.
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LAST year, my 94-year-old great-aunt moved into a nursing home. Blind and frail, housekeeping was too much for her and she would not tolerate live-in aides. She lived as a recluse in her room in the friendly nursing home; nurses could not entice her out to eat or socialize. Fear of falling confined her to her rocking chair and bed. She went to bed clothed and resented the obligatory weekly bath and the nurses' efforts to do up her hair. She was not depressed; she spoke warmly with family callers, especially the nephew who managed her affairs.

Like many who have attained great age, Maude expressed surprise at having lived so long. She did not want to die but was prepared for death. Her will was made out. She had appointed her nephew (my father) to manage her affairs. Through a durable power of attorney, she appointed my father and


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