Moral Considerations for the Treatment of the Elderly

Naomi, Kahoua, Kelcey, and Nicole

Class Activity

• What age do you think is old?• What do you see yourself doing at that age?– Married and family?– Where do you live?– Who do you live with?– Retired or working?– Hobbies?– Ambitions, hopes and dreams

Moral Problem

• “How will the U.S. address the ethical and moral treatment of elders in light of the future

increase of the elder population?”

Overview

• Impact of Philosophy• Impact of Psychology• Four Ways of Thinking• Definitions • Statistics• Individual Presentations• Counterarguments• Recommendations• Conclusion

Impact of Philosophy

• Moral Reason– Human Dignity– Human Autonomy

• Deontology • Categorical Imperative and Test of Universality

– Treat other the way you want to be treated.– How would you want someone to act in your position.

Impact of Philosophy

• Utilitarianism– Greatest Happiness Principle: achieving the

greatest happiness for the greatest amount of people.

– Elders will be a Larger Portion of the Population– Requiring

Impact of Psychology

• Psychology: the study of behavior• Lawrence Kohlberg – Moral Developmental Stages• Individual Action and Society• Reason and Logic Dictate Moral Decision Making

– This makes change difficult, but not impossible.

?Four Ways of Thinking?

• Truth– Elder population is growing– More ethnically diverse

• Character– Treatment of elderly based on country

• Fairness– Everyone deserves to be treated equally with dignity and respect – Autonomy

• Elders, Caregivers, and Society

• Consequences– Not providing more resources or care– Providing more resources or care

Definitions

• Elderly: Adults 65 years and older• Abuse: "a single or repeated act, or lack of appropriate action

occurring within any relationship where there is an expectation of trust which causes harm or distress to an older person"(WHO 2002b, p.152)

• Caregiver: someone who devotes time to supporting and maintaining another human being

• Caregiver Stress: debilitating stress that does not allow an individual to function properly in day-to-day life

• Hospice: A quality and compassionate care given to people facing a life-limiting illness or injury. About caring not curing (National Hospice and Palliative Care Orgnization)

Elder Statistics

• “By 2030, there will be about 72.1 million older persons, more than twice their number in 2000.” – From 12.4% to 19% of the population– ~1/5 of the population

(Retrieved from: AOA, 2009)

Elder Population by Percentage

Retrieved from: AOA, 2009

Individual Presentation

• Kahoua: Elder Abuse and Neglect• Naomi: Caregiver Stress and Autonomy• Kelcey: Hospice and End of Life Decisions • Nicole: Comparing Eastern and Western

Cultures Attitudes and Treatment of Elders

Elder Abuse

• Overview– Types of Abuse– Prevalence– Factors to Elder Abuse– Moral Dilemma– Recommendations

Elder Abuse

• Abuse: “a single or repeated act, or lack of appropriate action occurring within any relationship where there is an expectation of trust which causes harm or distress to an older person" (WHO 2002b, p.152)

• Types of Abuse• Physical• Emotional• Psychological• Sexual• Financial• Abandonment/Neglect• Self-Neglect

Elder Abuse

• Prevalence: Exact number unknown– “More than 1 in 10 elders may experience some type of abuse, but

only one in five cases or fewer are reported” (Thobaben, 2012).

• Study: Recognition and Perception of Elder Abuse by Pre-hospital and Hospital-based care providers (Rinker, 2009). – “Abuse, neglect, and domestic violence in the elderly are rare”

• False: 96.5%

– Reason to suspect patients exposed to abuse or neglect• No: 52.3%

– Elder Abuse a medical problem or social problem?• 76% Medical problem• 20.3% Social Problem

Elder Abuse

Factors to Abuse• Elder• Caregiver • Medical Professionals• Laws• Lack of Knowledge

Elder Abuse

• Deontology– Fairness• Autonomy & Dignity of Elderly• Categorical Imperative• Moral Duty

• Utilitarianism– Happiness and Suffering of elderly

Elder Abuse

• Recommendations:– Protect the autonomy of the elderly.• More Knowledge• More Services• Improve Current Laws

Caregiver Stress

• Paper Overview– Caregiver and Elder– Why people become caregivers– Services and Resources Currently Available – Recommendations for Community Assistance

• Scenario: – 45 Years Old– Children, job, friends, and relatively good health– Elderly mother

• Check on her • Bring her groceries• Taker her to appointments

Caregiver Stress

• Most likely caregiver: – “A 46 year old woman with some college experience and

provides more than 20hrs of care each week to her mother.”

• Moral Problem– Caregiver to experience debilitating stress– The elder to not receive the best and most effective care

• Address– Fairness to the Elder and Caregiver– Moral Responsibility of Community

(CDC, 2007)

Caregiver Stress• Caregiver Stress- Caregiver

– Physical• People caring for individuals with cognitive disabilities can have

impoverished immune system for up to 3 years after their caregiving experience

– Mental• “40% to 70% of family caregivers have clinically significant symptoms of

depression with about a quarter of these caregivers meeting the diagnostic criteria for major depression” (2006).

• Issues of Elder– Abuse and Neglect

(Caregiving in the U.S: National Alliance for Caregiving, 2009)Coughlin, J., (2010). Estimating the Impact of Caregiving and

Employment on Well-Being: Outcomes & Insights in Health Management, Vol. 2; Issue 1]

Fairness and Community Responsibility

• Moral Problem– Caregiver– Elder– Reason=Morality– Categorical Imperative

• Moral Responsibility – Trolley and Footbridge problem

• “When harmful actions are sufficiently impersonal, they fail to push our emotional buttons, despite their seriousness, and as a result we thing about them in a more detached, actuarial fashion.” (Greene, 2007).

• Young v.s. the old

Caregiver Stress

• Recommendations:– La Crosse Community• Colleges and Elder Living Facilities• Religious Communities• Volunteers• Traveling Doctors

Hospice and End of Life Care

• Overview of Paper: -Hospice and end of life care taken more seriously

-More clear, concise rules and guidelines for caregivers-Comfort and dignity of the person is attained

• 4 Ways of thinking -Fairness during end of life decisions and the

autonomy of the person. • Consequences

-Assisted Suicide -Autonomy of patient, caregiver and families

Hospice and End of Life

• Interesting Fact -Relatives reported that the patient was treated with

respect and dignity at all times boy 87% of doctors and 80% of nurses in the hospice, but by57% of doctors and 48% of nurses in hospitals (Office for National Statistics 2012).

• Recommendations - To create more clear guidelines for hospice care

givers. -Offer more seminars-More opportunities to learn

Conclusion

• How will the U.S. address the ethical and moral treatment of elders in light of the future increase of the elder population?– Respect the Dignity and Autonomy – Community Effort to Provide Services and Support

• Class Activity– How has this presentation effected your thought

about aging?– How would you change your answer?