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?