16 July 2012

MORAL OBLIGATION TO CARE FOR NEGLECTED SENIOR CITIZENS

The rapid ageing of the world population* has brought about visible changes in the familial, social and economic spheres of human life. The changes have affected areas like the intergenerational equilibrium of population, long term care, gender ageing, and socio-economic condition of elderly. As people live longer, specially the old-old and oldest old, have longer dependent life too. The situation for the poor elderly and also of those who are living alone is more difficult because they have to depend on others for their security (economic, social) and health care. The advancing age brings along with it health concerns like frailty, morbidity and vulnerability to abuse, exploitation and neglect.

Vulnerability implies that the personal integrity of the elderly can be harmed or violated because he/she is too weak to protect him/her self. It is precisely because the elderly is vulnerable to harm or violation that we are required to work towards the protection of his integrity.  The principle of vulnerability poses before us a normative value. What is central to vulnerability of elderly is the loss of power due to economic and social insecurity, chronic illness or inability to get long term formal (directly from the government) or informal (from community or family) care. It is the fear that one is no more master of one’s own life. Every human being has a three fold urge, namely, to live, live well and live better.1

The neglect is a complex, multifaceted problem that can have profound effects on elderly. Researches have shown that neglected elderly are at risk of a number of behavioral, social, psychological, and medical problems.  Some of the consequences of neglect include poverty, lack of social support by family members, increased dependency, loneliness, low self-esteem, depression, anger, impaired cognitive functions, a risk of delinquent behavior and illness. When the effects of neglect become more severe it results in “cumulative malignant effects" on elderly. Certainly the most severe, irrecoverable consequence of neglect is death.

Neglect of the elderly can be either physical or emotional#. A caregiver who physically neglects an elder does not provide for basic physical needs. This kind of neglect includes: lack of supervision and monitoring ,inappropriate housing or shelter ,inadequate provision of food or water ,lack of assistance with eating or drinking, inappropriate clothing for the weather, abandonment, denial or delay of medical care, inadequate help with hygiene or bathing , inadequate hand-washing on the part of the caregiver, which leads to infections ,physical restraint (in bed or in another area of the house),incorrect body positioning, which can lead to limb and skin damage ,lack of help in moving around, either within the bed or within the physical environment  and lack of access to the toilet or inadequate changing of diapers or disposable briefs, which can lead to incontinence, agitation, falling when trying to get to the bathroom independently, skin damage from sitting in urine and faeces, and indignity.

Emotional ( or psychological) neglect is a lack of basic emotional support, respect, and love, such as: not attending to the elder; ignoring moans, calls for help, or hospital call bells, inattention to the elder's need for affection ,failure to provide necessary psychological care to the senior, such as therapy or medications for depression, isolation of the elder from the outer world, including restriction of phone calls, mail, visitors, and outings and lack of assistance in doing interesting activities, such as watching preferred television programs or going out for cultural or intellectual activities .@

The problem of neglect poses ethical or moral issues before the state, society to which elderly belong, and the individuals or the family members. Keeping in view the individual ageing and the population ageing moral or ethical issues may be addressed from micro-ethical approach and from macro-ethical approach. The micro-ethical approach studies the individual aspect of elderly care and macro-ethical approach emphasizes the collective dimension of the care of the older persons. Family care is the principle facet of the micro-ethical approach. Macro-ethical approach focuses on the importance of the principle of distributive justice in elderly care.

Abandonment or neglect of elderly means that  some one ( or care giver) is not recognizing her/his dignity as human being and treating her/him accordingly. Generally speaking, when someone says of an act that it is a "moral obligation," they refer to a belief that the act is one prescribed by their set of values. Moral philosophers differ as to the origin of moral obligation, and whether such obligations are external to the agent (that is, they are, in some sense, objective and applicable to all agents) or are internal (that is, they are based on the agent's personal desires, upbringing, conscience, and so on).

An obligation arises out of considerations of right and wrong. Obligation/duty/ responsibility are the social force that binds an individual to the courses of action (social, legal or moral) demanded by that force. In other words an obligation is the act of binding oneself by a social, legal, or moral tie.

Moral obligation or ethic of responsibility is based on the notion of the human person. It is true that human person is a “social being”; he is always “with others” ”by others” and “for others”. Human person expresses his very identity in being related to the other. The fundamental aspect of human being is that they are individuals responsible for another. The respect for each other’s dignity and recognition of the vulnerability enables the members of the society to create situations conducive to human growth and self-realization.

The principle of human dignity is associated with human person. The article 1 of the Universal Declaration of Human Rights (UDHR), 1948, affirms the equal dignity of all human beings. All human beings are equal in their dignity and that this dignity accords them a special worth and value.

Etymologically speaking the word “dignity” comes from the Latin noun “dignitas” (worth) and adjective “dignus” (worthy). Subsequently, we believe that dignity is something that is inherent to all the members of human kind and that has to be respected and upheld as inviolable or sacrosanct. Moreover, our relationship with our fellow beings is determined by this dignity. We relate our selves with other people on the basis of their being endowed with dignity, they are “worthy” of my respect in view of their dignity.

There exist diverse views on human dignity and its basis but it is believed by all the religions that all human beings share one common characteristic- human being is an image of good or is having same Atman ( self) or is a being having consciousness like other human beings. The dignity is special worth of the human person, the core of being human. The implications for human dignity are for the community life. The dignity of human person is basically relational. We stands in relation to God, fellow beings, creation of God and ourselves. We are required to live ethically right life, if we are to nurture and promote this multidimensional relationship. Human dignity is recognized in  most of the  world religions that it is some thing rooted in the person’s being human. Human dignity is not an attribute that is attached to the human nature but essential to human person.

We employ the notion of human dignity in two senses: descriptive sense and prescriptive sense. From descriptive sense it simply means that all human beings possess equal dignity, and therefore, are set apart from the rest of creation. In its prescriptive (normative) sense, dignity suggests that in view of their exclusive worth, they deserve respect.2

Generally the dignity of human being (or elderly) is questioned or violated when that person (elderly) is used, neglected or a banded, forced or injured. A human being (elderly) can not be subjected to above mentioned treatments as dignity implies that the well being of human being must be preserved.

From dignity point of view, when a person ( or elderly) is considered in his/her totality, he receives special recognition  or honour due to him in the society and family . This honour forms the basis of true and authentic moral actions grounded in unselfish love.

The security (social, economic, psychological and health care) of elderly should also be seen from the point of view of the concept of justice. There are different theories of Justice (such as Utilitarian theories, Libertarian theories, Communitarian theories). For the present purpose mention of John Rawals’ point of view (egalitarianism) would suffice.3 Justice     consists in giving each person what is due to him/her. Rawls presents the principle of fair equality of opportunity. He maintains that social and economic inequalities must be arranged in such a way that they produce greatest benefit to the least advantaged. For him the just society is the one in which the least advantaged group is at the highest level. Rawls proposes two principles of justice. According to him, “social and economic inequalities are to be arranged so that  they are both (a) reasonably expected to be every one’s advantage and (b) attached to the positions and offices open to all. He holds that truth and justice are the first virtues of human activities and hence they are uncompromising. Each person possesses an inviolability founded on justice and even the welfare of the society as a whole can not override this inviolability.

Social justice is the basic structure of the society. In other words, justice has to do with the way in which the major social institutions distribute fundamental rights and duties and determine the division of advantages by social cooperation. The major social institutions define people’s rights and duties and influence their life –prospects: what they can expect to be and how well they can hope to do. Accordingly, social justice is concerned with providing   a standard whereby the distributive aspects of the basic structure of society are to be assessed.

The micro-ethical approach, which affirms the individual dimension of the human person, is directly related to the principles of dignity and vulnerability. Under this approach we examine how the principles of dignity and vulnerability are significant to the care of those aged persons who are dependent on others for their care and security. On the other hand, the macro –ethical approach addresses the persons collectively or as groups, is based on the principle of distributive justice. In this context we can examine Government’s policy of social security and health care provisions of elderly population.

Elderly are an integral part of the human society, and hence, must be so recognized and respected. Therefore, the plans and policies for the care of elderly must not hold on the “need based approach” (which assumes that older persons are passive target group) and should emphasize “right –based participatory approach”. This approach recognizes the rights of older persons to equality of opportunity and treatments in all aspects of life.@
NOTES AND REFERENCES

*Individual ageing and population ageing are two distinct concepts. Individual ageing refers to the constant process of growth taking place in individual. It is related to the biological, emotional, intellectual and spiritual development of human person. Population ageing is the result of demographic transition. The population or society ages when there is a quantitative increase in the elderly population along with the quantitative decrease in the rest of the population.

The rapid growth of elderly members in relation to younger members in the developed and developing countries is due to the availability of better medical facilities and ever growing awareness of ideal life style. The increase in life expectancy and low mortality rates at all stages of life and sharp decline in fertility rates are also causes of population ageing ( or ageing of a society).

1. Hoffmaster, Barry, “What Does Vulnerability Mean?” Hasting Center Report 36 (March-April 2006) 38-45

# Some overlap exists between the definitions of emotional abuse and emotional neglect; regardless, they are both elder abuse.

@Elders can neglect themselves by not caring about their own health or safety. Elder self-neglect can lead to illness or injury. The senior may deny themselves or ignore the need for: food or water, bathing or other personal hygiene, proper clothing for the weather, shelter, adequate safety, or clean surroundings and essential medications or medical attention for serious illness.

In addition, self-neglectful elders may have the following behaviors:

  • Hoarding
  • Leaving a stove on, but unattended
  • Confusion

Note that some elders who are sound of mind may choose to deny themselves some health or safety benefits. This is not self-neglect, but, rather, personal choice. Others must therefore be sensitive about intervention.

2. Collste, G. Is Human life Special:  Religious and Philosophical Perspectives on the Principle of Human dignity,Bern: Peter Lang,2002

3 Rawls : A Theory of Justice,  Cambridge:HarvardUniversityPress, 1971

@  National Policy on Older Persons (NPOP )and Maintenance and Welfare of Parents and Senior Citizens Act 2007 are steps of Indian Government in this direction.

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