Older Adults, Autonomy, and Dignity

-

 



What exactly is dignity? What is autonomy? The majority of healthcare professionals have a vague idea of these concepts, yet dignity and autonomy have profound impacts on older adults, especially those who have impaired cognition. Those terms are not commonly used in conversation, although dignity and autonomy are the cornerstone of person-centered care. It is our moral duty to respect the rights of all humans. Older adults with impaired cognition are especially vulnerable and therefore, dignity and autonomy have profound ethical consequences.

Dignity has two aspects including human dignity and dignity of identity. Human dignity relates to biomedical ethics and suggests that all humans have intrinsic [fundamental] value and rights because they are human beings. Human dignity is applied and preserved in clinical settings and part of standards of patient care and suggests that every human has the right to be treated in a respectful manner. Dignity of identity is also known as autonomy or self-governance, is “the capacity of a person to choose and act on the basis of their own preferences regarding their life and their own body” (Rejno et al., 2020, p. 105). Decisional autonomy and autonomy of execution are two subsets of dignity of identity.

Understanding the consequences of decisions and being able to execute them are imperative for retaining autonomy and self-governance. Cognitive impairment alone does not determine whether self-governance is compromised. People with cognitive impairment may retain their decision-making abilities until such time that they do not understand the consequences. Resorting to paternalism or taking away their decision-making because they are old or have cognitive losses results in violating their human rights and dignity.

A diagnosis of degenerative dementia [one that progresses over time] should trigger consultation with and elder law attorney for advance directives and/or living wills so that their wishes, made when they have decisional autonomy and autonomy of execution, are later carried out on their behalf (Muiznieks, 2018).

An investigation by the World Health Organization found that in Europe, there were four million older people who experienced maltreatment in long-term care annually. Examples of human rights violations included “lack of medical care, verbal and physical aggression, overuse of medication, locking doors from the outside, disrespecting patient intimacy [showering together], lack of heating, lack of food, and not allowing patients to file written complaints” (Muiznieks, 2018, p. 3).

There is a gray area in understanding decisional autonomy and autonomy of execution, especially among family members who believe that getting old requires authoritarian edicts including less freedom, fewer choices, more restrictions and limitations, and withholding of affection. Another type of human rights violation concerns money and how it is spent in old age. In most families I have dealt with, grown children exert undue influence and pressure on financial decisions with the intent of “preserving their inheritance.” They make recommendations based on their own self-serving intentions, a violation of basic human rights and dignity.

References:

Muiznieks, N. (January 18, 2018). The right of older persons to dignity and autonomy in care. Council of Europe, Commissioner for Human Rights. Retrieved from https://www.coe.int/en/web/commissioner/-the-right-of-older-persons-to-dignity-and-autonomy-in-care

 

Rejno, A., Ternestedt, B., Nordenfelt, L., Silfverberg, G., & Godspeed, T.E. (2020). Dignity at stake: Caring for persons with impaired autonomy. Nursing Ethics, 27(1), 104-115. doi 10.1177/0969733019845128 https://pubmed.ncbi.nlm.nih.gov/31104584/

 

Photo by Markus Spiske on Unsplash

 


Comments

Post a Comment

Popular posts from this blog

Generic Prescription Drugs - You Decide Who Benefits

-
Image
    Did you know that clinicians and patients requested branded prescription drugs over generics 30% of the time, yet branded dispensing wastes billions of dollars yearly?    A cross-sectional study of 169 million Medicare Part D prescription claims from 2017 was examined by researchers Mariana Social, Ge Bai, and Gerard Anderson and published in the March 2, 2021 edition of JAMANetw Open . Their findings suggest that billions of dollars in savings could impact patients and the Medicare program by switching to generic drugs. According to the findings, older patients are often suspicious of generics and believe they are not the same as branded drugs. However, the FDA ensures they are equivalent.    According to the FDA, generic drugs undergo a rigorous review to ensure patient safety. However, companies are allowed variation for non-active ingredients such as fillers, but the active ingredients must be identical to the branded drug. “Some differences, which must be shown to not affe
Read more

Voter Resources

-
Image
Hi Readers, below are resources for my readers in the United States who need ACCURATE and timely resources for voting and contact information for your elected representatives. Three issues related to aging and caregivers are listed below in the Act Now section. Find out who represents you and contact him/her today! You make a difference! VOTE!  Act now Choose an action below and make your voice heard! Help Low-Income Americans Get Long-Term Care at Home Help us expand Medicaid Home and Community-Based Services Ask Congress to invest in healthy aging programs Urge your Senators to at least match the $10 million provided by the House for OAA heath promotion and disease prevention. Tell Congress: Older adults need more food assistance Join NCOA in advocating to expand SNAP benefits. I email my senators and congressman on a regular basis. This link will help you identify your elected representatives:   https://cqrcengage.com/ncoa/elections?0
Read more

Hoarding Disorder ~ Facts Not Fiction

-
Image
  In a recent online seminar with hoarding expert Dr. Catherine Ayres, I gained insights about hoarding among older adults, as this has only been identified as a diagnostic disorder five years ago. Before that, hoarding was classified as a type of “obsessive compulsive disorder (OCD).” However, during the past few years, scientists and therapists have gained a clearer understanding of identification and treatment approaches. HGTV is now on their thirteenth season of “Hoarders,” a documentary featuring people with hoarding disorders. I have watched all of them. For the record, I am not in favor of hoarding as entertainment and some of their approaches are appalling because they harm people. The show has brought attention to hoarding but has created a plethora of misunderstandings and draconian solutions, especially apparent in the earlier seasons. Hoarding is not just “collecting stuff.” A critical element of hoarding disorder is severe distress and impairment if items are taken away.
Read more