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Older Persons' Rights for Self-Determination in End-of-Life Decisions

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Title: Older Persons' Rights for Self-Determination in End-of-Life Decisions


1
Older Persons' Rights for Self-Determination in
End-of-Life Decisions Abroad
  • Sooyoun Han, PhD, MSW, Founder
  • Care Rights (Republic of Korea)

2
Table of Contents
  • Problem Statements.... 3
  • Increase of Ageing Migration in South
    Korea........ 5
  • Lack of Awareness and Cultural Incompetency
    Regarding EOL
  • Decisions in South Korea....
    6
  • Identified Problems for Foreign Travelers and
    Foreign Nationality
  • Residents. 9
  • Care Rights Program Goals, Activities
    Outcome.. 12

2
3
Problem Statements
  • The phenomenon of rapid global ageing has led to
    challenges related to
  • human well-being.
  • The older population is itself ageing. Globally,
    the share of older persons aged 80 years or
    over (theoldest old) within the older
    population was 14 percent in 2013 and is
    projected to reach 19 percent in 2050.
  • If this projection is realized, there will be
    392 million persons aged 80 years or over by
    2050 more than three times the present number
  • (U.N. Department of Economic and Social
    Affairs, 2013)
  • The number of international migrants worldwide
    reached 232 million,
  • up from 154 million in 1990. The global
    population of international migrants is
    growing at a rate of about 1.6 percent per year
    (U.N. DESA, 2013).

3
4
Figure. 1. International Migration, 2013
4
5
Figure 2. Age distribution of international
Migrants, 2013
5
6
Figure 3. Eight-Point Agenda for Making Migration
Work
6
7
Problem Statements
  • Numerous potential obstacles for foreigners in
    need of EOL
  • care abroad are seen, including
  • Absence of EOL decision processing for
    foreigners
  • Differences in cultural and healthcare
    legislation regarding
  • patients autonomy between two countries
  • Language barriers
  • Such problems could lead to
  • Disparities in the decision-making process
    regarding EOL care
  • Violation of human rights
  • Elder abuse in crisis situations, including
    stranded migrants
  • Unnecessary medical expenditures

7
8
Increase of Ageing Migration in South Korea
  • Return migrants persons returning to their
    country of citizenship after
  • having been international migrants in another
    country and who are
  • intending to stay in their home country for at
    least a year
  • (U.N. Division for collecting data on
    international migration, 1998).
  • In 2011, 2,128 people reverse migrated to South
    Korea from the U.S. the largest population
    of reverse migrators to South Korea overall.
  • (Korean Ministry of Foreign Affairs, 2012).
  • 95,234 American Nationals aged 60 years or older
    entered South Korea in 2011 14,708 of them
    remained in the country three months or longer
  • with registered foreigner status from the U.S.
    (Han, 2012).

8
9
Lack of Awareness and Cultural Incompetency
Regarding EOL Decisions
  • 1. Family Norms and Patients Autonomy
  • on EOL Decisions in South Korea.
  • Cultural ideas and expectations for family
    caregiving play a crucial role
  • in the EOL decision process Many Asian
    countries find such discussions
  • taboo and against filial piety.
  • Often, elders do not understand the concept of
    patient autonomy and EOL
  • decisions are relegated to family caregivers
  • (Haung, Hu, Chiu, Chen, 2008 Kwon 2010).
  • As a result, Korean healthcare staffs are not
    trained in EOL communication
  • skills for EOL decision making processing (Han
    Lee, 2013).

9
10
Lack of Awareness and Cultural Incompetency
Regarding EOL Decisions
  • 2. Lack of
    Hospice Services and Social Services
  • for EOL Decisions in South Korea.
  • Lack of legal and social services raise the risk
    of misconduct and/or
  • neglectance in EOL processes, leaving
    insufficient EOL decisions that
  • could lead to elder abuse in the forms of
    neglect, inequality, and
  • discrimination.
  • Foreign travelers or residents are vulnerable to
    have possibly unwanted
  • aggressive treatments, as opposed to
    pre-requested EOL decisions that are
  • culturally-designed, pain-free and provided by
    comfortable hospice care.

10
11
Lack of Awareness and Cultural Incompetency
Regarding EOL Decisions
  • 3. Healthcare Legislature and Patients Autonomy
    Regarding EOL Decisions in South Korea.
  • Legislation such as the U.S.s Patient
    Self-Determination Act (Pub. L. No. 101-
  • 508, PSDA), which calls for Advance
    Directives for Health Care, but not yet
    enacted in South Korea.
  • As of now, the South Korean Emergency Medical
    Service Act (EMSA)
  • requires that hospitals and healthcare
    providers provide mandatory emergency
  • medical services to all patients, contingent
    upon certain disparities.

11
12
Identified Problems for Foreign Travelers and
Foreign Nationality Residents
  • 1. Conflicts Between Legal and Health Insurance
    Systems
  • The Korean government founded the Emergency
    Service Fund (ESF) to
  • reimburse unpaid expenses to medical service
    providers (Song, Kim Lee,
  • 2008). One fourth of this fund was paid for by
    foreign emergency patients.
  • Most travel insurance plans have a max. coverage
    cap and do not always
  • cover all options for life-sustaining
    treatments.
  • Public insurance like Medicare does not cover
    medical costs abroad others
  • cover only partial medical costs.

12
13
Identified Problems for Foreign Travelers and
Foreign Nationality Residents
1. Conflicts Between Legal and Health Insurance
Systems (continued)
  • Issues such as unwanted life-sustaining
    treatments for those with
  • completed Advance Directives for Health Care
    may arise due to
  • responsibility of expenses and national and
    international legal issues.
  • Reasons for such problems include
  • Lack of clear and culturally-sensitive
    information
  • Deficits in health care legislation
  • Lack of legislation for self-determination of
    EOL decision in some countries
  • Cultural differences and language barriers

13
14
Identified Problems for Foreign Travelers and
Foreign Nationality Residents
  • 2. Violation of Human Rights
  • Foreign travelers and/or residents are at a
    higher risk for misconduct and/or
  • neglectance in EOL care left with insufficient
    EOL decisions that could form
  • another type of elder abuse abroad.
  • Foreign travelers and/or residents are easily
    deprived of rights to being informed about
    self-determination at EOL care in abroad.
  • In South Koreas current state, the rights of
    foreign travelers and/or residents
  • who do not wish to receive aggressive
    life-sustaining treatments cannot be
  • protected if unable to make EOL decisions at
    the time of service.

14
15
Program Goals
Care Rights is working
  1. To prevent neglect, abuse, and the violation of
    human rights of older persons in their EOL care
    in South Korea.
  2. To ensure human rights are met by allowing older
    adults who are foreign travellers or foreign
    national residents to make EOL decisions in
    advance with the benefits of cultural sensitivity
    and competent language services.

15
16
Program Goals
Care Rights is working
  • To reduce misconduct in life-sustaining
    treatments caused
  • by a lack of health legislation,
    communication, and educational
  • materials about EOL care and the rights of
    foreign travellers and
  • foreign nationality residents.
  • To provide a psychoeducational intervention
    program to reduce
  • the tremendous emotional and psychological
    burdens of long-
  • distance family caregivers, as well as
    healthcare providers and
  • staffs.

16
17
Program Target Population
  • Care Rights Target Populations
  • Foreign travellers and foreign nationality
    residents in South Korea
  • Long-distance family caregivers of foreign
    travellers and foreign
  • nationality residents in South Korea
  • Health care providers and staffs who provide
    emergency medical
  • services to patients who are foreign
    travelers and/or foreign
  • nationality residents

17
18
Program Activities
  • Care Rights Activities
  • Provide a psycho-educational intervention
    program for older persons
  • who are foreign travelers and/or foreign
    nationality residents and
  • their caregivers about end-of-life care and
    rights in South Korea
  • 2. Implement National Advance Directives for
    Health Care Form and
  • provide them to foreign travelers and
    foreign nationality residents on
  • a regular basis.
  • 3. Educate healthcare workers and social workers
    about EOL decision
  • processing, and publicly advocate the rights
    of elderly patients in their
  • autonomy in EOL decisions.

18
19
Program Activities
  • Care Rights Activities
  • Develop brochures and materials about the rights
    to EOL decisions,
  • National Advance Directives for Health Care
    Form, and cultural
  • supports to ensure that foreign travelers
    and foreign nationality
  • residents are aware of their rights and do
    make decisions regarding
  • their EOL care
  • Work collaboratively with the Korean Ministry of
    Foreign Affairs
  • and National Immigration Service to provide such
    materials and
  • services to foreign travelers and foreign
    nationality residents visiting
  • South Korea.

19
20
Care Rights Program Outcome
  • Care Rights Outcome
  • Protect older foreign travelers and foreign
    nationality older
  • residents rights to EOL decisions abroad,
    ensured by the Madrid
  • International Plan of Action on Ageing,
    2002.
  • Improve older persons dignity and autonomy in
    the process of
  • dying.
  • Lighten stress and burden of long-distance family
    caregivers,
  • including those who are located abroad.

20
21
Program Outcome
  • Care Rights Outcome
  • Reduce unnecessary medical expenses incurred by
    misconduct and neglect that go against the rights
    of foreign older travelers and foreign
    nationality older residents in their EOL
    decisions.
  • Develop International Older Persons Human Rights
    Instruments for EOL decisions and well-dying
    processing, focused on one of the main areas of
    concern for the lack of special measures,
    mechanisms and services (The Second Assembly on
    Ageing, A/66/173, 2011).

21
22
References
  1. UNDP(2013). Population Prospects, 2012 Revision.
  2. U.N. Department of Economic and Social Affairs
    (2013). World Population Polices 2013. New York
    U.N.
  3. U.N DESA. (2013). World Population Ageing 2013.
    New York U.N.
  4. United Nations (1998). Statistics Division for
    collecting data on international migration.
  5. Korean Ministry of Foreign Affairs (2012)
    Diplomatic White Paper. www.mofa.go.kr/ENG/pol
    icy/whitepaper/index.jsp?menum_20_160
  6. Han, S. B. (2012, 05 03) Rush of reverse
    migration due to expensive medical cost in
    abroad. Seoul Newspaper http//www.seoul.co.kr/
    news/newsView.php?id20120503010010.
  7. Huang, C-H., Hu, W-Y., Chiu, T-Y., Chen,
    C-Y.(2008). The practicalities of Terminally Ill
    Patients Signing Their Own DNR Orders A
    Study in Taiwan. Journal of Medical Ethics,
    34(5). 336-340.
  8. Kwan, Iro Bae, H.A. (2011). A Narrative
    Analysis of Ethical Issues Regarding End-of-Life.
    J of Korean Medicine Ethic, 14(2). 157-170.
  9. Han, S. K. Lee, H.J.(2013). A Discussion on
    Elderly Patients and their Family Caregivers
    Decision Making for Life Sustaining
    Treatments. GRI, 15(2).
  10. Song, K.M., Kim, Y. S., Lee, Y. H. (2008).
    Legalistic Study of the Subrogation Payment in
    Emergency Medicine. The Korean Study of Law and
    Medicine, 9(2), 139-179.
  11. UN, Economic and Social Council (2012). Report
    of the UN High Commissioner for Human Rights.
    Substantive Session

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