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Elderly Patients' Rights in End-of-Life Care

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Elderly Patients' Rights in End-of-Life Care & Decisions: Domestic/Abroad. Sooyoun Han, PhD, MSW, Founder. CARE RIGHTS (Republic of Korea) – PowerPoint PPT presentation

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Title: Elderly Patients' Rights in End-of-Life Care


1
Elderly Patients' Rights in End-of-Life Care
Decisions Domestic/Abroad
  • Sooyoun Han, PhD, MSW, Founder
  • CARE RIGHTS (Republic of Korea)

2
Increase in World Ageing and International
Migration
  • 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 in
  • 2013, 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).
  • Globally, there are close to 26 million migrants
    aged 65 and over. These
  • older migrant represent 11 of the total
    migrant population (U.N.
  • Population Division, 2013)

3
Figure 1 Age Distribution Among International
Migrants, 2013
4
Increase in Ageing and Migration in South Korea
  • South Korea has the fastest growing ageing
    population in Eastern Asia.
  • In 2011, 2,128 people reverse migrated to South
    Korea from the U.S, which
  • marked the largest population of reverse
    migrators to South Korea that year.
  • (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 for three or more months
  • with registered foreigner status from the U.S.
    (Han, 2012).

5
Figure. 2. International Migration, 2013
6
Identified Problems in Elderly Patients EOL
Care Decisions, Domestic/Abroad in South Korea
  • Multidimensional Understanding about Elderly
    Patients
  • Autonomy by Family Norms on EOL Care Decisions
  • Cultural ideas and expectations for family
    caregiving play a crucial role
  • in the EOL care decision making process
    Many Asian countries consider
  • these discussions taboo and filial impiety.
  • Often, elders do not understand the concept of
    patient autonomy. Thus, EOL
  • decisions are relegated to family caregivers
    (Kwon, 2010).
  • Korean healthcare staffs rarely discuss issues
    related to EOL care directly
  • and privately with the elderly patients. In
    fact, they are often excluded
  • entirely from the EOL decision making process
    (Han Lee, 2013).

7
Identified Problems in Elderly Patients EOL Care
Decisions, Domestic/Abroadin South Korea
  • 2. Lack of
    Health Care Legislation Regarding EOL Care
    Decisions
  • Lack of Health Care Legislation promoting
    Advance Directives raises
  • the risk of immature EOL decisions that could
    result in healthcare deficits
  • such as neglect, abuse, and discrimination for
    elderly patients EOL care
  • decision, domestic/abroad.
  • Differences in legal systems and health
    insurance plans among countries in
  • EOL care decision results in lack
    coordination in upholding the
  • Emergency Medical Service Act and utilizing
    the Emergency Service Fund
  • (ESF) to aid domestic and foreign elderly
    patients.

8
Contingent Disparities to Domestic/Abroad Elderly
Patients and Their Family Caregivers in EOL Care
and Decision
  • 1. Violation of Human Rights
  • Older persons should receive medical care only
    upon their free and
  • informed consent, and may freely withdraw
    consent at any time.
  • (Recommendation CM/Rec(2014)2, Council of
    Europe).
  • Domestic and foreign elderly patients are too
    often deprived of their rights to informed
    consent during EOL care decision in South
    Korea.
  • Domestic and foreign elderly patients desire to
    refuse aggressive
  • life-sustaining treatments may not be fully
    preserved if they are unable to
  • make EOL decisions at the time of service in
    South Korea.

9
  • Most elderly patients, domestic or foreign, in
    South Korea are often
  • administered unwanted aggressive
    life-sustaining treatments without
  • protection from culturally-designed, advanced
    EOL decision making process
  • that makes available and promotes pain-free
    and comfortable hospice care.

  • Video Clip

10
Contingent Disparities to Domestic/Abroad Elderly
Patients and Their Family Caregivers in EOL Care
and Decision
  • 2. Health Care Expenditure for Unmet Needs
  • The Korean Emergency Service Fund (ESF) expends
    one third of the total
  • budget for emergency care to patients from
    abroad, who are also funded
  • partially by travel insurance and private
    medical insurance. However, unmet
  • needs still remain due to insufficient
    development of health care protocol in
  • EOL care decision making.
  • Of U.S. Medicare decedents (85 years of age),
    who required Intensive Care
  • Unit/Coronary Care Unit services in their last
    30 days of life varied by race
  • White (21.3), Black (26.2), and Other
    (27.9).
  • Percentage of Medicare decedents (age 85) who
    died in an
  • in-patient/hospital setting varied by
    ethnicity Asian (43.6), Hispanic
  • (41.1), Non Hispanic Black (38.0), and
    Non-Hispanic White (31.1).

11
  • Figure.3 65 Medicare Decedents Place of Death
    by Ethnicity (U.S.)
  • Figure.4. Preliminary Data on Place of Death by
    Country in E.U.

Sources United States Weizen SMS et al. (1)
England and Wales Office of National Statistics
2000 Switzerland extrapolations from Federal
Statistics 1985 France INSERM 1999.
Netherlands Central Office of Statistics in the
Netherlands, 2000, M Ribbe, personal
communication. Germany Thomas Schindler,
personal communication. Ireland Julie Ling,
personal communication. Note Data from different
countries are collected in different ways and
sometimes not at all. This has limited the
comparison that can be drawn, but highlights
the need for health care systems across Europe to
begin to collect this information routinely. Some
15 of deaths in the Netherlands also occur in
residential homes for the elderly, and these are
not included in the graph above.
12
Contingent Disparities to Domestic and/or Abroad
Elderly Patients and Their Family Caregivers in
EOL Care and Decision
  • 3. Unsolved Emotional Complications and
    Bereavement
  • Korean family caregivers who made EOL decisions
    to admit their elderly
  • parents and/or spouses into Hospice programs
    experienced tremendous grief,
  • loss, guilt, anger, and confusion with regard
    to their decision on behalf of
  • their parents and/or spouses (Han Kim,
    2013).
  • In South Korea, social workers in a healthcare
    settings such as LTC practices,
  • help elderly patients and their family
    caregivers in the EOL decision making
  • process but lack structured education and
    training in specific communication
  • skills related to EOL care decision making
    (Han, 2014).

13
Murder of A Lineal Ascendant2013Case
citation Uijeongbu District Court, 392.
  • Defendants Son, Daughter, and Wife of the Victim
  • Victim Father and Husband to the Defendants
  • Case The victim got diagnosed with terminal
    stage brain cancer in January of 2013. His
    daughter, one of the defendants, was his primary
    caregiver who covered his medical cost (300) and
    provided for the rest of the family with her
    monthly income (1,500) ever since. The victim
    continually requested his death to eliminate his
    terrible pain. The daughter conspired with her
    brother to grant the victims wish. The victims
    wife was present as witness.
  • Clauses
  • Article 250 - Section 2 of Criminal Code
  • Whoever kills ones own or
    spouses lineal ascendants shall be
  • sentenced to death or more
    than seven years in prison
  • Article 30 - Criminal Code
  • When two or more persons
    jointly committed a crime, a self shall
  • be punished for the sin of
    the principal offender
  • Verdict Son Daughter were found guilty and
    sentenced to serve 3 years and 6 months in
    prison. Wife was found guilty and sentenced to
    serve 1 year and 6 months in prison.

14
International Enactment for EOL Care Decision
Act about Domestic/Abroad Elderly Patients
Rights
  • Directions in the Madrid Plan of Action on Ageing
  • Advancing Health and Well-Being into Old Age
  • Universal and equal access to health-care
    service for elderly patients as well as their
    family caregivers in their EOL care and decision
  • Care Rights provides Hospice Shelter Program to
    domestic and foreign elderly patients during
    their EOL care decision making process to
    promote comfortable, and culturally-designed
    care.
  • In diaspora communities,
    hospital ICUs, homeless shelters, prisons and any
    setting where human rights in their final stages
    of life may be deprived, we should take extra
    concern to protect them.

15
International Enactment for EOL Care Decision
Act about Domestic/Abroad Elderly Patients Rights
  • Directions in the Madrid Plan of Action on
    Ageing(2002)
  • Advancing Health and Well-Being into Old Age
  • Training of care providers and health
    professional for elderly patients in their EOL
    care and decision
  • Care Rights provides Psycho-Educational
    Intervention Program for domestic and foreign
    elderly patients and their family caregiver in
    EOL care decision with evidence-based,
    cost-effective and culturally-designed.
  • Psycho-Educational
    Intervention Program improves family caregivers
    understanding and their ability to navigate the
    EOL decision making process (Han et al, 2013).

16
References
  • U.N. Department of Economic and Social Affairs
    (2013). World Population Polices 2013. New York
    U.N.
  • U.N DESA. (2013). World Population Ageing 2013.
    New York U.N. http//www.un.org/en/development/de
    sa/population/publications/pdf/popfacts/popfacts_2
    013-4.pdf
  • Korean Ministry of Foreign Affairs (2012)
    Diplomatic White Paper. www.mofa.go.kr/ENG/pol
    icy/whitepaper/index.jsp?menum_20_160
  • 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.
  • 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.
  • 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).71-91.
  • Council of Europe (2014). The Promotion of Human
    Rights of Older Persons, Recommendation
    CM/Rec(2014)2.
  • Federal Interagency Forum on Aging Related
    Statistics.(2013). Older Americans 2012 from
    http//www.agingstats.gov/agingstatsdotnet/Main_Si
    te/Data/2012_Documents/docs/EntireChartbook.pdf.
  • 9. WHO (2004). The Solid Facts, Palliative
    Care from
  • http//www.euro.who.int/__data/assets/pdf_f
    ile/0003/98418/E82931.pdf?ua1
  • 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
  • 12. Han, S.K. Kim, T.H.(2013).Desperate Family
    Caregivers and EOL Decision of Elders with
    Dementia in S. Korea. AAA Annual
  • Conference, Chicago presented in the Round
    Table Discussion.
  • 13. Han, S.K.(2014). A Study of Social Workers
    Understanding of EOL decision and of their Role
    in Life Sustaining Treatment
  • Decision Making of Elderly Patients and
    their family caregivers in LTC. GRI (under
    reviewed).
  • 14. Han, S.K., Kim, John, Han, Jason, Lee, H. J.,
    Park, S.Y.(2013). The Effects of an
    Psycho-Educational Intervention Program on Family
    Caregivers
  • Understanding about EOL decision for Korean
    Immigrant Elderly with Dementia K. J of Social
    Welfare Research, 35. 1-23.
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