Respect for Equality and the Treatment of the Elderly: Declarations of Human Rights and Age-Based Rationing

Abstract

Aristotle, Nicomachean Ethics 1 Demographic Revolution and Related Ethical Issues A demographic revolution is taking place in Europe and worldwide. According to World Health Organization (WHO) estimates, the number of people aged 60 and over is growing faster than any other age group. 2 This change in the population structure affects disease patterns 3 and is deemed to cause an increase in the demands on healthcare systems. 4 This raises concerns about the ethics of healthcare delivery (among others). What criteria should direct healthcare distribution? Is it right to meet the demands of an ageing population, to the detriment of the younger strata of population? International organizations, such as the European Union (EU), the World Health Organization (WHO), and the United Nations (UN) have condemned any form of "ageism," including ageism in healthcare provision. 5 Age-based discrimination is deemed to violate the principle of equality. Virtually all declarations, conventions, and charters on human rights stress the fundamental value of equality. Since the earliest documents, the notion of equality has been at the heart of claims of respect for fundamental human rights, such as dignity, life, and integrity. These rights apply equally "to all members of the human family." 6 In these declarations, equality is understood mainly in terms of nondiscrimination. The Charter of Fundamental Rights of the European Union, for example, reads: Any discrimination based on any ground such as sex, race, colour, ethnic or social origin, genetic features, language, religion or belief, political or any other opinion, membership of a national minority, property, birth, disability, age or sexual orientation. (Art. 21, Nondiscrimination; my emphasis) 7 Similar statements occur in virtually all other declarations and conventions, for example, in the Convention for the Protection of Human Rights and Fundamental This paper has been written thanks to the support of the European Union, which has sponsored my project on ageism with a Postdoctoral Marie Curie Fellowship. More details on this project are available at the website http://les.man.ac.uk/simona/. I thank Prof. John Harris for our discussions on the topic and for his comments on this paper.

Health care prioritization in ageing societies: Influence of age, education, health literacy and culture

“…Veatch [24] suggested guidelines for limiting care for people who are old and terminally ill and saw younger people as being worse off than older people because they have lived less of their lives [25]. On the other hand, several researchers [11,[26][27][28][29][30][31] have argued against these theorists on the grounds of discrimination and ageism. As Giordano [29] stated that "there is no valid reason, either theoretical or empirical, to deny the elderly full membership to the human family (p.…”

Altersrationierung

“…Die vorliegende Arbeit konnte weiterhin verdeutlichen, dass im deutschen Gesundheitswesen zumindest inoffizielle und individuelle implizite Arten und Formen von Altersrationierungen bekannt sowie existent sind bzw. bewusst oder unbewusst insbesondere auf der Mikroebene bereits praktiziert werden [8,9,10,16,22,23,24,28,33]. Eine offizielle bzw.…”

“…Eine offizielle bzw. explizite Altersrationierung auf der Makroebene findet hingegen national nicht statt [11,16,24]. Indessen ist in Großbritannien die Altersrationierung nach chronologischem Alter explizit für bestimmte Fälle existent (z.…”

„Alter“ und „Kosten“ – Faktoren bei Therapieentscheiden am Lebensende? Eine Analyse informeller Wissensstrukturen bei Ärzten und Pflegenden1

“…Sämtliche Aussagerichtungen wurden berücksich-tigt. 5 Als ein Beispiel für die Bedingung "hohes Lebensalter" kann das Statement eines Arztes dienen: "Wenn ein Patient sehr alt ist, stellt sich dann schon die Frage, ob die Pneumonie behandelt werden soll" (1,15,7). Als Beispiel für die Bedingung "progrediente Erkrankung" berichtet ein Berufskollege Folgendes: "Bei Patienten, die unter Demenzen leiden, ist es sehr häufig ein Thema, ob eine Therapie angefangen oder abgebrochen wird" (1, 14, 5 …”

“…Reiter-Theil [26] argumentiert in Einklang mit anderen Autoren, dass "Alter" ethisch betrachtet als alleiniges Kriterium für Zuteilung oder Vorenthaltung einer lebenserhaltenden Maßnahme nicht geeignet sei; das "Alter" solle nur indirekt herangezogen werden, wenn es in die Prognostik der "ability to benefit" eingeht, wenn eine Maßnahme also nur innerhalb empirisch ermittelter Altersgrenzen Erfolg verspreche. Auch Giordano [15] …”