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Ethics and old age

  • Published
    30th Sep, 2022

For the elderly, ethics is about how they want to be treated and allowed to make their own decisions. 

For family members as caregivers, ethics is about doing what is right even when no one is looking. 

For professionals providing eldercare, ethics is about adherence to established canons of ethics promulgated by organizations.

Each of the stakeholders has to fulfill one’s ethical duty for the betterment of elderly people.

This can be linked to the theory of Ethics of Care.

Care involves treating people not only with respect but actually attempting to empathize with them and try to help them in anyway that is feasible. The distinctive elements of an ethic of care are:

  1. Attention to particular others in actual contexts
  2. A focus on the needs versus the interests of those others
  3. A commitment to dialogue as the primary means of moral deliberation
  4. It is not a system of principles, but a mode of responsiveness.

Hence, Ethic of Care is a theory that is centered around the interdependence of all individuals. It takes into account the fact that certain communities and people are more vulnerable than others, and that you (as the non-vulnerable population) should afford extra consideration to the vulnerable community depending on how they are affected by your choices. Ethic of care also asserts that there is no universal truth; it considers the contextual details of a moral situation to promote the specific needs and interests of the vulnerable communities.

Ethic of Care does not promote a dependency relationship between people but talks about maintaining a relationship of interdependence and mutual efforts and benefits.

According to the law, a "senior citizen" means any person being a citizen of India, who has attained the age of sixty years or above. India has fastest growing demography of Sixty-plus, yet there are no significant public policies to address the elderly.

As per the 2011 Census, citizens over the age of 60 years comprise 8.6% of India’s population, and their share of the population is projected to grow to 21% by 2050.

With more than 135 million elderly people, India today has the second-largest population of senior citizens who deserve care and concern.

Further, the fast-paced and ever-changing life of today is continuously widening the gap between generations and thus the creation of a happy environment for the elderly is our traditional, moral, and now even legal responsibility.

The elderly faces many challenges related to financial security, healthcare and nutrition, shelter, protection of life and property and issues such as loneliness, abuse and neglect.

  1. Lack of economic insecurity: This problem arises when elderly are unable to sustain themselves economically. They either lack the capacity to be productive or lack the opportunity as they were before. They lose their independency due to increase in competition from young generation, sluggishness in physical and mental faculties, mindset of society, malnutrition, decrease in access to resource, lack of awareness about the rights and entitlements with changing
  2. Housing Related Problems: Housing for elderly should be suitable not only to the living pattern which they have established in optimum health, but also to conditions of failing health and illness. Majority of housing that is there for elderly may be found not adequate and not suitable to their needs. The sizeable populations of elderly widows and elderly males have been facing problem of shortage of peaceful place to live in. With age a common complaint of many elderly is the feeling of loneliness and sense of being isolated. In most case isolation is imposed purposefully by the families or communities where the old age people live in. Changing lifestyles and values, job culture, various means of distractions like internet, television, societal shift such as nuclear family structures and redefined priorities have led to increased neglect of the elderly by families or communities, and with this isolation comes in. With it the problem of housing rises again. It is not only terrible thing but also it leads to detrimental quality of life.
  3. Psychological Problems: They face lowered self-esteem. It includes neglect, decrease in value, deteriorating worth, and isolation.
  4. Problem of Elder Abuse: Elder abuse is defined as any ill treatment to an older person. Around 81 percent of the elders face the verbal abuse problem, 53 percent of them face neglect, 37 percent face material abuse and 23 percent face physical abuse. In abuse person is usually harmed by a person who is the part of family or closed to the person. As elderly are relatively weak, they are prone to physical abuse. They are abused financially, emotionally, and mentally as well for various reasons and in various ways.

Respect for individuality is a core value in the human society and in case of elderly it is even more needed because the elderly are usually not as able as the younger population to stand up for their rights and their decisions. 

  • One key economic implication of an aging population is the strain on social insurance programs and pension systems.  With a large increase in an aging population, many nations have to raise their budget allocations for social security.For example, India’s social security system presently covers only 10 percent of its working-age populace, but its system is operating at a deficit with more funds exiting than entering.  In other words, the amount of money coming into social security will lessen due to fewer contributions from workers and more funds going to an aging retired population.  In Europe, in order to fund their social security system, 24 nations have payroll tax rates equaling or exceeding 20 percent of wages.  The situation is also precarious for pensions.  As the global population for elderly and retired workers increases, pensions must provide more income to these recipients so that they can enjoy at least a reasonable standard of living.
  • Another key economic implication of an aging population is the increase in health care costs.As the population ages, health generally declines with more medical attention required such as doctor visits, surgery, physical therapy, hospital stays, and prescription medicine. There are also increased cases of cancer, Alzheimer’s, and cardiovascular problems.  All of this costs money and will increase not only due to rising demand by an aging populace, but also because of inflation.  For example, in the United States, it is projected that public health expenditures will rise from 6.7 percent of GDP in 2010 to 14.9 percent in the year 2050.   This increase in health care costs will mean that nations must put more funds and human resources into providing health care while also attending to the needs of other segments of their people.
  • With an aging global population, economic growth will also be impacted.Most importantly, there will ultimately be less workers available for firms to make products and provide services.  This shrinking labor force will mean that fewer workers must support greater numbers of retirees since they must pay taxes for social security, health care programs, and public pension benefits.   Nations, such as China and Mexico, are expected to witness declines in their workforce from the year 2030 to 2050.  Other large economies such as Japan are projected to see a 19 percent decrease in their worker population within the next 25 years followed by a 24 percent decrease over the next 20 years.  Europe is also expected to see declining numbers in its workforce which will impact their chance to have a growing, competitive economy.

This decline in the global workforce will lead to an increase in the age dependency ratio which is the ratio of working-age to old-age individuals.  Globally, the dependency ratio in 1970 was 10 workers for each individual over age 64, but the expected ratio in 2050 is four workers for each person over 64.

  • Very old people, due to their reduced mobility and debilitating disabilities, need other people to do things for them. With the increasing trend of nuclear families in the society and with fewer children in the family, the care of older persons in the families gets increasingly difficult. To fulfill caring needs of aged persons more and more nursing people with appropriate skills are required.
  • Constitution of India, Directive Principles, Article 41:

The well-being of senior citizens is mandated in the Constitution of India under Article 41. ‘The state shall, within the limits of its economic capacity and development, make effective provision for securing the right to public assistance in cases of old age’. The Right to Equality is guaranteed by the Constitution as a fundamental right. Social security is the concurrent responsibility of the central and state governments.

  • Code of Criminal Procedure (Chapter IX, Section 125(1) (2)):

It requires persons who have sufficient means to take care of his or her parents if they are unable to take care of themselves. It facilitates monthly maintenance of Rs. 500 to the beneficiaries.

  • Hindu Adoption and Maintenance Act, 1956:

It requires Hindu sons and daughters to maintain their elderly parents when parents are unable to maintain themselves.

  • Maintenance and Welfare of Parents and Senior Citizens Act

It is an Act to provide for maintenance and welfare of parents and senior citizens for ensuring their basic needs; safety and security; establishment, management and regulation of institutions and services; and for the rights guaranteed and recognised under the Constitution and for matters connected therewith or incidental thereto.

It requires children to provide maintenance for their parents, and the government to provide old age homes and ensure medical care for senior citizens.  It sets up Administrative Tribunals and Appellate Tribunals to ensure maintenance.

Ministry of Social Justice and Empowerment has taken many progressive steps for their welfare. The ministry develops and implements acts, policies and programmes for senior citizens in collaboration with State Governments/ Union Territory administrations to ensure that senior citizens lead a secured, dignified and productive life.

Initiatives are:

  • Vayoshrestha Samman is conferred as a national award on eminent senior citizens and institutions under various categories for their contribution. Recipients for the award are drawn from diverse fields
  • The schemes currently being implemented for the welfare of senior citizens include the Atal Vayo Abhyuday Yojana (AVYAY) formerly known as National Action Plan for Senior Citizens (NAPSrC) and the Rashtriya Vayoshri Yojana (RVY). The mission of AVYAY is to create a society in which senior citizens live a healthy, happy, empowered, dignified and self-reliant life along with strong social and inter-generational bonding.
  • The NAPSrC, has two components-the Integrated Programme for senior citizens (IPSrC) and the State Action Plan for Senior Citizens (SAPSrC). The IPSrC entails setting up homes to improve the quality of lives of senior citizens, especially indigent senior citizens by providing basic amenities like shelter, food, medical care and entertainment opportunities and by encouraging productive and active ageing. Under the SAPSrC, each State/Union Territory is expected to frame their own State Action Plans for the welfare of their senior citizens.
  • Under the Scheme of ‘Rashtriya Vayoshri Yojana (RVY)’ physical aids and assisted living devices are provided to senior citizens belonging to BPL (Below Poverty Line) category, free of cost, to restore near normalcy in their bodily functions.
  • The Ministry of Rural Development runs the National Social Assistance Programme (NSAP) that extends social assistance for poor households for the aged, women who have lost their husbands, ‘Divyangs’ and in cases of death of the primary breadwinner. This scheme provides financial assistance to persons of age 60 years and above and belonging to families living below poverty line.
  • The Annapurna scheme started by the Ministry of Rural Development in 2000 covers indigent senior citizens not able to get pension under the Indira Gandhi National Old Age Pension Scheme (IGNOAPS), get 10 kg of food grains per person per month free of cost under the scheme.
  • Department of Food and Public Distribution also implements Antyodaya Anna Yojana (AAY), under which rice and wheat at a highly subsidised cost, is extended to households, headed by widows/terminally ill/ disabled persons/senior citizens, with no assured means of maintenance or societal support.
  • The scheme on Poshan Abhiyan addresses the nutritional deficiencies in senior citizens, especially indigent elderly. It aims to provide one nutritious, hot and cooked meal during the day (mid-day), through Gram Panchayats and Urban Municipalities.
  • The scheme on Livelihood and Skilling Initiatives for senior citizens include the Senior Able Citizens for Re-Employment in Dignity (SACRED) Portal. The portal facilitates identification of such persons through virtual matching of preferences.
  • Under Elderly Self Help groups, senior Citizens are encouraged to form SelfHelp Groups (SHGs), which provide them a platform to share their time constructively with one other. To attain financial assistance under the Scheme, SHGs will function as ‘Action Groups Aimed at Social Reconstruction (AGRASR Groups)’.
  • Another scheme on Awareness Generation and Capacity Building for welfare of senior citizens includes components such as the national helpline for senior citizens, research, awareness generation, sensitisation, emotional empowerment etc. for the welfare of senior citizens, and spreading awareness and sensitising the youth and other sections of the society towards issues related to the elderly.
  • The Ministry of Health and Family Welfare (HFW) has been implementing National Programme for Health Care of the Elderly (NPHCE) from the Financial Year 2010-11 to provide dedicated healthcare services to the elderly people at various levels of state healthcare delivery system. Government has also launched Ayushman Bharat PMJAY during 2018-19 to cover over 10 crore poor and vulnerable families (approx. 50 crore beneficiaries) providing coverage upto Rs. 5 lakh per family per year for secondary and tertiary hospitalisation.
  • The Pradhan Mantri Vaya Vandana Yojana (PMVVY) was launched in May 2017 to provide social security during old age.
  • India’s senior citizens will soon be able to register their grievances on a toll free national helpline and regain financial independence by exploring work opportunities on innovative government run portals. The toll free helpline, ELDERLINE, reported to be working like a confidence building measure for the elderly in eight states, will now be extended to 20 more States

Senior Citizens and COVID 19

COVID-19 has changed the older people’s daily routines, the care and support they receive, their ability to stay socially connected and how they are perceived.

Older people are being challenged by requirements to spend more time at home, lack of physical contact with other family members, friends and colleagues, temporary cessation of employment and other activities; and anxiety and fear of illness and death – their own and others.

The health insurance cost has become prohibitively expensive for senior citizens at a time of their lives when their medical needs are greatest. For example, two 70+ members of a family have to shell out more than Rs. 60,000 per year to get a megre Rs 3 lakh medical cover each. Even with medical insurance, they usually have to bear 20-30% of hospital bill out of their pockets, as insurance does not cover all expenses. This is after undergoing the hassles and harassment from the insurance companies to reimburse expenses on all kinds of pretexts.

Elders need love, care and affection. They do not need sympathy but the interrelation that depends on mutual care and respect.  There is a need to understand their views, cultural norms to avoid clash.  The balanced interdependence of communities and individuals is paramount

As a society, we have an obligation to ensure that the elderly receive the care they need and that their human dignity, right to self-determination and right to live according to their personal values are respected.

For all this to happen, government intervention is very much important along with high-level social organizations. Holistic approach to address the issue of social problems of elders is need of the hour.

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