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LEGAL AND ETHICAL LEGAL AND ETHICAL PROTECTION OF AGING PROTECTION OF AGING PERSONS PERSONS Cordelia Thomas Cordelia Thomas Senior Legal Adviser Senior Legal Adviser New Zealand Bioethics New Zealand Bioethics Council Council [email protected] [email protected] .nz .nz

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LEGAL AND ETHICAL PROTECTION OF AGING PERSONS Cordelia Thomas Senior Legal Adviser New Zealand Bioethics Council [email protected]. INTRODUCTION. Number of people aged 65 years and over has doubled over the last 50 years - expected to double again in next 50 years. - PowerPoint PPT Presentation

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Page 1: INTRODUCTION

LEGAL AND ETHICAL LEGAL AND ETHICAL PROTECTION OF AGING PROTECTION OF AGING

PERSONSPERSONSCordelia ThomasCordelia Thomas

Senior Legal AdviserSenior Legal AdviserNew Zealand Bioethics CouncilNew Zealand Bioethics [email protected]@mfe.govt.nz

Page 2: INTRODUCTION

INTRODUCTION INTRODUCTION

• Number of people aged 65 years and over has doubled over the last 50 years - expected to double again in next 50 years.

• By 2051 22 % of older people projected to be aged over 85

• Changing social trends have led to drastic changes in the lives of older people

• The aging of the “baby boom” generation -greater demand for long-term care services.

• Movement to encourage home care in preference to hospitalisation and residential care.

Page 3: INTRODUCTION

• Medical technology extending length of life - little indication of ability to lift burdens of life in old age.

• growing level of very aged persons with high prevalence of chronic impairment and dementia

• Future -substantial increase in number of elderly people needing social and legal support to– take care of themselves,– remain independent and – avoid abuse, neglect and economic hardship.

Page 4: INTRODUCTION

• Need for substitute decision making will increase • Choices between institutional and home care -

proving ground for public policy, social consensus and personal ethical issues.

• This paper will consider the limitations of enduring powers of attorney

• Provisions of the Protection of Personal and Property Rights Act 1988 (PPRA)

• Law Commission Report • Protection of Personal and Property Rights Bill

Page 5: INTRODUCTION

HOME CARE VERSUS HOME CARE VERSUS INSTITUTIONALISED CAREINSTITUTIONALISED CARE

• Institutional care – services readily available when needed– reduces the risk of accidents through

protective supervision– high cost – loss of privacy and individuality. – Loss of physical and mental capability

Page 6: INTRODUCTION

• Home care– greater self reliance, – lesser costs – positive physical and emotional effects of

remaining in own home. – But.. greater risk of accidents and having

needs unmet.

Page 7: INTRODUCTION

COMPETENCECOMPETENCE

• Every adult person presumed “competent”.• No special test • Elderly persons generally presumed capable to

make decisions and have the same rights and legal status as any other competent person in society

• Loss of competence may be gradual and partial • Proxy decision maker to make decisions on

behalf of consumer - Protection of Personal and Property Rights Act 1988 (PPPR Act).

Page 8: INTRODUCTION

PROTECTION OF PERSONAL PROTECTION OF PERSONAL AND PROPERTY RIGHTS ACT AND PROPERTY RIGHTS ACT

19881988• Used to protect adults unable to make or

communicate their decisions.• Court may appoint a welfare guardian or• Person may appoint an attorney- appointment

endures beyond the onset of mental incapacity • At the time of signing- donor must have legal

“capacity” or “competence”.• PPPR Bill new section 94A - witness must certify

no reason to suspect donor mentally incapable when s/he signed

Page 9: INTRODUCTION

CONCERNS ABOUT THE PPPR CONCERNS ABOUT THE PPPR ACTACT

• Age Concern identified problems as:– Financial impropriety– Failure to provide appropriate careLaw Commission’s concerns:– Donors’ level of capacity when enduring powers of

attorney signed and come into force– Lack of independent legal advice – Lack of requirement for attorneys to file accounts – Lack of independent monitoring– Powers of the Family Court dependent on someone

taking action on behalf of incompetent donor– Donors reluctant to take action against family

members

Page 10: INTRODUCTION

PPPR BILL PPPR BILL

Creation • witness of the donor's signature must be

independent of the attorney and must either be a lawyer, or an officer or employee of a trustee corporation

• before donor signs, witness must explain effects and implications of enduring power attorney

• No medical examination required• No registration requirement

Page 11: INTRODUCTION

When Power Comes Into EffectWhen Power Comes Into Effect

• Mental illness and incompetence -different concepts • Attorney may not act unless donor mentally incapable • PPPR Bill provides donor is mentally incapable with regard

to– property if not wholly competent to manage own

property. – personal care and welfare if lacks capacity:

– to make a decision; or – to understand the nature of decisions; or – to foresee the consequences of making or not

making decisions or– wholly lacks the capacity to communicate decisions

Page 12: INTRODUCTION

• If decision about personal care and welfare – significant matter donor must be certified as

mentally incapable by health practitioner. – not significant matter- attorney may act if satisfied

donor is mentally incapable – PPPR Bill new s93B every person presumed able to

understand and communicate decisions until contrary shown

– attorney must promote and protect donor's best interests while seeking at all times to encourage donor to develop competence

Page 13: INTRODUCTION

• Attorney must:– encourage the donor to act independently– facilitate donor's integration into community– consider financial implications when deciding

any matter relating to the donor's personal care and welfare.

Page 14: INTRODUCTION

FAMILY DYNAMICS AND FAMILY DYNAMICS AND DECISION MAKINGDECISION MAKING

• Some impaired people able to make decisions for themselves with support of family members.

• Balance between self determination and paternalistic decision making complex if the older person has fluctuating capacity

• Fine line between protection and control or exploitation.

• In practice medical professionals seek consent and advice from family members

• Older person may feel unable to resist if professionals join with family to convincing them of merits of institutionalisation

• Erosion of autonomy may be incremental not sudden

Page 15: INTRODUCTION

SHARED DECISION MAKINGSHARED DECISION MAKING

• However…sharing decision making may strengthen relationships

• Some older persons have reduced wish for control over and information about decisions

• Sharing may delay the point at which an attorney or welfare guardian assumes full responsibility

• May assist communication between older person and clinicians

Page 16: INTRODUCTION

RISKRISK

• Family may exercise a high degree of control with intention to protect older person from perceived risks

• Some older people willingly accept high level of risk

• Re RMS [PPPR] (1993) 10 FRNZ 387

Page 17: INTRODUCTION

PROTECTION OF THE DONOR’S PROTECTION OF THE DONOR’S AUTONOMYAUTONOMY

• Difficult to protect autonomy of all elderly persons

• Elderly may value other concepts, such as collective rights, family caring and interactions with society more highly than individual autonomy.

• Rather than amending legislation, what may be needed are protective social services.

• Government policies to avoid institutional care, together with a familial wish to preserve property of the older person may result in increased neglect and abuse

Page 18: INTRODUCTION

CONCLUSIONSCONCLUSIONS

• Major difficulties in regulating the gradual and varying onset of reduced capacity

• Better promoted by way of public education programmes than by legislation

• Legislation will not prevent avaricious and/or uncaring conduct towards vulnerable elderly


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