End of Life Issues: Should Dying Be a Choice? Research Paper Example

Introduction

Improvements in the longevity of life expectancy have been expected to increase with time. In fact, the number of individuals over 65 years of age is expected to increase from 524 million in 2010 to an estimated 1.5 billion in the year 2050. The increase in life expectancy has been suggested as due to the change in the leading causes of death over the past century. For instance, the major causes of death in the beginning of the 20^th century were communicable diseases such as, parasitic and infectious diseases. Currently, the major causes of death and disease are non-communicable diseases such as heart disease, diabetes and stroke. In addition, the increase in non-communicable disease affecting adults and older individuals has been causing issues in regard to global health. Increases in non-communicable diseases have resulted in changes in diet, lifestyle and aging, further resulting in changes of economic and societal costs needed to help and maintain individuals living with these issues. (National Institute of Health, 2011) The current paper discusses the current situation for the elderly today in the United States, as well as the high economic costs incurred with growing old. In addition, the paper investigates the social issues that arise with the elderly, in regard to family issues and costs, and the debate on euthanasia as a choice to alleviate the burden bestowed on the individual and family.

Currently, adults in the United States are faced with a changing social trend that will affect them as they age. Economics are changing with the changing urbanization and technology. With the changing economy, more people are moving to larger cities, which results in a decrease in family available to help older family members as they age. In addition, the trend is showing that people are having fewer children, further decreasing the availability of care and increasing the ratio of older to younger people in the population. The problem that persists is maintaining health at an old age. For instance, dementia increases with age and it has been found that almost 30% of individuals aged 85 and older are diagnosed with dementia. The prevalence of dementia is expected to increase with the increasing aging population in the United States. Therefore, from this example alone, an economic change would occur. (National Institute of Health, 2011)

Literature Review

The increase in the population of elderly adults prompts different government policy challenges. The challenges presented are new to society since people over the age of 60 have different types of needs than younger generations. For instance, elderly for the most part do not work and try to save less; therefore, less capital is provided to the economies. In addition, the elderly usually need more health care and depend upon the government for their income and health care needs. Individuals aged 80 and up also have different needs than the younger generation, as well as individuals in the 60 year old group. There is an increase in health problems and for most, full-time care is necessary. Therefore, the need for finances increases and personal savings diminishes. These requirements put more need towards government funds and family help. (Bloom et al., 2011) Although it is predicted that the elderly will need more health care, other researchers suggest that the increase in life expectancies correlated with an increased income, further suggesting better health profiles. For instance, Kulish et al. (2006) indicates that people who are entering the age groups of 60 and 70, are healthier than the previous generations at that age and therefore, the health care needs will not increase. In addition, the researchers also indicate that these individuals are more likely to continue working and contribute to the economy for a longer period of time.

Other research has analyzed the increase in certain noncommunicable diseases, such as diabetes and dementia, which are used as indicators of the effect of aging on economic growth. Sanderson and Scherbov (2010) used two factors, employment and rise in obesity. The researchers found that in general most elderly individuals are not working and are retired. In addition, an increased rise in obesity amongst the elderly population was also found, resulting in decreased work productivity. Obesity in adults has been indicated to incur numerous financial burdens on individuals, employers and government agencies. For instance, employers are faced with a lower productivity at the jobs, increased time-off, and health care programs must over the medical portions and disabilities from obesity. (Dor et al., 2010)

Dementia rises in the United States have had a dramatic effect on the economy. The cost of dementia has been evaluated at a range of $157 billion to $215 billion per year. In addition, dementia has been referred to as the most costly disease in the United States, even in comparison to heart disease and cancer. In fact, over a ten year span from 2000 to 2010, the deaths caused by Alzheimer’s disease or dementia rose 68 percent; whereas, heart disease decreased 16 percent. (Alzheimer’s Association, 2013) The economic set-back for dementia is associated with the care that must be provided. Most individuals must be institutionalized and if not, they require long-term home care. Studies conducted by the National Institute of Aging have established that dementia diagnoses are increasing with age and through this study, it is predicted that the costs associated with dementia patients will double by the year 2040. (RAND Corporation, 2013) The impact of dementia on an economy can be severe. Studies have shown that people 65 years and older can survive on average around four to eight years after a diagnosis of dementia; however, some individuals have shown to survive up to 20 years. In addition, these patients are usually in a nursing home for the duration of the illness. (Alzheimer’s Association, 2013). The researchers in the study suggest that the federal government address the issue of the increasing cases of dementia in the United States in order to develop a plan of care for societal and economical purposes. (RAND Corporation, 2013)

Some questions that are being brought up in regard to elderly and the economic impact are the notion of the quality of life. The quality of life can be referred to as an individual’s emotional, physical and social well-being, as well as their ability to function on a daily basis. The stigma that is attached with dementia is that there is no quality of life for individuals diagnosed with dementia and individuals with dementia live without awareness. However, others argue that patients diagnosed with Alzheimer’s can continue to lead meaningful lives with the help of caregivers. (Alzheimer’s Association, 2013) Research has been underway in order to provide indicators that measure the direct impact on patients and their families. Caregivers for patients diagnosed with Alzheimer’s or dementia are usually the immediate family members, but sometimes other close relatives or friends. It has been estimated that during 2012, caregivers have provided 17.5 billion hours of unpaid care to patients with dementia. This value totaled over $216 billion dollars if costs were incurred on the government. Although, family caregivers have alleviated medical costs, the impact to family members is substantial. Individuals with dementia disease usually begin to deteriorate in regard to judgment and orientation and even the ability to understand language and communicate properly. The caregivers are the ones who help manage these symptoms. This can become challenging and stressful of the caregiver resulting in an increased amount of supervision, further resulting in emotional stress, decreased immune system, health problems, and employment problems and salary loss. (Alzheimer’s Association, 2013)

Family caregivers for elderly diagnosed with Alzheimer’s find themselves in situations that lead to placing their loved one in a nursing home. Some of the daily stress of taking care of the individual leaves; however, the caregiver can undergo stress from guilt and adapting to the change. In addition, for family members who do not place their loved one in a home, during the end-of-life care, the family caregivers have reported extreme stress involved with care and have even reported feelings of relief when the person passed. (Alzheimer’s Association, 2013) Furthermore, the effects of becoming the caregiver are mostly negative with increased social isolation and finance problems. On average, caregivers have reported a decrease in their pay from having to miss work or quit jobs in order to care for their family member. In addition, the caregivers reported that financial support was insufficient. Furthermore, family members indicate that a big portion of their income is spent on health care for their family member. (National Institute of Health, 2007)

Most caregivers to elderly with disease such as dementia are nurse aides or home care aids. In nursing homes, nurse’s aids comprise most of the staff who works with such patients. Due to the increase in the amount of elderly advancing in age and entering nursing homes, there is a projection an a huge increase in need of additional health care staff for nursing homes. It is foreseen to need an increase of 3.5 billion staff members by the year 2030 in order to maintain a ratio of health care staff and elderly. This need for additional staff in the fore-coming years is seen as a problem since fewer individuals are pursuing this career path. Currently the amount of geriatricians is estimated at half of the current need. (Alzheimer’s Association, 2013)

Other countries have developed alternatives to dealing with the end-of life situations present in the elderly population. Countries have developed such things known as directives for euthanasia, where individuals can indicate their preference for future care in the case they become incompetent and do not want to burden their families emotionally, physically, and financially. Practices of Euthanasia date back to 1870 and have varied from assisted suicide to physician-assisted suicide. The rationale for euthanasia is that it is a painless death of a patient who is suffering from a painful disease or illness which is incurable. (Televantos et al., 2013) Some countries have set procedure known as advanced directives. For instance, in the Netherlands, euthanasia and assisted suicide are against the law unless a physician follows the defined care requirements. There are specific requirements which are laid out in which the physician must follow such as, the physician must be convinced that the patient has made voluntary and well thought out request for euthanasia, the physician is convinced that the patient’s suffering is unbearable with no chance of improvement, the physician has informed the patient about their situation, the physician has come to a final conclusion that there is no other alternative, the physician has consulted another physician and the physician has terminated the patient’s life with proper care. (Marike et al., 2009)

Although these measures have been implemented in other countries, does it actually work and is it effective for families, society, and the economy? Research in the Netherlands has shown that only 15 of the 110 people studied with dementia spoke about the directive for euthanasia and their wishes for undergoing euthanasia. In addition, physicians noted that most of the people were not capable of making such a decision due to their diminishing coherence. In addition, the relatives of the individuals were also studied. Only 16 of the relatives out of the 110 cases wanted to use the directive for euthanasia. Furthermore, around the same amount did not want the physician to undergo the patient wishes for euthanasia. (Marike et al., 2009)

Overall, research has shown that there are major debates on Euthanasia and its actual effect on helping the individual, family or society. Some may view euthanasia as by no means a way to increase economic status, but more of a compassionate form of relief from severe suffering. Therefore, individuals who support euthanasia insist that the current laws against it force patients to continue to suffer and deny the patients request to end their life in dignity. Some believe that patients have a right to choose the way in which they would like to die, rather than die in a hospital connected to tubes and unaware of what is happening. In addition, some patients want to not only relieve their pain, but the pain that their close family members undergo throughout their illness. On the other hand, other responses to euthanasia argue that there is sufficient care to provide comfort to patients who are undergoing pain and suffering. (Cartwright, 2011)

A main point in the debate of Euthanasia is a result of United States being a democracy. The United States is built on freedom and if assisting terminally ill older patients to die, it should be their choice. As in the Netherlands, there are sets of standards and procedures that the physicians must follow; however, the patient has the choice to decide how he/she wants to end their life if in a position where they are incapable of a good quality of life or are undergoing immense pain and suffering.

Conclusion

The variations in diseases and status of the elderly can vary; however, dementia is a problem in which the United States and other countries will have to deal with as the longevity of life increases with time. Estimations have suggested that 115 million people will be living with and suffering from some form of dementia by 2050. Projected health care costs for caring for dementia was over $600 billion in 2010 alone. Since family members play an integral part in the caregiving, this can turn into a stressful situation for the family as well. Debates on medical care and keeping patients alive with disease, such as dementia is highly debated. For the most part, moral issues arise and the family members are the ones left with the final decisions. Euthanasia would be a choice and therefore, how many individuals and families would choose this route? Previous research in the Netherlands has shown that a small percentage of individuals actually would consider this option. Therefore, how effective would this strategy be in helping the individual cope, the family cope, and society cope with longevity of life issues? Having a choice is the democratic way; however, this issue should be separate from the economic standpoint of aging and society. (National Institute of Health, 2011)

With the increasing population of elderly and the effects of this population burst on economic growth, the problem should not focused on longevity of life issues, but on government policies. The problem with an increased aging population is the lack of policies within the government. New policies should be developed in order to help families and individuals who are faced with financial struggles due to disease or illness in their retirement ages.

References

Alzheimer’s Association. (2013). Alzheimer’s Disease Facts and Figures, Alzheimer’s & Dementia, Volume 9, Issue 2. Retrieved from: Alzheimer’s Society. (2009). Counting the cost. Caring for people with dementia on hospital wards.

Bloom D., Canning, D., Fink, G. (2011). Implications of Population Aging for Economic Growth. PGDA Wordking Paper No. 64. Harvard University. Retrieved from: http://diseaseriskindex.harvard.edu/pgda/WorkingPapers/2011/PGDA_WP_64.pdf

Cartwright, C. (2011). Planning for the End of Life for People with Dementia. Living with Dementia. A Report for Alzheimer’s Australia.

Dor, A., C. Ferguson, C. Langwith, and E. Tan (2010). A Heavy Burden: The Individual Costs of Being Overweight and Obese in the United States”. Research Report. George Washington University.

http://www.gwumc.edu/sphhs/departments/healthpolicy/pdf/HeavyBurdenReport.pdf

Kulish, M., Smith, K., Kent, C. (2006). Ageing, Retirement and Savings: A General Equilibrium Analysis. The New York Times. Reserve Bank of Australia Research Discussion Paper (2006-06).

Marike E. de Boer, Rose-Marie Dröes, Cees Jonker, Jan A. Eefsting, and Cees M. P. M. Hertogh. (2011) Advance directives for euthanasia in dementia: how are they dealt with in Dutch nursing homes? Experiences of physicians and relatives. Journal of the American Geriatrics Society, 59(6): 989-96.

Nation Institute of Health. (2011). Global Health and Aging. National Institute of Aging. World Health Organization. NIH Publication no. 11-7737. 26pgs. Retrieved: http://www.who.int/ageing/publications/global_health.pdf

RAND Corporation. (2013). Cost of Dementia Tops $157 Billion Annually in the United States. Retrieved from: http://www.rand.org/news/press/2013/04/03.html

Sanderson, W.C., and S. Scherbov (2010). “Remeasuring Aging.” Science. 239: 1287-1288.

Televantos et al. (2013). Attitudes towards euthanasia in severely ill and dementia patients and cremation in Cyprus: a population-based survey. BMC Public Health 2013, 13:878 http://www.biomedcentral.com/1471-2458/13/878.