Wednesday, November 8, 2017

WHO - World Health Organization 13th General Programme of Work - Need for Action

Spreading the call from action received from IFA - the International Federation on Aging:
The World Health Organization has just published its draft of the 13th General Programme of Work (GPW13) (see attached). 
 It is shocking to note that ‘ageing’ does not factor in the draft and unless there are strong voices from NGOs, academics and member states in the field stating that this is unacceptable any progress which has been made in the recent past will dwindle once again. 
 
It is strongly recommended that as many organisations / experts / interested people in this field write to register their strongest possible concern in a succinct way http://www.who.int/about/gpw-thirteen-consultation/en/.  IFA is reaching out far and wide and would appreciate efforts through your networks – we must stand together!
 
Detailed feedback is not what is needed but rather many leading voices noting that the total absence of work on ageing considering the incredible demographic shift is absolutely unacceptable and will impact current and future generations
Comments must be in by 15th November

 

Monday, October 23, 2017

MIPAA 3rd Review and Appraisal - Lisbon Ministerial Conference on Ageing - September 2017

MIPAA, the Madrid International Plan of Action on Aging of 2002, which was adopted by the 2nd World Assembly on Ageing, is still the leading policy document in the field of aging - on the global level.
Unlike VIPAA, the Vienna plan of action of 1982, MIPAA introduced a review and appraisal process in order to follow up its implementation evaluate its impact. The first review of MIPAA concluded in 2008, and the second review concluded in 2013.
In 2015 the third review started and it will be concluded in 2018.
During the month of September this year a Ministerial Conference on Ageing: A Sustainable Society for All Ages: Realizing the Potential of Living Longer - in Lisbon, Portugal.
This meeting was very constructive and with various documents submitted and produced, including NGOs forum and declarations.
Here is the link to the Ministerial Declaration
http://www.unece.org/fileadmin/DAM/pau/age/Ministerial_Conference_Lisbon/Documents/2017_Lisbon_Ministerial_Declaration.pdf
This is yet another development  - slow - but yet dynamic movement which eventually will mature to a new convention for human rights of older persons.....

Friday, October 6, 2017

IOPHRI - International Human Rights Index for Older Persons

Since the nineteenth century, the world’s population of older persons has increased dramatically. Older persons now comprise nearly twenty percent of the world’s population, and will likely comprise nearly thirty percent of it by 2040. Because of this increase, there has been a surge of interest in the development of Composite Indicators aimed at measuring the well-being of older persons. However, there has not yet been an effort to create an index that attempts to measure, compare, and evaluate the rights of older persons on a global-scale. In a recent Article, Professor Doron and Dr. Spanier justify the need for, and the process of developing, an index which looks at these rights. Their index is to be named the International Older Persons’ Human Rights Index, or “IOPHRI”, and it will be the first of its kind.
For the full text of the article and index and for a real life example of the operation of this index see the following link:
https://papers.ssrn.com/sol3/papers.cfm?abstract_id=2916577

Thursday, September 21, 2017

Do older women have the right to sex? The Case of Carvalho Pinto de Sousa Morais v. Portugal - ECoHR

Elder rights as such are not part of the European Convention on Human Rights. However, through different other articles of the European Convention for Human Rights, throughout the year, the European Court of Human Rights has addressed and promoted (but sometimes restrained) the development of human rights of older persons.
In a recent decision (25 July 2017), the ECoHR made an interesting decision, which touches upon both sexism and ageism as well.
The short facts of the facts were as follows:
The applicant was born in 1945. In December 1993 the applicant became a patient at the gynaecology department of the Alfredo da Costa Maternity Hospital. On 9 December 1993 the applicant was diagnosed with bartholinitis, a gynaecological disease. She started treatment, and On 21 May 1995 the applicant was admitted to the CHLC for a surgical procedure  and on 22 May 1995 the applicant had both glands, on the left and right sides of the vagina, removed. On an unknown date after being discharged, the applicant began to experience intense pain and a loss of sensation in the vagina. She also suffered from urinary incontinence, had difficulty sitting and walking, and could not have sexual relations. Later on, the applicant was informed after being examined at a private clinic that the left pudendal nerve had been injured during the operation.
On 26 April 2000 the applicant brought a civil action with the Lisbon Administrative Court against the CHLC under the State Liability Act seeking damages of approximately 325,050 euros (EUR), of which PTE 50,000,000 (EUR 249,399) was in respect of non-pecuniary damage owing to the physical disability caused by the operation.
As to the merits, the Lisbon Administrative Court found that the surgeon had acted recklessly by not fulfilling his objective duty of care, in breach of leges artis, and established that there was a causal link between his conduct and the injury to the applicant’s left pudendal nerve. The Lisbon Administrative Court also established that it was that injury which caused her, among other problems, the pain and loss of sensation in the vagina and urinary incontinence. As a consequence, she had difficulty walking, sitting and having sexual relations which, all together, made her feel diminished as a woman. Consequently, the applicant was also depressed, had suicidal thoughts and avoided contact with members of her family and friends. For those reasons the Lisbon Administrative Court considered that the applicant should be awarded EUR 80,000 compensation for non-pecuniary damage. As for pecuniary damage, the Lisbon Administrative Court granted EUR 92,000, of which EUR 16,000 was for the services of a maid the applicant had had to hire to help her with household tasks.
This decision was appealed, and for the purposes of this short summary, the following text of the Appeal court's decision as to reduce the damages:
"Additionally, it should not be forgotten that at the time of the operation the plaintiff was already 50 years old and had two children, that is, an age when sex is not as important as in younger years, its significance diminishing with age."
In light of this justification for the reduction of the damages - the application was made to the ECoHR. The relevant articles were Article 8 (re the right to private and family life); and Article 14 (re anti discrimination).
We will not get into all of the ECoHR discussion and considerations, but will focus on its references to the justification re the age of the applicant:

The Court acknowledges that in deciding claims related to non-pecuniary damage within the framework of liability proceedings, domestic courts may be called upon to consider the age of claimants, as in the instant case. The question at issue here is not considerations of age or sex as such, but rather the assumption that sexuality is not as important for a fifty-year-old woman and mother of two children as for someone of a younger age. That assumption reflects a traditional idea of female sexuality as being essentially linked to child-bearing purposes and thus ignores its physical and psychological relevance for the self-fulfillment of women as people. Apart from being, in a way, judgmental, it omitted to take into consideration other dimensions of women’s sexuality in the concrete case of the applicant. In other words, in the instant case the Supreme Administrative Court made a general assumption without attempting to look at its validity in the concrete case of the applicant herself, who was fifty at the time of the operation at issue.

In the Court’s view, the wording of the Supreme Administrative Court’s judgment when reducing the amount of compensation in respect of non-pecuniary damage cannot be regarded as an unfortunate turn of phrase, as asserted by the Government....

In the Court’s view, those considerations show the prejudices prevailing in the judiciary in Portugal , as pointed out in the report of 29 June 2015 by the UN Human Rights Council’s Special Rapporteur on the Independence of Judges and Lawyers .... They also confirm the observations and concerns expressed by the Permanent Observatory on Portuguese Justice regarding the prevailing sexism within judicial institutions in its report of November 2006 about domestic violence (see paragraph 29 above).

In light of these justifications and more, the ECoHR found that there has been a violation of Article 14 (taken in conjunction with Article 8).

However, this case is of much importance regarding how the different judges reflect not only about sexism (the discrimination of the applicant based her gender), but about ageism (to what extent age was a justifiable reasoning).

In general, it should be noted, that ageism is almost "non-existent" in the ECoHR reasoning. If it was not for the feminist ideology, it seems that the legal result would have been different. It is highly expressed in the minority opinion of judges Ravarani and Bosnjak, which base their dissent on the argument that age classification is justified for the purposes of damages, and hence, this justifies the outcome of this case as well.

It is disappointing to see how the ECoHR is still unaware to the concept of ageism and its socio-legal consequences, and it is a about time that this reality would change.

For more on this topic see for example the following articles:

 https://link.springer.com/article/10.1007/s10823-013-9212-7

https://papers.ssrn.com/sol3/papers.cfm?abstract_id=2827294












Thursday, September 7, 2017

Older persons, human rights and assistive and robotics technology

The inter-relations between technology, human rights and older persons is becoming more and more relevant and of importance. As the technological world recognizes the importance and relevance of the aging of societies, and as more and more technological developments are aimed at older persons - some ethical and social concerns are being raised as to the impact and challenges these developments produce.
I a recent report submitted by the UN Independent Expert on the Enjoyment  of Human Rights by Older Persons, Mrs. Rosa Kornfeld-Matte, the IE has addressed some of these issues.
As background ,the IE stresses how:
"....new technologies, including assistive devices, built-in environmental applications and robotics are gaining traction as cost-effective and efficient solutions to the increased need for individualized support for older persons. Such technology can perform simple, routine tasks, such as bringing meals and medications to patients, which will free up human staff who could dedicate themselves more to those elements or parts of care that require human interaction. As their development progresses, those robots begin taking on more and more medical or caregiving tasks and operate increasingly autonomously. For authority to shift from humans to algorithms, their performance only needs to exceed the average human performance."
The IE moves on to describe the legal and policy framework, and describes how:
"There is no specific reference to the right to assistive technology in the United Nations Principles for Older Persons, the International Covenant on Civil and Political Rights or the International Covenant on Economic, Social and Cultural Rights. In the absence of a dedicated instrument on older persons and while not applicable to all older persons, the provisions in the recently adopted Convention on the Rights of Persons with Disabilities offer some guidance as they recognize the importance of access to assistive technology."
Hence, she concludes that:
"It follows from the above that existing normative and policy frameworks have not explored the full potential of adequate and appropriate support that may allow older persons, in particular through assistive and robotics technology, to continue living in the place of their choice without restriction. There is no mention of the use of assistive technology in residential settings, and the few references that exist focus on medical technologies, failing to encompass the full range of devices that can assist older persons to fully participate in society on an equal basis with others."
In light of this background, the IE moves to discuss the ethical and legal implications of robotics and technology, and touches upon key aspects in this complicated field. For example, in the context of robotics v. human care, the IE states that:
Assistive technology cannot substitute for human care. The extent to which it is appropriate to rely on a machine instead of a human will, however vary, depending on the context, task and individual. Based on a human rights-based approach, support should be available as a means to expand opportunities and not as a method of maintenance. Assistive technology should enable human capabilities and enhance human dignity. This aim should be integrated from the conception to the application of assistive devices and robotics."
Undoubtedly, the dilemmas around technology, robotics and aging are going to be at the center of public debates in the coming year. Hence the IE report in this field is a timely and relevant document. See the full report:
http://ap.ohchr.org/documents/dpage_e.aspx?si=A/HRC/36/48







Monday, August 28, 2017

Should we legally regulate older physicians?

Around the world, countries are abolishing mandatory retirement laws. And rightfully so: mandating persons to stop working only because of their chronological age - regardless of their personal wishes or their individual abilities - is wrong.
On the other hand, some new challenges develop as an outcome of these legal changes. One of these challenges regards the aging of the medical profession. In specific, the medical profession in many countries has experienced a reality of the aging of its working force. For example, in the US, since 1975, the number of practicing physicians older than 65 years has increased by more than 374%. Taking into account the normal - and non ageist fact - that there is some statistical correlation between older age and some decline in cognitive and physical abilities - may raise the question how and to what extent should there be any way to address the risk of physician who may lose their professional abilities in older age without falling into negative stereotypes and ageism.
A recent article in JAMA Surgery, by Dellinger, Pellegrini, & Gallagher (2017) discuss this issue and provide some proposals to solutions.
See link to the full article below:
http://jamanetwork.com/journals/jamasurgery/article-abstract/2644000



Wednesday, August 16, 2017

Re-framing aging and ageism

One of the key challenges law faces is how to combat ageism.
Various legal instruments, such as anti-discrimination legislation attempt to tackle the issue by either making age discrimination illegal, or by legally empowering older persons through legal representation and rights advocacy.
However, sometimes, law itself uses an ageist approach. Some examples can be found in the field of elder guardianship or anti elder abuse and neglect legislation. Many times these legal policies adopt a negative and stereotypical approach towards older persons, portraying them as weak, incapable, or vulnerable. 
In an interesting move, a group of American organizations, including   ASA, AARP, Archstone Foundation, The Atlantic Philanthropies, the Endowment for Health, The John A. Hartford Foundation, the Fan Fox and Leslie R. Samuels Foundation, The Retirement Research Foundation, Rose Community Foundation, and The SCAN Foundation - have funded a project titled "ReFraming Aging".
One of the reports, written by the FrameWorks Institue, entitled "Finding the Frame: An Empirical Approach to Reframing Aging and Ageism" presents some very interesting insights regarding the way we as a society should "frame" our discourses around age and aging. The report emphasizes the importance of values, words, language, metaphors, as social vehicles which shape our social construction of old age.
We as lawyers, and legislatures, and as professionals who use law as an instrument for social change, are responsible for the usage of words and language in order to secure justice.
Hence, it seems that this report may be of much relevance to all elder law persons around the world. Here is a link to the report:LINK TO REPORT
http://frameworksinstitute.org/assets/files/aging_elder_abuse/aging_research_report_final_2017.pdf