Supported Decision-Making Service

Supported Decision-Making Service for Persons with Disabilities | Service Model

The Human Rights Center for People with Disabilitis

C. Suitability of Bizchut model to senior citizens

In this part of the document, having presented the current legal situation with respect to

guardianship for senior citizens under Israeli law; criticism of it; and the current situation as

it applies to support in decision-making as an alternative to guardianship for senior citizens, I

shall now examine the model, as presented in Bizchut's 'Supported Decision-Making Service for

Persons with Disabilities Service Model' document, from the specific perspective of the extent to

which it accommodates – in my humble opinion – the population of senior citizens.

Preface, background and vision

First, it should be remembered and emphasized that the most adults currently under guardianship

are senior citizens. Therefore, and without detracting from the role and importance of the

institution of guardianship as far as the rights of persons with disabilities are concerned, any

change or reform in the institution of guardianship in Israel will mainly affect the population of

senior citizens.

Second, senior citizens are not "persons with disabilities" as such. Aging is a natural biological

process, and does not necessarily involve disability. Most human beings age, reach old age and

even very old age without disability, or with impaired functioning that does not interfere with or

deprive them of the ability to continue to conduct an independent and autonomous life.

Third, without detracting from the above said, there is a clear correlation and connection between

increasing chronological age (mostly in advanced ages in the eighth decade and beyond) and an

increase in disability rates – both physical and cognitive. Accordingly, for instance, data points

to a significant growth in the rate of senior citizens suffering from dementia (mostly Alzheimer's

dementia) in advanced ages. Therefore, a connection exists between advanced chronological age

and an increasing disability rate in these age groups.

Fourth, unlike the population of persons with disabilities, senior citizens are exposed to and

suffer from the phenomena of ageism. This phenomenon, although it shares characteristics that

are likened to other similar phenomena such racism, sexism or ableism, is unique and pertains

to the social structuring of old age. In general, the elderly are stereotypically labeled as senile,

helpless and incapable of caring for themselves only due to their chronological age, regardless

of their individual abilities. At the same time, and similar to the experience of the population of

persons with disabilities, ageism very easily facilitates and justifies the violation and interference

in the life and liberty of the elderly, justified by the need to "protect" them. It also exposes them

to discrimination and exclusion based on ageist prejudice and stereotypes manifested partly in the

manner and form in which the guardianship institution is applied to them.

Fifth, senior citizens who have dementia suffer from what may be referred to as "Alzheimerism", a

social structuring and a specific stigma pertaining to what was referred to in the past as "senility",

and what is currently regarded as "living death". This specific stigma consists of a quasi "medical/

scientific" aspect which goes beyond the above described "ageism", and facilitates not only social

disregard for the violation involved in guardianship, but also, a sort of "surrender" or "resignation"

with respect to using alternatives such as "supported decision-making" since "either way" they

will eventually lose all ability and capacity of any kind.

Sixth, the cognitive abilities of many senior citizens, unlike (generally speaking) other populations

in the realm of persons with disabilities – and particularly in states of chronic and progressive