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The Ethics of Decision Making for the Critically Ill Elderly

Published online by Cambridge University Press:  29 July 2009

Madelyn Anne Iris
Madelyn Anne Iris
Affiliation:
An anthropologist at the Buehler Center on Aging, McGaw Medical Center, and Adjunct Assistant Professor in the Department of Anthropology, Northwestern University, as well as Assistant Professor of Medicine at Northwestern University Medical School, Chicago, Illinois
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Extract

The ethics of decision making for the critically ill elderly is an area of concern for all those involved in the decision-making process. The number of participants involved in decision making around end-of-life issues may be many: treatment and care decisions often bring together not only the patient and the physician, but the family, an extended medical care team, and impartial members of a hospital or institutional ethics committee. In addition, treatment and care decisions made at the end of life occur in a variety of settings, not just the acute care hospital. Elderly patients who are critically ill, or in the final days or weeks of life, are found in intensive care or medical units of hospitals, in hospital and nursing home based hospice programs, in long-term care settings such as skilled nursing facilities, or at home, where they are tended by family caregivers. Differences in patterns of decision making regarding the care and treatment of critically ill older adults can be found across these settings, and decisions often vary according to the roles of the participants.

Type
Special Section: Elder Ethics
Information
Cambridge Quarterly of Healthcare Ethics , Volume 4 , Issue 2 , Spring 1995 , pp. 135 - 141
Copyright
Copyright © Cambridge University Press 1995

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References

Notes

1. An earlier version of this paper was presented at the annual meetings of the American Anthropological Association, December, 1990.

2. Cruzan v. Director, Missouri Department of Health, 497 U.S. 111, 110 Supreme Court 2841. 1990.

3. Omnibus Budget Reconciliation Act of 1990, Public Law No. 101 508 §§4206, 4751, 1990.

4. Callahan, D. Setting Limits: Medical Goals in an Aging Society. New York: Simon and Schuster, 1987.Google Scholar

5. Siegel, JS, Taeuber, CM. Demographic dimensions of an aging population. In: Pifer, A, Bronte, L, Eds. Our Aging Society: Paradox and Promise. New York: W.W. Norton, 1986:79–110.Google Scholar

6. Davis, K. Paying the health care bills of an aging population. In: Pifer, A, Bronte, L, Eds. Our Aging Society: Paradox and Promise. New York: W.W. Norton, 1986:399–418.Google Scholar

7. Quill, TE. Utilization of nasogastric feeding tubes in a group of chronically ill elderly patients in a community hospital. Archives of Internal Medicine 1989;149:1937–41.CrossRefGoogle Scholar

8. Lakshmipathi, C, Pinsky, MR, Donahoe, MP, Grenvik, A. Long-term outcome of critically ill elderly patients requiring intensive care. journal of the American Medical Association 1993;269(24):3119–23.Google Scholar

9. Ebell, MH, Smith, MA, Seifert, KG, Poisinelli, K. The do-not-resuscitate order: Outpatient experience and decision-making preferences. The Journal of Family Practice 1990:31(6):630–4.Google ScholarPubMed

10. Barondess, JA, Kalb, P, Weil, WB, Cassel, C, Ginzberg, E. Clinical decision-making in catastrophic situations: The relevance of age. Report of a conference convened by the American Geriatrics Society, April 17–18, 1987. Journal of the American Geriatrics Society 1988;36:919–37.CrossRefGoogle ScholarPubMed

11. Wanzer, SH, Federman, DD, Adelstein, SJ, et al. The physician's responsibility toward hopelessly ill patients. The New England Journal of Medicine 1989;320(13):844–9.CrossRefGoogle ScholarPubMed

12. Waymack, M. Old age and the rationing of scarce health care resources. In: Jecker, N, Ed. Aging and Ethics. Clifton, NJ: Humana Press, 1991.Google Scholar

13. Iris, MA, Berman, RLH. Qualitative study of aging in Chicago. Final Report to the Chicago Community Trust. 1995.Google Scholar

14. Kayser-Jones, J, Kapp, MB. Advocacy for the mentally impaired elderly: A case study analysis. American Journal of Law and Medicine 1989; 14(4):353–76.Google ScholarPubMed

15. Gubrium, JF, Wallace, JB. Who theorizes age? Aging and Society 1990;10:131–49.CrossRefGoogle Scholar

16. Sankar, A. The living dead: Cultural constructions of the oldest old. In: Silverman, P, Ed. The Elderly As Modern Pioneers. Bloomington, IN: Indiana University Press, 1987:345–56.Google Scholar

17. Kaufman, S. Frailty, risk and choice: Cultural discourse and the question of responsibility. In: Smyer, M, Schaie, W, Eds. Decision-making Capacity: Behavioral, Legal and Ethical Perspectives. New York: Springer, 1994.Google Scholar

18. Iris, M. Guardianship and the elderly: A multi-perspective view of the decisionmaking process. The Gerontologist 28 (Suppl)1988:39–45.CrossRefGoogle ScholarPubMed

19. Savashinsky, J. The Ends of Time: Life and Work in a Nursing Home. New York: Bergin and Garvey, 1991.Google Scholar