Aging is a public health priority that is becoming increasingly important in both developed and less developed nations, with individual health care providers and law-makers each facing difficult ethical and policy dilemmas. The complex issues physicians deal with include informed consent and patient decision-making capacity, use of advance care planning and decision-making by family and medical staff, and withdrawing and withholding life-sustaining interventions. Broader questions include: has aging been over medicalized? Is it ethical for older patients to receive less medical care than younger ones, through unspoken practice or formal rationing? Is there inevitable conflict between the generations over scarce medical resources? How should physician, patient and family confront end-of-life decisions? How have different nations responded to increasing numbers of the elderly? Have social values changed as to family responsibility and individual autonomy?

This volume brings together the most significant published essays in the field.

Contents: Introduction. Part I Healthcare in an Aging Society: The Demographic Context: Making aging a public health priority, Robert Kane; Health care implications of an aging population, Michael Micklin; Healthcare policy in the later 20th century, Carroll Estes. Medical and Cultural Models: Aging and the limiting conditions of the body, Chris Gilleard and Paul Higgs; The medicalization of aging and disability, Irving Kenneth Zola. Ethical Choices for an Aging Society: 4 scenarios for an aging society, Harry R. Moody; Introduction: the frame of nature, gerontology and law, Martin Lyon Levine. Part II Decision-Making for the Older Patient: Ethical issues in geriatrics: a guide for clinicians, Paul S. Mueller, C. Christopher Hook and Kevin C. Fleming. Consent and Full Disclosure: Some limits of informed consent, O. O'Neill; Consent to medical treatment: the complex interplay of patients, families and physicians, Ruiping Fan and Julia Tao. Competence: Mental incapacity: some proposals for legislative reform, J.V. McHale; Pacing extremely old patients: who decides – the doctor, the patient or the relatives?, G.M. Sayers and H.W.L. Bethell. Deciding for the Incompetent: Japan's new safety net: reform of statutory guardianships and the creation of voluntary guardianships, Makoto Arai; Key issues in the ethics of dementia care, Stephen G. Post; Quality of life and non-treatment decisions for incompetent patients: a critique of the orthodox approach, Rebecca S. Dresser and John A. Robertson. Decision-Making at the End of Life: A combined ethics and psychiatric consultation, Cavin P. Leeman, Joel Blum and Marguerite S. Lederberg; Ethical issues at the end of life, Ernlé W.D. Young; Futility judgments and therapeutic conversation, Terrence J. Ackerman; Ethical issues in end-of-life geriatric care: the approach of 3 monotheistic religions – Judaism, Catholicism and Islam, A. Mark Clarfield, Michael Gordon, Hazel Markwell and Shabbir M.H. Alibhai; End-of-life decision making: practical and ethical issues for health professionals, Colleen Cartwright; Stewardship of the aged: meeting the ethical challenge of ageism, David C. Thomasma. Advance Directives: Adherence to advance directives in critical care decision making: vignette study, Trevor Thompson, Rosaline Barbour and Lisa Schwartz; Breaking down the barriers to a good death, Jane Feinmann. Palliative Care: Palliative care nursing; ensuring competent care at the end of life, Marianne L. Matzo and Deborah Witt Sherman. Deliberate Death: Euthanasia: killing and letting die, Martin Levine; Legalizing physician-aided death, Alexander M. Capron; Assessing the arguments for and against euthanasia and assisted suicide: part 2, David C. Thomasma; Voluntary active euthanasia, AGS Public Policy Committee; Voluntary active euthanasia and physician-assisted suicide in Dutch nursing homes: are the requirements for prudent practice properly met?, M.T. Muller, G.van der Wal, J.Th.M. van Eijk and M.W. Ribbe; New information on 'death with dignity', Constance E. Putnam. Part III Are the Needs of the Elderly Met?: Clinical Outcomes: Age-related differences in care preferences, treatment decisions and clinical outcomes of seriously ill hospitalized adults; lessons from SUPPORT, Mary Beth Hamel, Joanne Lynn, Joan M. Teno, Kenneth E. Covinsky, Albert W. Wu, Anthony Galanos, Norman A. Desbiens and Russell S. Phillips. Health System: Caregiving needs for 2020: implications for Hong Kong and other newly industrialized countries, Marie E. Cowart and William J. Serow; Ethics and health care reform: outlook for older Americans, Marie Raber and Michelle Hawkins; The health and social system for the aged in Japan, Shinya Matsuda. Long Term Care: International long-term care reform: a demographic, economic and policy overview, Pamela Doty; Caring for the frail elderly: an international review, Mark Merlis; Long-term care policy for older Americans: building a continuum of care, Howard A. Palley. Part IV Distributive Justice: Issues of Ethnicity: Cross-cultural geriatric ethics: negotiating our differences, Harry R. Moody; Race and the intensive care unit: disparities and preferences for end-of-life care, Howard B. Degenholtz, Stephen B. Thomas and Michael J. Miller. Family Responsibility: Care of the elderly – whose responsibility?, Nelson Chow; Care and inheritance: Japanese and English perspectives on the 'generational contract', Misa Izuhara. Setting Limits: Setting limits: a response, Daniel Callahan; Medical implications of setting limits: using age as a criterion, Ellen Olson. Age Discrimination: The ethical challenge of providing healthcare for the elderly, David C. Thomasma; (How) is aging a health policy problem?, Joseph White; Ageism in the NHS and the Human Rights Act 1998: an ethical and legal enquiry, Gwen M. Sayers and Tim Nesbitt. Age-Based Rationing: Rationing fairly: programmatic considerations, Norman Daniels; Priority setting: a sensible approach to Medicaid policy?, Thomas W. Grannemann; Age-based rationing in the allocation of health care, Ian Dey and Neil Fraser; Medicare: an appropriate age-related program?, Marilyn Moon; 'Should the grandparents die?' Allocation of medical resources with an aging population, Margaret A. Somerville; Ethical issues in geriatric medicine: a unique problematic?, Eike-Henner W. Kluge; Index.

About the Editor: Martin Lyon Levine, J.D., LL.D., holds the UPS Foundation Chair in Law and Gerontology, and is Professor of Psychiatry and the Behavioral Sciences at the University of Southern California, USA, where he is University Vice Provost for Faculty Affairs. Both an attorney and a psychoanalyst, he was President of the National Senior Citizens Law Center, USA, and was Chair of the Ageing and Law section of the Association of American Law Schools.

Extracts from this title are available to view:

Full contents list

Acknowledgements

Index