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Ethical Management of the Elderly Patient

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Geriatric Anesthesiology

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Abstract

Because of the increasing growth of the elderly population, geriatric care is rapidly emerging as a unique medical specialty in its own right. Advancements in medical science and changes in the health care delivery system that impact the care of the elderly are accompanied by myriad ethical dilemmas that confront not only the physician and patient, but social workers, nursing home staff, and relatives. Settings involving the extremes of age and illness are the most complex in ethical deliberation. Although anesthesiologists may confront a variety of ethical issues, such as patient confidentiality, care of Jehovah’s Witnesses, substance abuse, and so forth, this chapter will focus on those issues unique to and more likely to be encountered in the elderly patient.

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References

  1. Gadow S. Medicine, ethics, and the elderly. Gerontologist 1980;20(6):680–685.

    PubMed  CAS  Google Scholar 

  2. Leach E. Society’s expectations of health. J Med Ethics 1977;1(85):89.

    Google Scholar 

  3. Jung PB. Differences among the elderly: who is on the road to Bremen? In: Hauerwas S, Stoneking CB, Meador KG, Cloutier D, eds. Growing Old in Christ. Grand Rapids: William B. Eerdmans; 2003:115.

    Google Scholar 

  4. US Department of Health and Human Services. Vital and Health Statistics: Current Estimates from the National Health Survey, 1990, Series 10: Data from the National Health Survey, No. 181. Hyattsville, MD: DHHS, Publication No. [PHS] 92-1509; 1991.

    Google Scholar 

  5. Shelley M. Frankenstein: Or, The Modern Prometheus. London: Penguin Books; 1994.

    Google Scholar 

  6. Rieff P. The Triumph of the Therapeutic: Uses of Faith after Freud. New York: Harper & Row; 1966.

    Google Scholar 

  7. Mayer PJ. Biological theories about aging. In: Silverman P, ed. The Elderly as Modern Pioneers. Bloomington, IN: Indiana University Press; 1987:21.

    Google Scholar 

  8. Spielman BJ. On developing a geriatric ethic: personhood in the thought of Stanley Hauerwas. J Relig Aging 1989; 5(1/2):23–33.

    Google Scholar 

  9. Hauerwas S. A Community of Character: Toward a Constructive Christian Social Ethic. Notre Dame: University of Notre Dame Press; 1981.

    Google Scholar 

  10. Hauerwas S, Bondi R, Burrell DB. Truthfulness and Tragedy. Notre Dame: University of Notre Dame Press; 1977.

    Google Scholar 

  11. Silverstone B. Preface. In: Haug MR, ed. Elderly Patients and Their Doctors. New York: Springer; 1981:xii.

    Google Scholar 

  12. Childress JF. The place of autonomy in bioethics. Hastings Cent Rep 1990;20:12–17.

    PubMed  CAS  Google Scholar 

  13. Meisel A, Kuczewski M. Legal and ethical myths about informed consent. Arch Intern Med 1996;156:2521–2526.

    Article  PubMed  CAS  Google Scholar 

  14. Beauchamp TL, Childress JF. Principles of Biomedical Ethics. Oxford: Oxford University Press; 1994.

    Google Scholar 

  15. US Congress Office of Technology Assessment. Losing a Million Minds: Confronting the Tragedy of Alzheimer’s Disease and Other Dementias. Washington, DC: US Government Printing Office; 1987.

    Google Scholar 

  16. Marson DC, McInturff B, Hawkins L, Bartolucci A, Harrell LE. Consistency of physician judgments of capacity to consent in mild Alzheimer’s disease. J Am Geriatr Soc 1998;45(4):453–457.

    Google Scholar 

  17. Buchanan AE, Brock DW. Deciding for Others: The Ethics of Surrogate Decision Making. Cambridge: Cambridge University Press; 1989.

    Google Scholar 

  18. President’s Commission for the Study of Ethical Problems in Medicine and Biomedical Research. Deciding to Forgo Life-Sustaining Treatment. Washington, DC: US Government Printing Office; 1982.

    Google Scholar 

  19. President’s Commission for the Study of Ethical Problems in Medicine and Biomedical Research. Making Health Care Decisions, Volume One: Report. Washington, DC: US Government Printing Office; 1992.

    Google Scholar 

  20. Appelbaum PS, Grisso T. Assessing patients’ capacities to consent to treatment. N Engl J Med 1988;319(25): 1635–1638.

    PubMed  CAS  Google Scholar 

  21. Fellows LK. Competency and consent in dementia. J Am Geriatr Soc 1998;46(7):922–926.

    PubMed  CAS  Google Scholar 

  22. Fitten LJ, Lusky R, Hamann C. Assessing treatment decision-making capacity in elderly nursing home residents. J Am Geriatr Soc 1990;38(10):1097–1104.

    PubMed  CAS  Google Scholar 

  23. Grisso T, Appelbaum PS, Hill-Fotouhi C. The MacCAT-T: a clinical tool to assess patients’ capacities to make treatment decisions. Psychiatr Serv 1997;48(11):1415–1419.

    PubMed  CAS  Google Scholar 

  24. Ratzan RM. Informed consent in clinical geriatrics. J Am Geriatr Soc 1984;32(3):176.

    Google Scholar 

  25. Sugarman J, McCrory DC, Hubal RC. Getting meaningful informed consent from older adults: a structured literature review of empirical research. J Am Geriatr Soc 1998;46(4): 517–524.

    PubMed  CAS  Google Scholar 

  26. Dror IE, Katona M, Mungur K. Age differences in decision making: to take a risk or not? Gerontology 1998;44(2): 67–71.

    Article  PubMed  CAS  Google Scholar 

  27. Stanley B, Guido J, Stanley M, Shortell D. The elderly patient and informed consent: empirical findings. JAMA 1984;252(10):1302–1306.

    Article  PubMed  CAS  Google Scholar 

  28. Lieberman M. The physician’s duty to disclose risks of treatment. Bull NY Acad Med 1974;50:943–948.

    CAS  Google Scholar 

  29. Ingelfinger FJ. Informed (but uneducated) consent. N Engl J Med 1971;287:465–466.

    Google Scholar 

  30. Taub HA. Informed consent, memory, and age. Gerontologist 1980;20(6):686–690.

    PubMed  CAS  Google Scholar 

  31. Johnston SC, Pfeifer MP. Patient and physician roles in end-of-life decision making. End-of-Life Study Group. J Gen Intern Med 1998;13(1):43–45.

    Article  Google Scholar 

  32. Stiggelbout AM, Kiebert GM. A role for the sick role. Patient preferences regarding information and participation in clinical decision-making. Can Med Assoc J 1997; 157(4):383–389.

    CAS  Google Scholar 

  33. Strull WM, Lo B, Charles G. Do patients want to participate in medical decision making? JAMA 1984;252(21): 2990–2994.

    Article  PubMed  CAS  Google Scholar 

  34. Starr TJ, Pearlman RA, Uhlmann RF. Quality of life and resuscitation decisions in elderly patients. J Gen Intern Med 1986;1:373–379.

    Article  PubMed  CAS  Google Scholar 

  35. Midwest Bioethics Center Ethics Committee Consortium. Guidelines for the determination of decisional incapacity. Midwest Bioethics Cent Bull 1996:1–13.

    Google Scholar 

  36. Weinstock R, Copelan R, Bagheri A. Competence to give informed consent for medical procedures. Bull Am Acad Psychiatry Law 1984;12(2):117–125.

    PubMed  CAS  Google Scholar 

  37. Roth LH, Meisel A, Lidz CW. Tests of competency to consent to treatment. Am J Psychiatry 1977;134:279–284.

    PubMed  CAS  Google Scholar 

  38. Grisso T, Appelbaum PS. Assessing Competence to Consent to Treatment: A Guide for Physicians and Other Health Professionals. Oxford: Oxford University Press; 1998.

    Google Scholar 

  39. Pinkerton JV, Finnerty JJ. Resolving the clinical and ethical dilemma involved in fetal-maternal conflicts. Am J Obstet Gynecol 1996;175(2):289–295.

    Article  PubMed  CAS  Google Scholar 

  40. Dworkin G. Autonomy and behavior control. Hastings Cent Rep 1976;6(1):23–28.

    Article  PubMed  CAS  Google Scholar 

  41. Waymack MH, Taler GA. Medical Ethics and the Elderly: A Case Book. Chicago: Pluribus; 1988.

    Google Scholar 

  42. Hardwig J. What about the family? Hastings Cent Rep 1990;20(2):8.

    Google Scholar 

  43. Nelson JL. Taking families seriously. Hastings Cent Rep 1992;22(4):6–12.

    Article  Google Scholar 

  44. Waisel DB, Truog RD. Informed consent. Anesthesiology 1997;87(4):968–978.

    Article  PubMed  CAS  Google Scholar 

  45. Crooke D. Ethical issues and consent in obstetric anesthesia. In: Birnbach DJ, Sanjay S, Gatt SP, eds. Textbook of Obstetric Anesthesia. New York: WB Saunders; 2000: 744–753.

    Google Scholar 

  46. Waltz JR, Scheunemann T. Informed consent and therapy. Northwestern Univ Law Rev 1970;64:628.

    Google Scholar 

  47. Gild WM. Informed consent: a review. Anesth Analg 1989; 68:649–653.

    Article  PubMed  CAS  Google Scholar 

  48. Byrne J, Napier A. How informed is signed consent? Br Med J 1988;296:839–840.

    CAS  Google Scholar 

  49. Cassileth BR, Zupkis RV, Sutton-Smith K, March V. Informed consent-—why are its goals imperfectly realized? N Engl J Med 1980;302:896–900.

    PubMed  CAS  Google Scholar 

  50. Clark SK, Leighton BL, Seltzer JL. A risk-specific anesthesia consent form may hinder the informed consent process. J Clin Anesth 1991;3:11–13.

    Article  PubMed  CAS  Google Scholar 

  51. Waisel DB, Truog RD. The benefits of the explanation of the risks of anesthesia in the day surgery patient. J Clin Anesth 1995;7:200–204.

    Article  PubMed  CAS  Google Scholar 

  52. Knapp RM. Legal view of informed consent for anesthesia during labor. Anesthesiology 1990;72(1):211.

    Article  PubMed  CAS  Google Scholar 

  53. Teno JM, Licks S, Lynn J, et al. Do advance directives provide instructions that direct care? SUPPORT Investigators. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment. J Am Geriatr Soc 1997;45(4):508–512.

    PubMed  CAS  Google Scholar 

  54. American Geriatrics Society Ethics Committee. Making treatment decisions for incapacitated older adults without advance directives. J Am Geriatr Soc 1996;44(8):986–987.

    Google Scholar 

  55. Teno JM, Lynn J, Wenger N, et al. Advance directives for seriously ill hospitalized patients: effectiveness with the patient self-determination act and the SUPPORT intervention. SUPPORT Investigators. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment. J Am Geriatr Soc 1997;45(4):500–507.

    PubMed  CAS  Google Scholar 

  56. Jonsen AR, Siegler M, Winslade WJ. Clinical Ethics. 4th ed. New York: McGraw-Hill; 1998.

    Google Scholar 

  57. La Puma J, Silverstein MD, Stocking CB, Roland D, Siegler M. Life-sustaining treatment: a prospective study of patients with DNR orders in a teaching hospital. Arch Intern Med 1988;148(2193):2198.

    Google Scholar 

  58. Wenger NS, Greengold NL, Oye RK, Kussin P, Phillips RS. Patients with DNR orders in the operating room: surgery, resuscitation, and outcomes. J Clin Ethics 1997;8:250–257.

    PubMed  CAS  Google Scholar 

  59. Truog RD. “Do-not-resuscitate” orders during anesthesia and surgery. Anesthesiology 1991;74(3):606–608.

    Article  PubMed  CAS  Google Scholar 

  60. Clemency MV, Thompson NJ. “Do not resuscitate” (DNR) orders and the anesthesiologist: a survey. Anesth Analg 1993;76:394–401.

    PubMed  CAS  Google Scholar 

  61. Thurber CF. Public awareness of the nature of CPR: a case for values-centered advance directives. J Clin Ethics 1996;7(1):55–59.

    PubMed  CAS  Google Scholar 

  62. Committee on Ethics, American College of Surgeons. Statement on advance directives by patients: do not resuscitate in the operating room. Am Coll Surg Bull 1994; 79:29.

    Google Scholar 

  63. Committee on Ethics, American Society of Anesthesiologists. Ethical guidelines for the anesthesia care of patients with do not resuscitate orders or other directives that limit treatment (1993). 1997:12–13. ASA Standards, Guidelines and Statements.

    Google Scholar 

  64. Truog RD, Waisel DB, Burns JP. DNR in the OR: a goaldirected approach. Anesthesiology 1999;90(1):289–295.

    Article  PubMed  CAS  Google Scholar 

  65. Jackson SH, Van Norman GA. Goals-and values-directed approach to informed consent in the ‘DNR’ patient presenting for surgery: more demanding of the anesthesiologist? Anesthesiology 1999;90(1):3–6.

    Article  PubMed  CAS  Google Scholar 

  66. Sayers GM, Schofield R, Aziz M. An analysis of CPR decision-making by elderly patients. J Med Ethics 1997; 23:207–212.

    PubMed  CAS  Google Scholar 

  67. Krumholz HM, Phillips RS, Hamel MB, et al. Resuscitation preferences among patients with severe congestive heart failure: results from the SUPPORT Project. Circulation 1998;98(648):655.

    Google Scholar 

  68. Rosin AJ, Sonnenblick M. Autonomy and paternalism in geriatric medicine. The Jewish ethical approach to issues of feeding terminally ill patients, and to cardiopulmonary resuscitation. J Med Ethics 1998;24:44–48.

    Article  PubMed  CAS  Google Scholar 

  69. Uhlmann R, Pearlman R, Cain K. Physicians’ and spouses’ predictions of elderly patients’ resuscitation preferences. J Gerontol 1988;43:M115–M121.

    PubMed  CAS  Google Scholar 

  70. American Medical Association Council on Ethical and Judicial Affairs. Guidelines for the appropriate use of donot-resuscitate orders. JAMA 1981;265(14):1868–1871.

    Google Scholar 

  71. SUPPORT Investigators. A controlled trial to improve care for seriously ill hospitalized patients. The study to understand prognoses and preferences for outcomes and risks of treatments (SUPPORT). JAMA 1995;274(20): 1591–1598.

    Article  Google Scholar 

  72. Potter RL. Treatment redirection: moving from curative to palliative care. Bioethics Forum 1998;14(2):3–9.

    PubMed  Google Scholar 

  73. Feinstein AR, Horwitz RI. Problems in the ‘evidence’ of ‘evidence-based medicine.’ Am J Med 1997;103:529–535.

    Article  PubMed  CAS  Google Scholar 

  74. Weeks JC, Cook EF, O’Day SJ, et al. Relationship between cancer patients’ predictions of prognosis and their treatment preferences. JAMA 1998;279(1709):1714.

    Google Scholar 

  75. Hanson LC, Danis M, Tulsky JA. What is wrong with end-of-life care? Opinions of bereaved family members. J Am Geriatr Soc 1997;45:1339–1344.

    PubMed  CAS  Google Scholar 

  76. Bulger RJ. The quest for mercy: the forgotten ingredient in health care reform. West J Med 1997;167:362–373.

    PubMed  Google Scholar 

  77. Lynn J, Teno JM, Phillips RS, et al. Perceptions by family members of the dying experience of older and seriously ill patients. Ann Intern Med 1997;126(2):97–106.

    PubMed  CAS  Google Scholar 

  78. Emanuel E. Cost savings at the end of life. Crit Care Med 1996;25:1907–1914.

    Google Scholar 

  79. Randolph AG, Guyatt GH, Richardson WS. Prognosis in the intensive care unit: finding accurate and useful estimates for counseling patients. Crit Care Med 1998;26(4): 767–772.

    Article  PubMed  CAS  Google Scholar 

  80. Rudberg MA, Teno JM, Lynn J. Developing and implementing measures of quality of care at the end of life: a call for action. J Am Geriatr Soc 1997;45(4):528–530.

    PubMed  CAS  Google Scholar 

  81. Kaiser HE, Brock DB. Comparative aspects of the quality of life in cancer patients. In Vivo 1992;6(4):333–337.

    PubMed  CAS  Google Scholar 

  82. Moss MS, Lawton MP, Glicksman A. The role of pain in the last year of life of older persons. J Gerontol 1991;56: P51–P57.

    Google Scholar 

  83. Cherny NI, Catane R. Professional negligence in the management of cancer pain. Cancer 1995;76(2181):2185.

    Google Scholar 

  84. Wanzer SH, Federman DD, Adelstein SJ, et al. The physician’s responsibility toward hopelessly ill patients: a second look. N Engl J Med 1989;320(13):844–849.

    PubMed  CAS  Google Scholar 

  85. Lichter I, Hunt E. The last 48 hours of life. J Palliat Care 1990;6(4):7–115.

    PubMed  CAS  Google Scholar 

  86. Martin EW. Confusion in the terminally ill: recognition and management. Am J Hosp Palliat Care 1990;73:20–24.

    Article  Google Scholar 

  87. Massie MJ, Holland J, Glass E. Delirium in terminally ill cancer patients. Am J Psychiatry 1983;140(8):1048–1050.

    PubMed  CAS  Google Scholar 

  88. Voltz R, Borasio GD. Palliative therapy in the terminal stage of neurological disease. J Neurol 1997;244(Suppl 4): S2–S10.

    Article  PubMed  Google Scholar 

  89. Power D, Kearney M. Management of the final 24 hours. Ir Med J 1992;85(3):93–95.

    PubMed  CAS  Google Scholar 

  90. Coyle N, Adelhardt J, Foley KM, Portenoy RK. Character of terminal illness in the advanced cancer patient. J Pain Symptom Manage 1990;5:83–93.

    Article  PubMed  CAS  Google Scholar 

  91. Back AL, Wallace JI, Starks HE, Pearlman RA. Physicianassisted suicide and euthanasia in Washington State. JAMA 1996;275:919–925.

    Article  PubMed  CAS  Google Scholar 

  92. May WE. Double effect. In: Reich WT, ed. Encyclopedia of Bioethics. New York: The Free Press; 1978:316–320.

    Google Scholar 

  93. Benrubi GI. Euthanasia—the need for procedural safeguards. N Engl J Med 1992;326(3):197–199.

    PubMed  CAS  Google Scholar 

  94. Jonsen AR. To help the dying die: a new duty for anesthesiologists? Anesthesiology 1993;78(2):225–228.

    Article  PubMed  CAS  Google Scholar 

  95. American Medical Association Council on Ethical and Judicial Affairs. Code of Medical Ethics: Current Opinions with Annotations. Chicago: American Medical Association; 1994.

    Google Scholar 

  96. American College of Physicians Ethics Committee. Ethics Manual. 2nd ed. Ann Intern Med 1989;111(245):335.

    Google Scholar 

  97. American Geriatrics Society Ethics Committee. Physicianassisted suicide and voluntary active euthanasia. J Am Geriatr Soc 1995;43(5):579–580.

    Google Scholar 

  98. Koenig HG, Wildman-Hanlon D, Schmader K. Attitudes of elderly patients and their families toward physician-assisted suicide. Arch Intern Med 1996;156(19):2240–2248.

    Article  PubMed  CAS  Google Scholar 

  99. American College of Physicians Ethics Committee. Ethics Manual. 3rd ed. Ann Intern Med 1992;117:947–960.

    Google Scholar 

  100. Post SG. Euthanasia, senicide, and the aging society. J Religious Gerontol 1991;8(1):57–65.

    Article  Google Scholar 

  101. Hill CS. When will adequate pain treatment be the norm? JAMA 1995;274:1880–1881.

    Article  Google Scholar 

  102. Hamel MB, Phillips RS, Teno JM, Lynn J, Galanos AN, Davis RB. Seriously ill hospitalized adults: do we spend less on older patients? SUPPORT Investigators. Study to Understand Prognoses and Preference for Outcomes and Risks of Treatment. J Am Geriatr Soc 1996;44:1043–1048.

    PubMed  CAS  Google Scholar 

  103. Evans RW, Yagi J. Social and medical considerations affecting selection of transplant recipients: the case of heart transplantation. In: Cowan DH, ed. Human Organ Transplantation. Ann Arbor: Health Administration Press; 1987:27–41.

    Google Scholar 

  104. Kjellstrand CM. Age, sex, and race inequality in renal transplantation. Arch Intern Med 1988;148:1305–1309.

    Article  PubMed  CAS  Google Scholar 

  105. Kjellstrand CM, Logan GM. Racial, sexual and age inequalities in chronic dialysis. Nephron 1987;45:257–263.

    Article  PubMed  CAS  Google Scholar 

  106. McClish DK, Powell SH, Montenegro H, Nochomovitz M. The impact of age on utilization of intensive care resources. J Am Geriatr Soc 1987;35(11):983–988.

    PubMed  CAS  Google Scholar 

  107. Hamel MB, Teno JM, Goldman L, et al. Patient age and decisions to withhold life-sustaining treatments from seriously ill, hospitalized adults. Ann Intern Med 1999;130: 116–125.

    PubMed  CAS  Google Scholar 

  108. Gurwitz JH, Osganian V, Goldberg RJ, Chen ZY, Gore JM, Alpert JS. Diagnostic testing in acute myocardial infarction: does patient age influence utilization patterns? The Worcester Heart Attack Study. Am J Epidemiol 1991;134: 948–957.

    PubMed  CAS  Google Scholar 

  109. Bearden DM, Allman RM, Sundarum SV, Burst NM, Bartolucci AA. Age-related variability in the use of cardiovascular imaging procedures. J Am Geriatr Soc 1993; 41:1075–1082.

    PubMed  CAS  Google Scholar 

  110. Naylor CD, Levinton CM, Baigrie RS, Goldman BS. Placing patients in the queue for coronary surgery: do age and work status alter Canadian specialists’ decisions? J Gen Intern Med 1992;7:492–498.

    Article  PubMed  CAS  Google Scholar 

  111. Sollano JA, Roe EA, Williams DL, et al. Cost-effectiveness of coronary artery bypass surgery in octogenarians. Ann Surg 1998;228(3):297–306.

    Article  PubMed  CAS  Google Scholar 

  112. Ott RA, Gutfinger DE, Miller M, et al. Rapid recovery of octogenarians following coronary artery bypass grafting. J Card Surg 1997;12(5):309–313.

    Article  PubMed  CAS  Google Scholar 

  113. Kirsch M, Guesnier L, LeBesnerais P, et al. Cardiac operations in octogenarians: perioperative risk factors for death and impaired autonomy. Ann Thorac Surg 1998;66(1): 60–67.

    Article  PubMed  CAS  Google Scholar 

  114. Jecker NS, Pearlman RA. Ethical constraints on rationing medical care by age. J Am Geriatr Soc 1989;37:1067–1075.

    PubMed  CAS  Google Scholar 

  115. Avorn J. Benefit and cost analysis in geriatric care: turning age discrimination into health policy. N Engl J Med 1984; 310(20):1294–1301.

    PubMed  CAS  Google Scholar 

  116. Cassel CK, Neugarten B. The goals of medicine in an aging society. In: Binstock RH, Post SG, eds. Too Old for Health Care? Controversies in Medicine, Law, Economics, and Ethics. Baltimore: Johns Hopkins University Press; 1991.

    Google Scholar 

  117. Dougherty CJ. Ethical problems in healthcare rationing. Testimony to the Senate Special Committee on Aging. Health Prog 1991;72:32–39.

    PubMed  CAS  Google Scholar 

  118. Evans JG. Aging and rationing [editorial]. Br Med J 1991; 303:869–870.

    CAS  Google Scholar 

  119. Kilner JF. Age as a basis for allocating lifesaving medical resources: an ethical analysis. J Health Polit Policy Law 1988;13(3):405–423.

    Article  PubMed  CAS  Google Scholar 

  120. Knaus WA, Harrell FE, Lynn J, et al. The SUPPORT prognostic model. Objective estimates of survival for seriously ill hospitalized adults. Study to understand prognoses and preferences for outcomes and risks of treatments. Ann Intern Med 1995;122(3):191–203.

    PubMed  CAS  Google Scholar 

  121. Knaus WA, Wagner DP, Draper EA, et al. The APACHE III prognostic system. Risk prediction of hospital mortality for critically ill hospitalized adults. Chest 1992;102(6): 1919–1920.

    Google Scholar 

  122. Rosenfeld KE, Pearlman RA. Allocatingmedicalresources: recommendations for a professional response. J Am Geriatr Soc 1997;45(7):886–888.

    PubMed  CAS  Google Scholar 

  123. Biblo JD, Christopher MJ, Johnson L, Potter RL. Ethical issues in managed care: guidelines for clinicians and recommendations to accrediting organizations. Bioethics Forum 1996;12(1):MC/1–MC/24.

    Google Scholar 

  124. Karlawish JHT, Sachs GA. Research on the cognitively impaired: lessons and warnings from the emergency research debate. J Am Geriatr Soc 1997;45(4):474–481.

    PubMed  CAS  Google Scholar 

  125. Capron AM. Incapacitated research. Hastings Cent Rep 1997;27(2):25–27.

    Article  Google Scholar 

  126. Prabhu VC, Kelso TK, Sears TD. An update on the PEGSOD study involving incompetent subjects: FDA permits an exception to informed consent. IRB 1994;16(1–2): 16–18.

    PubMed  Google Scholar 

  127. Haimowitz S, Delano SJ, Oldham JM. Uninformed decision making: the case of surrogate research consent. Hastings Cent Rep 1997;27(6):9–16.

    Article  PubMed  CAS  Google Scholar 

  128. Warren JW, Sobal J, Tenney JH, et al. Informed consent by proxy: an issue in research with elderly patients. N Engl J Med 1986;315(18):1124–1128.

    PubMed  CAS  Google Scholar 

  129. American College of Physicians. Cognitively impaired subjects. Ann Intern Med 1989;111(10):843–848.

    Google Scholar 

  130. Karlawish JHT. Research involving cognitively impaired adults. N Engl J Med 2003;348(14):1389–1392.

    Article  PubMed  Google Scholar 

  131. Baskin SA, Morris J, Ahronheim JC, Meier DE, Morrison RS. Barriers to obtaining consent in dementia research: implications for surrogate decision-making. J Am Geriatr Soc 1998;46(3):287–290.

    PubMed  CAS  Google Scholar 

  132. Coppolino M, Ackerson L. Do surrogate decision makers provide accurate consent for intensive care research? Chest 2001;119(2):603–612.

    Article  PubMed  CAS  Google Scholar 

  133. Emanuel EJ, Emanuel LL. Proxy decision making for incompetent patients. JAMA 1992;267:2067–2071.

    Article  PubMed  CAS  Google Scholar 

  134. Secker AB, Meier DE, Mulvihill M, Paris BE. Substituted judgment: how accurate are proxy predictions? Ann Intern Med 1991;115:92–98.

    Google Scholar 

  135. McCormick R. Proxy consent in the experimentation situation. Perspect Biol Med 1974;18(1):2–20.

    PubMed  CAS  Google Scholar 

  136. Appelbaum PS, Roth LH, Lidz CW, Benson P, Winslade W. False hopes and best data: consent to research and the therapeutic misconception. Hastings Cent Rep 1987; April(17):2–20.

    Google Scholar 

  137. Hochhauser M. “Therapeutic misconception” and “recruiting doublespeak” in the informed consent process. IRB 2002;24(1):11–12.

    Article  PubMed  Google Scholar 

  138. Miller FG, Rosenstein DL. The therapeutic orientation to clinical trials. N Engl J Med 2003;348(14):1383–1386.

    Article  PubMed  Google Scholar 

  139. Miller FG, Rosenstein DL, DeRenzo EG. Professional integrity in clinical research. JAMA 1998;280:1449–1454.

    Article  PubMed  CAS  Google Scholar 

  140. Department of Health and Human Services. Common rule, 45 CFR 46. Federal policy for the protection of human subjects; notices and rules. Federal Register 1991;56: 28003–28032.

    Google Scholar 

  141. Truog RD, Robinson W, Randolph A, Morris A. Is informed consent always necessary for randomized, controlled trials? N Engl J Med 1999;340(10):804–807.

    Article  PubMed  CAS  Google Scholar 

  142. Sade RM. Publication of unethical research studies: the importance of informed consent. Ann Thorac Surg 2003; 75(2):325–328.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Cardiovascular and Thoracic Anesthesiology Central Maine Heart Associates, Central Maine Heart and Vascular Institute, Lewiston, ME

    Paul J. Hoehner MD, MA, FAHA (Director, Harvey Fellow in Theology Ethics and Culture)

  2. Department of Religious Studies, University of Virginia Graduate School of Arts and Sciences, Charlottesville, VA, USA

    Paul J. Hoehner MD, MA, FAHA (Director, Harvey Fellow in Theology Ethics and Culture)

Authors
  1. Paul J. Hoehner MD, MA, FAHA
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Editors and Affiliations

  1. Department of Anesthesiology, Surgery, and Geriatrics and Adult Development , Mount Sinai School of Medicine, New York, NY, USA

    Jeffrey H. Silverstein MD (Professor, Vice Chairman for Research, Associate Dean for Research) (Professor, Vice Chairman for Research, Associate Dean for Research)

  2. Department of Anesthesiology, University of Washington and the Veterans Affairs Puget Sound Health Care System, Seattle, WA

    G. Alec Rooke MD, PhD (Professor and Visiting Professor of Anesthesia, Critical Care, and Pain Medicine) (Professor and Visiting Professor of Anesthesia, Critical Care, and Pain Medicine)

  3. Harvard Medical School Beth Israel Deaconess Medical Center, Boston, MA, USA

    G. Alec Rooke MD, PhD (Professor and Visiting Professor of Anesthesia, Critical Care, and Pain Medicine) (Professor and Visiting Professor of Anesthesia, Critical Care, and Pain Medicine)

  4. College of Medicine Department of Anesthesiology/College of Medicine, Medical University of South Carolina, Charleston, SC, USA

    J. G. Reves MD (Vice President for Medical Affairs, Dean) (Vice President for Medical Affairs, Dean)

  5. Salt Lake City, UT, USA

    Charles H. McLeskey MD

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Hoehner, P.J. (2008). Ethical Management of the Elderly Patient. In: Silverstein, J.H., Rooke, G.A., Reves, J.G., McLeskey, C.H. (eds) Geriatric Anesthesiology. Springer, New York, NY. https://doi.org/10.1007/978-0-387-72527-7_4

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  • DOI: https://doi.org/10.1007/978-0-387-72527-7_4

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