Ethical Problems in Geriatric Medicine

  • Christine K. Cassel


The complexity of modern medical care produces dilemmas and conflicts in which an ability to understand and explicitly address issues of moral choice and value differences is essential to the practicing physician. Ethical dilemmas are not rare or esoteric events. It is impractical and unnecessary to take every ethical problem to court, and every health care institution does not have a consultant ethicist or an ethics committee. Day-to-day decisions must be made as they arise. Therefore, in addition to technical competence in medicine, the geriatrician also must attain a certain level of ethical competence.


Nursing Home Ethical Dilemma Advance Directive Ethical Problem Persistent Vegetative State 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Beauchamp TL, Childers JF. Principles of Biomedical Ethics. 2nd ed. New York, NY: Oxford University Press Inc; 1985.Google Scholar
  2. 2.
    The Hastings Center. Guidelines on the Termination of Life-Sustaining Treatment and the Care of the Dying. New York, NY: The Hastings Center; 1987.Google Scholar
  3. 3.
    Schloendorff u Society of New York Hospitals,211 NY 125, 105 NE 92 (1914).Google Scholar
  4. 4.
    Katz J. The Silent World of Physician and Patient. New York, NY: Free Press; 1985.Google Scholar
  5. 5.
    Strull W, Lo B, Charles G. Do patients want to participate in medical decision making? DAMA 1984; 252: 2990 2995.Google Scholar
  6. 6.
    Novack D, Plumer R, Smith R, et al. Changes in physicians’ attitudes toward telling the cancer patient. JAMA 1979; 241: 897–899.PubMedCrossRefGoogle Scholar
  7. 7.
    Siegler M. Confidentiality in medicine: a decrepit concept. N Engl J Med 1982; 247: 2695.Google Scholar
  8. 8.
    May WF. Code, covenant, contract or philanthropy. Hastings Cent Rep 1975; 5: 29–38.PubMedGoogle Scholar
  9. 9.
    Evans R. Health care technology and the inevitability of resource allocation and rationing decisions. JAMA 1983; 249: 2047, 2208.Google Scholar
  10. 10.
    Avorn J. Benefit and cost analysis in geriatric care: turning age discrimination into health policy. N Engl J Med 1984; 310: 1294–1298.PubMedCrossRefGoogle Scholar
  11. 11.
    Eisenberg J. The internist as gatekeeper: preparing the general internist for a new role. Ann Intern Med 1985; 102: 537.PubMedGoogle Scholar
  12. 12.
    Miles SH, Cassel CK, Siegler MS, et al. Institutional Policies About the Use of Life-Sustaining Treatments. Institutional Protocols for Decisions about Life-Sustaining Treatments, Special Report. OTA-BA-389, Washington, DC: Government Printing Office, July 1988.Google Scholar
  13. 13.
    Glasser G, Zweibel NR, Cassel CK. The ethics committee in the nursing home: results of a national survey. J Am Geriatr Soc 1988; 36: 150–156.PubMedGoogle Scholar
  14. 14.
    President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research Making Health Care Decisions. Washington, DC: LC 82–600637; 1984.Google Scholar
  15. 15.
    McNeil B, Weichselbaum R, Pauker S. Fallacy of the five-year survival in lung cancer. N Engl J Med 1978; 299: 1397.PubMedCrossRefGoogle Scholar
  16. 16.
    McNeil B, Weichselbaum R, Pauker S. Speech and survival: tradeoffs between quality and quantity of life in laryngeal cancer. N Engl J Med 1979; 301: 444.CrossRefGoogle Scholar
  17. 17.
    Society for the Right to Die: Handbook of Living Will Laws. New York, NY: Society for the Right to Die; 1987.Google Scholar
  18. 18.
    Steinbrook R, Lo B. Decision making for incompetent patients by designated proxy. N Engl J Med 1984; 310: 1598–1601.PubMedCrossRefGoogle Scholar
  19. 19.
    President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research Defining Death. Washington, DC: 1981, publisher LC 81–600150.Google Scholar
  20. 20.
    Levy DE, Bates D, Coronna JJ, et al. Prognosis in nontraumatic coma. Ann Intern Med 1981; 94: 293–301.PubMedGoogle Scholar
  21. 21.
    Pearlman R, Jonsen A. Use of quality of life considerations in medical decision making. J Am Geriatr Soc 1985; 33: 344.PubMedGoogle Scholar
  22. 22.
    Cassel CK, Jameton AL. Dementia in the elderly: an analysis of medical responsibility. Ann Intern Med 1981; 94: 802–807.PubMedGoogle Scholar
  23. 23.
    Lynn J, ed. By No Extraordinary Means. Bloomington, Ind: Indiana University Press; 1986.Google Scholar
  24. 24.
    Watts D, Cassel CK, Hickam D. Nurses’ and physicians’ attitudes toward tube-feeding decisions in long-term care. J Am Geriatr Soc 1986; 34: 607–611.PubMedGoogle Scholar
  25. 25.
    Meier D, Cassel CK. Euthanasia in old age: a case study and ethical analysis. J Am Geriatr Soc 1983; 31: 294–298.PubMedGoogle Scholar
  26. 26.
    Wanzer S, et al. Care of the hopelessly ill patient: a second look. N Engl J Med 1989; 320: 844–849.PubMedCrossRefGoogle Scholar
  27. 27.
    Zweibel N, Cassel CK, eds. Clinical and Policy Issues in the Care of the Nursing Home Patient: Clinics in Geriatric Medicine. Philadelphia, Pa: WB Saunders Co; 1988.Google Scholar
  28. 28.
    Miles SH, Ryden M. Limited-treatment policies in longterm care facilities. J Am Geriatr Soc 1985; 33: 707.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1990

Authors and Affiliations

  • Christine K. Cassel

There are no affiliations available

Personalised recommendations