The Elderly and the Mentally-Ill

Abstract

Elderly and psychiatric patients share some common characteristics: limited autonomy, uncritical over-estimation of their physical and mental abilities, and need for assistance in daily activities. However, there are also some important differences: psychiatric disease often leads to stigmatisation and to a low social and economic position in society. When dealing with elderly, chronologic age is one important piece of information; yet, age alone should not be a decisive factor in choosing the preferred medical intervention. The main ethical problem is lack of knowledge concerning the elderly: they represent a small minority of patients in clinical trials and are seldom reported separately. In the absence of precise guidelines, we should consider slower metabolic, repair and adaptation processes in advanced age and exert all medical interventions with caution. Caution is also recommended in dealing with psychiatric diseases: every non-conforming behaviour and every minor complaint regarding emotional well-being should not be treated as a disease. Surrogate decision-making should respect the remaining patient’s autonomy and should be based on beneficence as the leading ethical principle. When clearly indicated, intervention against a patient’s will is ethically justified: effective treatment of the underlying disease will hopefully restore patient’s autonomy.