The Elderly

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.

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.

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 ma