Ethics is a fundamental part of geriatrics. Ethics, or the provision of ethical care, refers to a framework or guideline for determining what is morally good (ie, right) or bad (ie, wrong). Ethical problems arise when there is conflict about what is the “right” thing to do. This dilemma generally occurs when decisions need to be made whether or not a medical intervention should be implemented and whether or not the intervention is futile. The answers to ethical questions are not straightforward; they involve a complex integration of thoughts, feelings, beliefs, and evidence-based data. Ageism can play a strong role in these decisions. Acknowledging and acting on the wishes of the older individual are a critical component of ethical care.
While ethical dilemmas are central to the practice of medicine itself, the dependent nature of the older adult and the imminence of death raise special concerns. Discussions of ethics and aging seem to focus on the roles of autonomy and cost containment, since a significant portion of the cost of delivering health care is incurred at the end of life.
Table 17-1 provides a description of major ethical principles. The ethics of medicine is based on four principles: autonomy, beneficence, nonmaleficence, and justice, which are geared toward maximizing benefits over harm and doing the greatest good for the greatest number. Autonomy refers to one’s right to control one’s destiny, that is, to exert one’s will. Obviously, there are limits to how freely such control can be expressed, but for geriatric purposes the principal issue revolves around whether the patient is able to assess the situation and make a rational decision independently. This raises the second concept, beneficence, which refers to the duty to do good for others, to help them directly, and to avoid harm. Nonmaleficence involves doing no harm and avoiding negligence that leads to harm. Last, justice focuses on fairness in the treatment of others.
TABLE 17-1.Major Ethical Principles* |Favorite Table|Download (.pdf) TABLE 17-1. Major Ethical Principles*
Refers to one’s right to control one’s destiny, that is, to exert one’s will. The principal issue revolves around whether the older adult is able to assess the situation and make a rational decision independently.
Refers to the duty to do good for others, and specifically to avoid harm in the process.
Involves doing no harm and avoiding negligence that leads to harm. Last, justice focuses on fairness in the treatment of others.
Justice focuses on nondiscrimination and the duty to treat individuals fairly; not to discriminate on the basis of irrelevant characteristics. This involves a duty to distribute resources fairly, nonarbitrarily, and noncapriciously.