Ethics and the Elderly By Mark R. Wicclair, PhD, 1993, New York, NY: Oxford University Press, 244 pages, hardcover
The topic of ethics and aging has been receiving increasing emphasis in recent years, particularly in relation to health care issues. This book discusses many of mese major issues. Chapter I covers life-sustaining medical care for older persons with decision-making capacity. Sub-topics include shared decisionmaking, withholding and withdrawing life-sustaining treatment, and artificial nutrition and hydration. The problem of questionable decision-making capacity is thoroughly explored. The preferences and interests of iairúly members in shared decision-making are included. The discussion of medical futility in older patients is important. Inappropriate is different from futile. Personal values and medical expertise of physicians may conflict.
Chapter 2 continues with a discussion of lifesustaining medical care in older patients without decision-making capacity, an even more complicated and difficult issue. Subtopics are several types of advance directives such as instruction directives, proxy directives, and combination directives.
Chapter 3 on agerationing, age bias, ageism, and justice is very important and interesting. It is noted that agerationing allocates "health care on the basis of a criterion, age, that is no more relevant than sex or race." Both sides of the following arguments are thoroughly explored: the no-benefit argument, the lower changes of benefit argument, the equal opportunity argument, and the lifespan argument. Everyone in gerontology needs to be aware of these arguments in our changing health care delivery system.
Chapter 4 discusses the issue of autonomy versus paternalism when health care providers and family members are caring for older adults. Differences between son and hard paternalism are discussed with examples given for each one. Giving cognitively impaired older persons the "oprx>rtunity to affect decisions concerning their lives" may prevent further decrease in cognitive abilities. Research with older subjects, especially the concepts of informed consent and surrogate consent, is presented in Chapter 5. This chapter would be very helpful to researchers beginning studies with older subjects, especially those in nursing homes and /or those with decreased decision-making capacity. The final chapter discusses ethical issues related to the obligations of adult children caring for frail older parents.
All of the chapters have numerous excellent references and sample case studies with many thoroughly discussed arguments. This book needs to be read over a period of several hours at a time because it requires thoughtful concentration. It cannot be read a few pages at a time now and then. The writing is mostly clear, but somewhat complicated at times when several pages discuss the implications of one case study and the individuals described are labeled "A" and "S". It is interesting to note that all physicians are referred to as "her." The frequent use of "and so forth" is irritating, useless, and takes up space and time. Overall, however, the book is informative and stimulating reading.