Decisions and Care at the End of Life
Singer, Peter A.
Lancet. 1995 Jul 15; 346(8968): 163-166.
Successful public health and social policies and apparently inexorable medical advances are now compelling physicians and others who care for the elderly to confront clinical issues and ethical dilemmas that hardly existed fifty years ago. In North America and Europe more than 12% of the population are now over 65 years of age and all are facing decisions at the end of life which will affect their families and society....Despite the call for massive programmes of health promotion, many age-related conditions that cause disability (eg, Alzheimer's and Parkinson's diseases) and many malignancies and musculoskeletal syndromes have no identified pathophysiological process for which preventive measures are beneficial. Although treatments for the underlying disease vary in efficacy, old people who become unwell will often benefit from interventions targeted at improving function even when no cure can be offered. Virtually all countries find that they cannot afford all that medicine has to offer and are looking at ways to decrease health care costs. The elderly population, especially when life is drawing to a close, often become the focus of such efforts at cost control. Many issues arise at the end of life -- where should one's last days be spent, consent to treatment, advance directives, aspects of clinical care such as resuscitation and palliation, and the controversies of euthanasia and assisted suicide....
Advance Directives; Aged; Allowing to Die; Assisted Suicide; Competence; Consent; Decision Making; Disability; Disease; Euthanasia; Health; Health Care; Health Promotion; Informed Consent; Legal Aspects; Life; Medicine; Palliative Care; Patient Care; Patient Participation; Physicians; Public Health; Resuscitation; Suicide; Terminal Care; Third Party Consent; Voluntary Euthanasia;
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