Dealing with the brain-damaged old--dignity before sanctity

Abstract

The present and future rapid increase in the hospital population of geriatric patients is discussed with particular reference to the problem of advanced brain degeneration. The consequences of various clinical management options are outlined and it is suggested that extreme attempts either to preserve or terminate life are medically, morally and socially unacceptable. The preservation of life in senile patients has important economic consequences. In achieving a decision on the medical management of patients with advanced brain decay it is suggested that substantial help would be derived from: knowledge of the previously declared wishes of individual patients; improvements in geriatric assessments; broader consultation with relatives, and greater use of inter-disciplinary discussion in the preparation of criteria for terminating medical efforts to maintain survival.

KIE: Robertson discusses the medical and ethical issues involved in providing health care for Britain's growing population of hospitalized elderly, particularly patients suffering from advanced cerebral disease. He rejects the extreme solutions of either all-out clinical efforts to prolong life or active euthanasia, and outlines five factors that should be taken into account when deciding appropriate treatment for senile patients. While agreeing with many of Robertson's points, Hebbert questions his assumptions that there is competition between young and old for health resources and that living wills are valuable in guiding later treatment decisions.