Ethical Dimensions of Geriatric Care Value Conflicts for the 21st Century

There is both a timeliness and a transcendent 'rightness' in the fact that scholars, clinicians, and health professionals are beginning to examine the ethics-based components of decision making in health care of the elderly. Ethics - as the discipline concerned with right or wrong conduct and moral duty - pervades hospital rooms, nursing home corridors, physicians' offices, and the halls of Congress as decisions are made that concern the allocation of health-related services to individuals and groups in need. In particular, care of older persons recently has received dispropor tionate attention in discussions of ethics and clinical care. Age alone, of course, should not generate special focus on ill individuals about whom concerns arise based on value conflicts tacitly involved in the delivery of health care. Having said that age is not the principal criterion for attention to ethics-based concerns in health care, it must be acknowl edged that old people have a high prevalence of conditions that provoke interest and put them in harm's way if value conflicts are not identified and seriously addressed. Issues that concern autonomy, the allocation of scarce resources, inter-generational competition and conflict, the withholding of treat ment in treatable disease, and substitute and proxy decision making for the cognitively impaired all have special relevance for older persons.