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. (shrink)

In the operation of a health care system, defining the limits of medical care is the joint responsibility of many parties including clinicians, patients, philosophers and politicians. It is suggested that changes in the potential for prolonging life make it necessary to give doctors guidance which may have to incorporate certain features of utilitarianism, individualism and patient-autonomy.

In the context of 'Do-not-resuscitate' (DNR) decisions, there is a lack of information in the UK on the opinions of patients and prospective patients. Written anonymous responses to questionnaires issued to 322 out-patient subjects showed that 97 per cent would opt for cardiopulmonary resuscitation (CPR) in their current state of health. In the hypothetical circumstance of having advanced senile dementia only 10 per cent would definitely want CPR, with 75 per cent preferring not to have CPR. There were no significant (...) correlations between the responses and sex or age. Of 270 patients asked verbally if they found the questions disturbing, none said they did. These findings show that the great majority of patients would not wish CPR if severely senile, and that patients are not disturbed by questions relating to their choice for or against CPR. This should encourage further investigations of patients' opinions on CPR in a broader range of conditions, and greater use of DNR orders. (shrink)