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Whether you are a doctor or patient, you will be faced with a chronic condition called aging. Our patient population older than 65 years of age is going to increase and nearly double by 2020. Here in Florida, we are getting an early preview of what is to come. My patient population is about 80 percent Medicare age whereas my colleagues in other locations is closer to half of that.
Besides treating medical problems of the elderly, medical ethics is something that has to be looked at more and more as patients live longer and medical technology improves and we are always redefining the term “medical care.” Ethical principals in providing health care include the first mantra “do the patient no harm, do only what is good for he or she”. Respect in autonomy is also very important. Something all of us want to do as long as we can. I believe everyone feels that they would like to maintain and self-govern themselves as long as possible.
A third component of medical ethics are rights and privileges of the individual in certain situations where for example, he or she is unable to make his or her own decisions about what is best for their care. When the patient is not able and capable of making those decisions, family, sometimes friends or even court-appointed individuals will be making those decisions. People who decide on the behalf of others take on a task that is not always simple or easy to execute. We all envision ourselves being healthy, happy and keeping our mental and physical capabilities until the very end, but realistically we know that is not always the case.
Doctors, if well informed, can help their patients by stressing things like informed consent, giving you all the options and allowing to make your own decisions in some instances, ahead of time so that when a certain catastrophic event occurs, decisions are already made and no one has to be concerned or worried about what the next step should be. Changes in health care that are currently being entertained also bring another component to the table and that is considering what is beneficial for society as a whole and not just looking at the individual.
The problem ahead that I see is to try to develop neutral un-biased universal guidelines which are fair to all. These type of problems are currently being addressed by some of our professional medical organizations as well as nonmedical associations such as AARP. It is clear that in geriatric care, ethical issues needs to be discussed in undergraduate as well as graduate (medical school) and residency and continuing medical education settings if we are to expect a good and fair outcome for all.
Other challenges in medical ethics include incorporating cultural issues as America is a diverse community with many cultures and every culture has different ideas about how to deal with the aging population. Advance directives are a way which an individual can describe exactly what he or she would like done in certain circumstances while you are at the hospital. Advance directives need to be done prior and involve attorneys to make sure that they are proper, concise and cannot be challenged.
Matters that would be discussed are things like care, feeding tube issues, use of surgery in patients whose life expectancy may not be prolonged and sometimes just not treating a certain disease because the patient’s age is so advanced that it would not likely benefit he or she to be treated as they will likely succumb to other issues and illnesses. The benefit of all of this is obvious for the individual, but also it helps the health care system in general by addressing these big and sometimes costly issues. It will allow the country to keep the Medicare system more solvent by judiciously using its funds for treatment of individuals who are ill. We are all too familiar with the measures that are done sometimes for the patient, for the family and even the doctor that ultimately do not make a difference on the outcome.
Denis Grillo, D.O., FOCOO, is an ear, nose and throat specialist in Crystal River. Call him at 352-795-0011 or visit CrystalCommunityENT.com.