Ethical issues in geriatric medicine: a unique problematic?

It is commonly believed that geriatric medicine generates a distinctive set of ethical problems. Implicated are such issues as resource allocation, competence and consent, advance directives, medical futility and deliberate death. It is also argued that it would be unjust to allow the elderly to compete with younger populations for expensive and scarce healthcare resources because the elderly "have already lived," and that treating them the same as these other populations would diminish the available resources unfairly, prolong a life of inevitably failing health and result in increased health care expenditures. In fact, however, this perception of ethical uniqueness is mistaken. Differences in medical conditions, demographics and aetiology should not be allowed to obscure the fact that ethical issues in geriatric medicine are essentially the same as those faced in any other area of health care, and that the solutions that are adopted in the geriatric context must be consistent with the ethical principles that are followed elsewhere. The paper argues that the root of the mistaken perception lies in the abandonment of the Hippocratic mandate of medicine and in an unreflective adherence to the belief that medical advances are inevitably beneficial. It is suggested that a return to patient-centred medicine and the use of ethics impact analyses before introducing medical advances may be ethically appropriate.