A distinguished team of contributors from the fields of medicine, philosophy,
and law addresses some of the pressing issues which arise over the provision of
care for dependent elderly patients. Some of the chapters are concerned with the
challenge of achieving quality medical care, the chronic inadequacies of policy
making in the UK context, and the prospects for improvement in the medium term.
Other chapters look at some of the threats to dependent elderly patients posed
by longer term social and ideological trends which find expression in proposals
for age-limits to health care, advocacy of living wills and euthanasia,
arguments for withdrawing tube-feeding from certain categories of patient, and
certain proposals for resource allocation.
This interdisciplinary volume will have a wide appeal to those involved in
care of the dependent elderly, to health policy analysts and health care
economists, and to bioethicists.
Contents
Introduction - Luke Gormally
Difficult choices in treating and feeding the debilitated elderly
- Michael Horan
The American debate about artificial nutrition and hydration - Joseph
Boyle
Reflections on Horan and Boyle - Luke Gormally
The Living Will: the ethical framework of a recent Report - Luke
Gormally
Some reflections on euthanasia in The Netherlands - John Keown
Is there a policy for the elderly needing long-term care? - Graham
Mulley
Is it possible to provide good quality long-term care without unfair
discrimination? - Robert Stout
The prospects for long-term care: current policy and realistic alternatives
- David J Hunter
What is required for good quality long-term care of the elderly?
- Marion Hildick-Smith
Should age make a difference in health care entitlement? - Joseph
Boyle
Economic devices and ethical pitfalls: quality of life, the distribution
of resources and the needs of the elderly - Michael Banner
The Aged: non-persons, human dignity and justice - Luke Gormally
Economics, justice and the value of life: concluding remarks - John
Finnis
Reviews
"The book aims to cover issues in the care of geriatric patients from the
perspectives of justice and autonomy. Although there is good coverage of
issues such as withdrawal of life-sustaining treatment and euthanasia, there
are also accounts of health care and health care policy designed for the
chronically rather than terminally or critically ill. Economics also features
(Banner's chapter on the weakness of QALYs has much to recommend it). Another
contribution worthy of special mention is Boyle's on whether age should
make a difference in determining health care entitlement. Keown presents
a disturbing account of euthanasia in The Netherlands and is obviously convinced
that the practice of euthanasia there extends well beyond what is strictly
permitted under the law. All Gormally's own contributions were tightly argued
and successfully hold the volume together through its various themes. The
concluding sentence of his final contribution captures the direction of
the book as a whole '(t)he inadequate care of patients creates the temptation
to dispose of patients who are obviously held in low esteem. By contrast,
adequate care signifies that patients are valued' (p. 187). That effective
care and ethical care are inextricably linked in so many cases is illustrated
in Hildick-Smith's contribution. She outlines the features of good geriatric
nursing practice, and although she does not say so explicitly it is clear
that good nursing practice accords with the ethical principles of respect
for autonomy and justice....
The volume makes a useful contribution to health ethics. Its contributors
are well informed and their thoughts clearly presented. There is also a
good balance between the contributing disciplines, which work well in the
piece as a whole. It should be particularly valuable for those working with
the dependent elderly."
- Heather Draper
Journal of Applied Philosophy, Volume 10 Number 1 1993
"The treatment of the dependent
elderly is a major preoccupation in contemporary health care ethics for
very good reason. New medical technologies have advanced the cause of better
health, but at a cost. That cost may be expressed not only in terms of
money, but also in terms of the difficult ethical questions about when to
cease treatment and when not to initiate treatment....
This book contains a wide range of important contributions to the
discussion of issues affecting the dependent elderly which continue to perplex
serious scholars, the medical profession, and the wider community. The book
is well structured and edited such that the principle issues are well canvassed
from the diverse points of view represented by scholars from the key disciplines
involved. It is the kind of book to which the reader can profitably return
many times in the years ahead."