Distinctive Factors Affecting the Legal Context of End-of-Life Medical Care for Older Persons
34 Pages Posted: 25 Oct 2016
Date Written: October 24, 2016
Current legal regulation of medical care for individuals approaching the end of life in the United States is predicated essentially on a factual model emanating from a series of high-profile judicial opinions concerning the rights of adults who become either permanently unconscious or are clearly going to die soon with or without aggressive attempts of curative therapy. In many of today’s difficult medical situations, however, this prevailing, dramatic pull-the-plug end-of-life paradigm does not fit very neatly. Key decisions often fall outside the narrow withholding or withdrawing category, as multiple, seemingly non-dramatic but ultimately interconnected, decisions need to be made when the patient’s survival and recovery prognosis is uncertain. As lifespans increase, death often is preceded by long periods of very gradual decline, chronic illness, and an extension of the dying process the timeline of which cannot be predicted with any real precision. The need for a flexible, adaptable approach to medically treating people approaching the end of their lives, and a similar openness to possible modification of the legal framework within which treatment choices are made and implemented, are particularly important when older individuals are involved. This article outlines a few of the most salient clinical and social factors that distinguish the large and growing cohort of older persons, in potentially legally and policy relevant ways, from other population groups for whom end-of-life medical treatment choices may come into play. Some practice and policy implications are alluded to briefly.
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