Introduction

The most common legal and ethical issues in geriatric care involve assessment of decisional capacity and competence, identification of decision makers, resolution of conflicts about care, disclosure of information, termination of treatment at the end of life, and decisions about long-term care. Although the approach to resolution of these issues is similar for all age groups, the physiologic, psychologic, and social reserves of the elderly place them at greater risk of adverse outcomes. The fact that the elderly often lack the support of family and friends makes them especially vulnerable to the automatic and sometimes unthoughtful process of the health care system.

Although aging may pose some special challenges, it is unfair to make assumptions about a person's abilities or needs based on age alone. Rather, physicians should assess each elderly patient individually and delineate treatment options accordingly. Physicians must also advocate for their patients' ethical interests and legal rights, especially in the medical context, about which patients are often ill-informed or misled (see Table 14-1).

Elderly patients are often targets of unscrupulous schemes to defraud them of property or money. Health care practitioners may be the first to recognize such schemes and should offer help and referral for legal assistance. Attorneys knowledgeable about elder law can defeat these schemes with timely and effective legal intervention through services provided by the local agency on aging.