Surgical care of elderly persons focuses many of the difficult legal and ethical dilemmas that have arisen in modern medicine. Such issues arise at both macro and micro levels. This paper explores four micro level areas involving physician-patient interaction. These are: informed consent, dying patients, pain relief treatment and medical research, when the patients involved are elderly persons.
The discussion of informed consent includes consideration of refusal of treatment, scope of information, voluntariness, coercion and competency. In particular, the basic presumptions are articulated and variations in the application of these concepts, when aged persons are involved, and justification of such variations, are considered. Within the topic of dying elderly persons, the “living will” and “durable powers of attorney” are discussed. The obligation to provide pain relief treatment can be particularly important in the context of terminally ill and dying persons and it is suggested that there should be a legal obligation to provide such treatment, including in some circumstances, where the treatment could possibly, or even is likely to, shorten life. Finally, aged persons' participation in medical research and the special problems that can be involved in this are addressed.
In conclusion, it is suggested that the greater visibility and identification of old persons needing surgery than of those needing some other forms of medical care is likely to make this an important arena for setting far-reaching precedents regarding humane approaches to, and human rights in, access to and provision of medical care.