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Obtaining informed consent is the formal component of shared decision making by the physician and patient. Unfortunately, the documents developed by institutions to formally record the process of obtaining consent are often substituted for the process itself. Informed consent embodies certain conditions that must be satisfied; these include adequate information, freedom from coercion, and sufficient [...]

Developing a list of treatment options for a patient is a central component of good decision making. Two assumptions help in developing options for a patient. First, although society’s financial concerns are an issue, the choices made with a particular patient are ordinarily assumed to have negligible effects upon society as a whole, neither greatly [...]

If a competent patient rejects treatment that the physician believes is in the patient’s interest, especially if the treatment would prolong life, the physician should explore the patient’s reasons and correct any misunderstandings. However, a physician should not impose treatment if the patient refuses it—even if the treatment could prolong life. Instead, the physician should [...]

Just as patients may refuse treatment, they also may request treatment, including treatment to prolong life. Physicians have a strong obligation to respect a competent patient’s request, an advance directive, or a surrogate’s decision to prolong life. However, certain relevant limitations exist. Physicians are not obliged to provide physiologically futile treatments—that is, treatments that cannot [...]

Just as patients must be informed of their rights to make decisions about treatments and to give advance directives, patients should also have the opportunity to state whether they want to have CPR performed in the event of a cardiopulmonary arrest. In almost all jurisdictions, patients do not have a legal right to euthanasia, but [...]

Strictly speaking, do-not-resuscitate (DNR) orders mean only that CPR should not be performed for a cardiopulmonary arrest. Other treatment—such as antibiotics, transfusions, dialysis, and ventilator support—may still be given. More specific orders are required to indicate whether the person should be hospitalized or whether a patient should be treated in an intensive care unit. To [...]

Requests for euthanasia by competent patients suffering severely and irremediably from an incurable disease are understandable; however, legally they cannot be honored. Physicians are obliged to provide treatment and care that results in a peaceful, dignified, and humane death with minimal physical suffering. Statutory legalization of euthanasia by physicians could have an adverse impact on [...]

The social context of geriatric care influences the risk of disease, the experience of illness, and the physician’s ability to deliver timely and appropriate care. The social status of the elderly, the changing demographics of health and illness, and evolving social values exert complex pressures on the patchwork of policies, programs, and services that constitute [...]

Older persons are more likely to use health care services than younger persons. While the elderly made up only 12% of the US population in 1990, they accounted for 34% of all hospital stays and 45% of all hospital days. For persons over age 65, the average length of stay was 8.7 days; for persons [...]