Legal and ethical guidelines for physicians in geriatric terminal care

In the American legal system, the right to refuse treatment--the right, in other words, to be "let alone"--is an important aspect of autonomy and individuality. In health care decision making, people rarely choose to have no treatment at all, but usually choose from among various forms of medical treatment. Even when aggressive technological options are rejected, patients will often elect to have intensive nursing and pain control. Sometimes they choose to forego treatment and risk hastening death. Particularly among the elderly, a series of small decisions may have to be made as health status worsens over time. No matter what the decision, in observing patients' wishes, physicians will find support in current ethical and legal concepts.