Ethical considerations in critical and terminal illness in the elderly

In a Baltimore geriatric center and hospital, a program was developed to individualize the treatment of critically and terminally ill patients. Part of this program was an effort to involve the patients themselves in the discussion of their personal wishes, and the provision of a set of guidelines for staff members to help them individualize the care of the patients. Some of the practical problems involved the the application of these ethical ideals are discussed. Merely implementing the protocol helped staff members to become more aware of these complex questions. Physicians should deal forthrightly with "right-to-die" and associated issues. The decision-making should remain in medical hands, and out of the courts and legislatures.