End-of-life issues for very elderly women: incurable and terminal illness

Important demographic realities may have an impact on a woman's end-of-life options. The vast majority of Americans age 85 and older are women, and they are much more likely than their male counterparts to be widowed, live alone, live below the poverty line, or die in a nursing home. Although pain is not inevitable among the terminally ill, it is vastly undertreated, and elderly women are at heightened risk for undertreatment. Pain and other physical and psychological symptoms should be treated aggressively, according to well-delineated principles of palliative care, including avoiding painful, unwanted treatments that only serve to prolong the dying process. Patients have the right to refuse unwanted treatment, even if this would result in death, and patients who lack decisional capacity can refuse these treatments through an authorized surrogate decision maker. Formal, written advance directives are particularly important for older women, who may be the group least likely to desire life-sustaining treatment. Dying patients also have the right to receive adequate analgesia or sedation for intractable symptoms, even if it might hasten death. Societal and legal consensus has been reached that forgoing treatment and receiving adequate symptom control are permissible, while significant moral and legal debate over the permissibility of euthanasia and assisted suicide continues.