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There is both a timeliness and a transcendent 'rightness' in the
fact that scholars, clinicians, and health professionals are
beginning to examine the ethics-based components of decision making
in health care of the elderly. Ethics - as the discipline concerned
with right or wrong conduct and moral duty - pervades hospital
rooms, nursing home corridors, physicians' offices, and the halls
of Congress as decisions are made that concern the allocation of
health-related services to individuals and groups in need. In
particular, care of older persons recently has received dispropor
tionate attention in discussions of ethics and clinical care. Age
alone, of course, should not generate special focus on ill
individuals about whom concerns arise based on value conflicts
tacitly involved in the delivery of health care. Having said that
age is not the principal criterion for attention to ethics-based
concerns in health care, it must be acknowl edged that old people
have a high prevalence of conditions that provoke interest and put
them in harm's way if value conflicts are not identified and
seriously addressed. Issues that concern autonomy, the allocation
of scarce resources, inter-generational competition and conflict,
the withholding of treat ment in treatable disease, and
substitute and proxy decision making for the cognitively impaired
all have special relevance for older persons.
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