Abstract
Our capacity for cognitive function and the ability to express our intentions declines with age, and as a result of chronic diseases and other disorders. This often leads to difficulties in making decisions regarding medical treatment and clinical research. This paper aims to examine the range of methods which can be used to ensure that an elderly patient is competent to take part in the attendant decision-making process, and also considers the issue of appropriate medical care in cases of patients who are not considered competent. When considering the alleviation of symptoms, human dignity, and the quality of life of elderly individuals, aggressive yet life-sustaining treatment may not necessarily be desirable (or patient-orientated), and may fail to meet the needs of the patient. The patient and their family face with difficult choices, such as deciding whether or not to switch from aggressive treatment to palliative care, deciding whether to continue with life-sustaining care, or deciding whether to discontinue treatment. There are growing concerns regarding the extent to which elderly people (especially those whose decision-making capacity has declined due to conditions such as Alzheimer's Syndrome) are able to express their intentions freely regarding their treatment. When patients make these difficult choices, the processes through which the patient's intentions are assessed, and how their rights may be guaranteed, need to be considered. If a patient is determined to have no capacity to consent, advance directives provided by the patient while they were able to consent can be used, or an adult guardianship system can be adopted. In recent years, assessment methods have been developed that enable patients who cannot directly express themselves to outline their intentions in writing, or by using verbalization devices that sense eye movement. While various methods of determining capacity to consent have been developed, no fixed standard has been established. In both examples, it is hoped that the human rights and the dignity of elderly patients are fully respected throughout the decision-making process and subsequent treatment.
