The Ethical Dilemmas Doctors Face in Treating Older Patients

Doctors often find themselves in challenging ethical situations when treating older patients, particularly those with chronic illnesses or advanced dementia. The ability to predictively and reliably prevent death is a fallacy for most medical professionals. Instead, their role is to intervene and aid in managing health conditions, with the hope of recovery or at least mitigation of suffering.

Chronic Illnesses and Quality of Life

Patients and their families may opt for palliative care rather than aggressive medical treatments when the quality of life appears poor. For example, an elderly person in their nineties who is blind, deaf, wheelchair-bound, and in chronic pain may not desire extensive treatments such as surgeries, chemotherapy, or radiation if it means a return to a poor quality of life.

Theoretical Treatment vs. Practical Reality

While doctors are ethically obligated to offer all treatments, their patients may choose not to undergo treatment due to the low likelihood of success and potential suffering. This presents a theoretical dilemma, but in practice, the reality is often governed by limited medical resources.

Limited Medical Resources and Prioritization

Modern healthcare facilities are often stretched thin due to limited resources. Equipment such as ventilators and ICU beds are prioritized based on the likelihood of a patient's recovery. During the 2020 pandemic in Italy, for instance, doctors were forced to allocate scarce resources to younger patients, often regrettably making difficult decisions to allow older patients to pass away.

Even in non-pandemic times, certain treatments become less viable due to their high cost and limited availability. This can lead to critical decisions that may seem harsh but are often necessary for the sustainability of healthcare systems.

Examples from Slovenia

As a medical professional in Slovenia, I can attest to the reality that some hospitals struggle to provide the necessary intensive care to all patients due to resource limitations. In many cases, older, critically ill patients may not receive the same level of care as younger patients with a higher chance of recovery.

The Validity of Patient Choices

While doctors argue that certain complex treatments may only prolong suffering, there is a valid point to their argument. However, the issue often arises when patients are not given the choice to opt out of such treatments due to their circumstances.

Conclusion

The ethical dilemmas presented by limited medical resources and the age of patients are complex and multifaceted. Doctors must balance the desire to save lives with the practical constraints of healthcare systems. As society continues to age, these issues will only become more pronounced, requiring ongoing ethical and policy discussions to find solutions that respect both the wishes of patients and the practical realities of medical care.