Extending Life, Enhancing Life A National Research Agenda on Aging (1991) / Chapter Skim
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6. Research in Biomedical Ethics
6. Research in Biomedical Ethics
Pages 107-118
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From page 107... ...
RESEARCH PRIORITIES Sufficient funds should be made available to conduct research on the ethical dilemmas involved in the provision of life-sustaining treatment, the allocation of health care resources, and the participation in clinical research by frail and elderly persons. Using the broach areas of investigation listed here, one can formulate specific research questions to include both empirical and analytical studies.
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From page 108... ...
Educational interventions that encourage health care providers and patients to discuss life-sustaining treatments need to be developed. In the absence of explicit discussions, physicians and family members cannot predict a patient's preferences for (or against)
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From page 109... ...
The durable power of attorney for health care is the most effective type of advance directive because it allows competent patients both to designate surrogates and to specify the types of treatments they do ant] c30 not want [Presiclent's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research, 1983; Buchanan and Brock, 1986; Force, 1988)
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From page 110... ...
treatment (Youngner, 19881. Resolving Disagreements Between Health Care Professionals anc]
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From page 111... ...
The projected increase in the number of elderly Americans, the rising costs of Medicare, competing social needs, and continuing federal budget deficits have imposed artificial pressures on caregivers to limit health care spending in general and to limit care to the elderly in particular (as seen, for example, in the early discharge and decreased rehabilitative care given to patients operated on for hip fracture)
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From page 112... ...
Other research issues concerning allocation of resources include decisions about distribution of funds to support preventive care versus high-technology care in older persons, the allocation of funds to support health education compared with direct health care, the competition among different age cohorts for expensive treatment programs E.g., bone marrow and organ transplant, hemodialysis, coronary artery bypass surgery) , and the assignment of research
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From page 113... ...
For example, videotapes might enable persons with mild to moderate dementia to understand enough about a research project to give informed consent iCassel, 19871. Similarly, linguistic analysis of impaired language processing might help physicians communicate better with research-eligible patients suffering from mild dementia.
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From page 114... ...
Furthermore, eclucational interventions aimed at the elderly couIc] encourage them to give advance directives for participating in research, just as they are encouraged to do for medical care decisions.
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From page 115... ...
ADDITIONAL RESEARCH OPPORTUNITIES The following topics provide additional research opportunities: · treatment of oIcler persons with experimental therapies that may involve increased risk to them, such as genetic engineering or organ transplants, which may raise ethical issues that require systematic study through research; and · the trade-off between quality of care and quality of life for older patients. CONCLUSIONS AND RESOURCE RECOMMENDATIONS Ethical issues are an inevitable aspect of medical care and health care policy affecting the elderly.
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From page 116... ...
1984. Institutional Ethics Committees and Health Care Decision Making.
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1982. Making Health Care Decisions.
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From page 118... ...
New England Journal of Medicine 318:286-290. Tymchuck, A
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