Abstract:

Difficulties exist in making treatment decisions for the very old and dependent patient. In theyears to come, these difficulties will increase. It is argued that such persons should not be abandoned to their "rights" as autonomous persons; yet quality of life judgments should also be avoided except in limited circumstances. Since aging is a process of becoming more dependent, a dependency rule is proposed, by which greater responsibility for treatment decisions falls on caregivers as a person's dependency increases. In place of quality of life judgments, a medical indications policy is suggested, if the latter includes restoration of some affective function. There are various kinds of freedom, of which some, though not all, are lost in chronic illness & old age. It is suggested that life involves greater interdependence than the autonomy criterion can allow.