Conclusion

Although this chapter has covered a broad range of ethical issues evolving in the medical care of the aging, these cases illustrate ways in which bioethicists and medical caregivers are critically evaluating ethical problems. The principles of autonomy, beneficence, and nonmaleficence provide initial guidance for ethical analysis; however, empirical data from outcome studies, psychological studies, ethnographic research, and basic science also contribute to ethical decision making. The multifaceted nature of the resulting ethical analyses will not always fit comfortably into a model of ethical decision making based solely on weighing principles. Thus we have tried to indicate ways in which ethicists have looked beyond principles to concepts such as caring, virtue, and even institutional structures. As the costs of medical decisions increase, bioethicists, caregivers, and patients will experience increasing pressure to justify their decisions about medical care. An ethically informed view will be essential to health care providers and policymakers in evaluating these decisions.

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