Cassel C K, Meier D E, Traines M L
J Am Geriatr Soc. 1986 May;34(5):399-409. doi: 10.1111/j.1532-5415.1986.tb04326.x.
The disciplines of bioethics and geriatrics have had parallel development in recent years. From small and relatively esoteric fields 15 or 20 years ago, both have grown enormously. Although the numbers of geriatricians and ethicists in practice or in academic centers have increased substantially, these disciplines represent areas in which better understanding is sorely needed. This bibliography is intended to assist the clinician in locating salient literature concerning bioethical issues in geriatric medicine and research. It is highly selective; it does not attempt to cover all the literature on bioethics. There are several excellent general bioethics bibliographies for clinicians in the recent literature, as well (not limited to clinical journals or clinical topics), some of which are included in section 13 for the reader's further information. The ethical issues that arise in geriatric medicine are similar to those that arise in the care of younger patients, but certain kinds of problems happen with far greater frequency. Dilemmas concerning decisions about care at the end of life are particularly relevant in geriatrics, as persons of extreme old age are often presented with choices about life-sustaining therapy when critical illness occurs. This includes decisions about cardiopulmonary resuscitation and nutritional support. When these clinical decisions arise in the care of patients who cannot decide for themselves, the question arises as to what role the assessment of "quality of life" ought to play in decisions to pursue or to forego life-sustaining therapy. Informed consent to treatment and to participation in research has been an important area of ethical investigation. Dilemmas about consent to treatment are complicated in some elderly populations because of the higher incidence of cognitive impairment and the higher incidence of the clinician's suspicion (or assumption) of cognitive impairment. In consent to research, there are additional issues of voluntariness and equitable selection, especially when subjects are residents of nursing homes. Because of the increasing numbers of elderly persons in our society, and because of the role of social resources (federal, state, and local) in acute and long-term medical major concern in gerontologic bioethics. The topic headings for this bibliography reflect these common issues which arise in the care of the elderly.+2
近年来，生物伦理学和老年医学学科并行发展。从15或20年前规模较小且相对晦涩的领域发展至今，二者都已取得了巨大的发展。尽管从事临床工作或在学术中心的老年医学专家和伦理学家数量大幅增加，但这些学科仍是亟需深入理解的领域。本参考书目旨在帮助临床医生查找有关老年医学及研究中生物伦理问题的重要文献。它具有高度的选择性，并不试图涵盖所有生物伦理学文献。近期文献中也有几本面向临床医生的优秀生物伦理学综合参考书目（不限于临床期刊或临床主题），其中一些被收录在第13节，供读者进一步参考。老年医学中出现的伦理问题与年轻患者护理中出现的问题相似，但某些类型的问题出现的频率要高得多。关于临终护理决策的困境在老年医学中尤为相关，因为高龄患者在患重病时常常面临维持生命治疗的选择。这包括关于心肺复苏和营养支持的决策。当这些临床决策出现在无法自主决策的患者护理中时，就会产生“生活质量”评估在决定是否进行维持生命治疗时应扮演何种角色的问题。治疗知情同意和参与研究的知情同意一直是伦理调查的重要领域。在一些老年人群体中，由于认知障碍的发生率较高以及临床医生对认知障碍的怀疑（或假设）发生率较高，治疗同意的困境变得更加复杂。在研究同意方面，还存在自愿性和公平选择的额外问题，尤其是当受试者是养老院居民时。由于我们社会中老年人数量不断增加，以及社会资源（联邦、州和地方）在急性和长期医疗中的作用，这成为老年生物伦理学的一个主要关注点。本参考书目所设主题反映了老年护理中出现的这些常见问题。
