Care of Older Adults: Autonomy, Capacity and Duty to Protect

Abstract

Older adults represent a substantial proportion of dermatological visits, particularly surgical visits. Dermatologist have an obligation to attend to the unique ethical needs of older adults. Although informed consent is ethically and legally obligatory for all patients, particular attention must be paid to the capacity assessment of older adults. Capacity assessments require dermatologists to ask open ended questions that demonstrate the patient’s ability to appreciate their medical condition, use reason to make a decision and express that decision. In patients who are unable to make decisions for themselves, the dermatologist must continue to involve them in their care to the level of their ability and identify appropriate surrogate decision makers. In helping and supporting the decision making of older adults and their surrogates, decision aids may help everyone clarify the benefits, risks and preferences that will guide their decision making. Dermatologists have a particular ethical obligation to identify and report elder abuse within their patient population. Although concerns for medical futility and distributive justice can arise in patients of all ages, physicians may more quickly raise questions of futility when older adults are critically ill.