Skip to main content

Ethical Aspects of Interventional Cardiology in Geriatric Patients

  • Chapter
Interventional Cardiology in the Elderly
  • 576 Accesses

Abstract

Geriatric medicine deals with old, very old, patients who frequently are in need of help and care because of their higher risk for losses of physical, cognitive, emotional and social function. The situation of these vulnerable, frail patients often is not adequately taken care of by our social and healthcare system. Decisions about medical interventions are easier when the patients concerned have an intact decisional capacity. This situation becomes more complex and difficult when dealing with multimorbid, frequently cognitively impaired very old individuals. The big ethical challenge for interventional cardiology is to provide the solid evidence of an overall benefit of the invasive procedure translating into an individually acceptable improved quality of life of the geriatric patient. Only good facts make good ethical decision-making possible.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 159.00
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Austrian Bioethics Commission. Recommendations for the terminology of medical decisions in end-of-life Situations. 2011. https://www.bka.gv.at/DocView.axd?CobId=46713. Accessed 9 Jan 2015.

  2. Beauchamp TL, Childress JF. Principles of biomedical ethics. New York: Oxford University Press; 2001.

    Google Scholar 

  3. Boothroyd LJ, et al. Transcatheter aortic valve implantation: recommendations for practice based on a multidisciplinary review including cost-effectiveness and ethical and organizational issues. Can J Cardiol. 2013;6:718–26.

    Article  Google Scholar 

  4. Borasio GD. Lecture at the 66th annual German Jurist’s conference, Stuttgart, 20 Sept 2006.

    Google Scholar 

  5. Cameron AA, et al. Ethical issues for invasive cardiologists: society for cardiovascular angiography and interventions. Catheter Cardiovasc Interv. 2004;61:157–62.

    Article  PubMed  Google Scholar 

  6. Chen PW. Final exam – a surgeon’s reflections on mortality. New York: Knopf, Random House; 2007.

    Google Scholar 

  7. Ellershaw J, Ward C. Care of the dying patient: the last hours or days of life. BMJ. 2003;326:30–4.

    Article  PubMed Central  PubMed  Google Scholar 

  8. Ellis G, et al. Comprehensive geriatric assessment for older hospital patients. Br Med Bull. 2004;71:45–59.

    Article  PubMed  Google Scholar 

  9. Gawande A. Being mortal – illness, medicine and what matters in the end. Metropolitan Books, Henry Holt & Co. New York

    Google Scholar 

  10. Hawkins BM, et al. High-risk percutaneous coronary intervention in the Era of public reporting – clinical and ethical considerations in the care of the elderly patient with critical left main disease and shock. Circulation. 2014;129:258–65.

    Article  PubMed Central  PubMed  Google Scholar 

  11. Junod JP, Martin E. Ein kurzes Lehrbuch der Geriatrie. Bern: Huber; 1984.

    Google Scholar 

  12. Körtner U. Grundkurs Pflegeethik. Wien: Facultas; 2004.

    Google Scholar 

  13. Kunzmann P. dtv Atlas der Philosophie. Munich: DTV; 1996.

    Google Scholar 

  14. Levine GN, et al. ACCF/AHA/SCAI guideline for percutaneous coronary intervention. Catheter Cardiovasc Interv. 2011. doi:10.1002/ccd.23438.

    PubMed  Google Scholar 

  15. Loewy EH. Textbook of health care ethics. New York: Plenum Press; 1996.

    Google Scholar 

  16. Loewy EH. Ethics and evidence-based medicine: Is there a conflict? Medscape Internal Medicine. 2007. http://www.medscape.com/viewarticle/559977_2. Accessed 7 Jan 2015.

  17. Loewy EH, Loewy RS. The ethics of terminal illness: orchestrating the end of life. Dordrecht: Kluwer Academic Publishers; 2000.

    Google Scholar 

  18. Loewy EH, Loewy-Springer R. Textbook of healthcare ethics. 2nd ed. Dordrecht: Kluwer Academic Publishers; 2004.

    Google Scholar 

  19. Marckmann G, in der Schmitten J. Begrenzung lebenserhaltender Maßnahmen – eine Handreichung für die Praxis auf der Grundlage der aktuellen Gesetzgebung. Dtsch Med Wochenschr. 2010;145:570–4.

    Article  Google Scholar 

  20. Morrison RS, Meier DE. Geriatric palliative care. New York: Oxford University Press; 2003.

    Google Scholar 

  21. Ohldieck AE, et al. Implementation of transcatheter aortic valve insertion (TAVI) in clinical practice: an ethical analysis. Clin Ethics. 2014;9(2–3):96–103.

    Article  Google Scholar 

  22. Otto CM, et al. Aortic-valve stenosis – from patients at risk to severe valve obstruction. N Engl J Med. 2014;371:744–56.

    Article  CAS  PubMed  Google Scholar 

  23. Pauer-Studer H. Einführung in die Ethik. Wien: Facultas; 2003.

    Google Scholar 

  24. Pöltner G. Grundkurs Medizin-Ethik. Facultas, Wien; 2002.

    Google Scholar 

  25. Rehbock T. Autonomie, Fürsorge, Paternalismus – zur Kritik medizin-ethischer Grundbegriffe. Z Ethik Med. 2002;3:131–50.

    Article  Google Scholar 

  26. SAMW (Schweizerische Akademie der Medizinischen Wissenschaften). Medizin-ethische Richtlinien Betreuung von Patientinnen und Patienten am Lebensende. (2004, update 2012) http://www.samw.ch/de/Ethik/Richtlinien/Aktuell-gueltige-Richtlinien.html. Aaccessed 15 Jan 2015.

  27. Schneiderman LJ, et al. Medical futility: its meaning and ethical implications. Ann Intern Med. 1990;112:949–54.

    Article  CAS  PubMed  Google Scholar 

  28. Schneiderman LJ, et al. Medical futility: response to critiques. Ann Intern Med. 1996;125:669–74.

    Article  CAS  PubMed  Google Scholar 

  29. Schoenenberger AW, et al. Predictors of functional decline in elderly patients undergoing transcatheter aortic valve implantation (TAVI). Eur Heart J. 2013;34(9):684–92.

    Article  CAS  PubMed  Google Scholar 

  30. Schoenenberger AW, et al. Comprehensive geriatric assessment in patients undergoing transcatheter aortic valve implantation-rationale and design of the European CGA-TAVI registry. Eur Geriatr Med. 2014;5:8–13.

    Article  Google Scholar 

  31. Steinkamp N, Gordinj B. Ethik in Klinik – Ein Arbeitsbuch. Neuwied: Luchterhand; 2003.

    Google Scholar 

  32. Ungar A. A call to action – geriatrician’s experience in treatment of aortic stenosis and involvement on transcatheter aortic valve implantation. Eur Geriatr Med. 2013;4:176–82.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Thomas Frühwald .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Frühwald, T. (2015). Ethical Aspects of Interventional Cardiology in Geriatric Patients. In: Rittger, H. (eds) Interventional Cardiology in the Elderly. Springer, Cham. https://doi.org/10.1007/978-3-319-21142-8_11

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-21142-8_11

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-21141-1

  • Online ISBN: 978-3-319-21142-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics