Ethical Issues in Geriatric Gastroenterology

Physicians are often introduced to the concept of ethics in medical school, but ethics extends beyond the Hippocratic Oath. This chapter first establishes a theory of ethics in order to give physician readers a deeper understanding of ethics. A description follows on current trends and ethical practices of gastroenterologists as it pertains to the older adult. Areas covered are decision-making capacity and its importance, differentiation of capacity from competence, and its impact in practice. Patient autonomy and the principles of beneficence, nonmaleficence, and justice are explained. The importance of advance care planning, approach to implementing advance directives, and barriers to executing them in practice is explained. The adverse consequences of chemical and physical restraints are discussed. Suicide in older adults, bereavement, and the many forms of abuse are briefly addressed. Examples of cases are offered for illustration. Although this chapter is by no means comprehensive or intended to offer legal advice, the authors anticipate that the gastroenterologist and providers of care will gain an overview of ethical aspects applicable to the diagnostic tools and techniques used in the management of older people with gastrointestinal illness.