Shared Decision-Making at the End of Life

A critical transformation of the current era seems to be medicine’s conquest of old age, beginning with its acquired ability to prolong human life. Providing increasingly effective health care for the elderly has become the most extensive of medicine’s frontiers. This is also an ideal of a moral nature: it is a discrimination unworthy of medicine the idea that the age of the patient can be a variable to be taken into account, if there are the technical means to be able to bring him the benefits (the standards of treatment should not take into account the age). However, not everyone considers this orientation justified. More recently, following the current pandemic of COVID-19 has indicated age as a limit to entry into intensive care. Then the question of whether laparoscopic surgery should also be applied to the elderly patient also arose at first, and the conclusion was reached that despite underlying comorbidities, individuals older than 65 years tolerate laparoscopic procedures extremely well. Besides, sickness speaks to us of our limitations and human frailty. It can take the form of infirmity resulting from the simple passing of years or injury from the exuberance of youthful energy. It can be temporary or chronic, debilitating, and even terminal, but ethical principles that govern medical decisions in elderly and frail patients should be no different from those that guide all medical choices in all patients, although any decision cannot fail to take into account the condition of the elderly and frail patient as a contextual aspect and not as a decisional criterion. In surgery, it has been more difficult than in medicine to understand that when surgery is no longer possible, the surgeon’s task is not yet finished and he can offer palliative treatment to accompany patient. At this point, the ethical question arises as to whether what is technically possible is also ethically right.