Ethical implications of population ageing in the intensive care unit.

Population ageing has significant ethical implications in the management of elderly patients in the intensive care unit (ICU). In the aspects of beneficence and non-maleficence, conflicting evidence has long existed regarding an association of older age with poorer prognosis, but elderly patients who have poor prognosis in the ICU may have a worse outcome if not admitted. More randomised controlled studies are needed to study the benefits of ICU admission to different subgroups of critically ill elderly patients. The acute care for the elderly unit could be developed to provide more comprehensive care to the elderly. ICU resource rationing should follow clear guidelines with a pluralistic strategy of distributive justice, which incorporates the core proposition of "veil of ignorance" with the anti-ageist and equalist view so that age itself should not be a criterion but any associated risks with age confirmed by studies should be taken into account of assessing prognosis and outcome. There may be a need for improvement in protection for patients' right to autonomy in the ICU.