Refusal of treatment.

The decision regarding refusal of treatment ultimately rests with competent adult patients. When the elderly patients is an inadequate or incompetent decision-maker, in order to protect the interests of the patient, the physician should have some knowledge of the way decisions are and ought to be made, particularly when a decision to forgo life-sustaining treatment is being deliberated. In acquiring this knowledge, the physician needs to develop clear understanding about who has the authority and responsibility to speak for the patient and what standards are to guide the decision-making process involving the incompetent patient. This is not an easy task for any physician. In many instances, the process can become clouded by a host of complex ethical and legal issues that make any decision a questionable one. A beginning point might be the acceptance of the fact that every elderly patient possesses values and goals that are quite unique to him, even though they might seem identical to those held by many other patients. This fact, more than anything else, will help to remove many of the impediments that face the physician during the decision-making process.