The strange case of Mr. H. Starting dialysis at 90 years of age: clinical choices impact on ethical decisions

BMC Medical Ethics 2017 18:61
Authors: Giorgina Barbara Piccoli, Andreea Corina Sofronie, Jean-Philippe Coindre
“Starting dialysis at an advanced age is a clinical challenge and an ethical dilemma. The advantages of starting dialysis at “extreme” ages are questionable as high dialysis-related morbidity induces a reflection on the cost- benefit ratio of this demanding and expensive treatment in a person that has a short life expectancy. Where clinical advantages are doubtful, ethical analysis can help us reach decisions and find adapted solutions.”
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Dutch geriatrician faces charges over euthanasia case

BMJ 2017; 359: j4639
Author: Tony Sheldon
“A specialist in elderly care medicine could face prosecution under the Netherlands’ euthanasia laws after ending the life of a 74 year old nursing home patient with advanced dementia. The woman was considered no longer competent to consent but had previously signed a living will requesting euthanasia. Yet Dutch public prosecutors have launched a criminal investigation, claiming a “serious suspicion” that a criminal offence had been committed. This is the Netherlands’ first such investigation under the reporting arrangements established in the 2002 euthanasia law.”
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A Prospectus for ethical analysis of ageing individuals’ responsibility to prevent cognitive decline

Bioethics, 2017;00:1–9
Authors: Cynthia Forlini, Wayne Hall
“Ethical tensions arise when this individual responsibility collides with social and personal realities of ageing populations. First, we contextualize the priority given to healthy cognitive ageing within the current brain-based medical and social discourses. Second, we explore the individual responsibility by examining the economic considerations, medical evidence and individual interests that relate to the priority given to healthy cognitive ageing. Third, we identify three key ethical challenges for policymakers seeking to implement lifestyle recommendations as an effective population-level approach to healthy cognitive ageing. The result is a prospectus for future in-depth analysis of ethical tensions that arise from current policy discussions of healthy cognitive ageing.”
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Pathogenic variants in the healthy elderly: unique ethical and practical challenges

Journal of Medical Ethics 2017; 43: 714-722.
Author: Paul Lacaze, Joanne Ryan, Robyn Woods, Ingrid Winship, John McNeil
“Genetic research into ageing, longevity and late-onset disease is becoming increasingly common. Yet, there is a paucity of knowledge related to clinical actionability and the return of pathogenic variants to otherwise healthy elderly individuals. Whether or not genetic research in the elderly should be managed differently from standard practices adapted for younger populations has not yet been defined. In this article, we provide an overview of ethical and practical challenges in preparing for a genetic study of over 14?000 healthy Australians aged 70?years or older enrolled in the ASPirin in Reducing Events in the Elderly (ASPREE) Healthy Ageing Biobank.”
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Nursing Home Certificate-Of-Need Laws Should Be Repealed

Health Affairs Blog, 9 June 2017
Author: David Grabowski
“Despite evidence against them, 34 states still have certificate-of-need laws on the books. One reason why states have maintained these laws is their incredible popularity with nursing homes. If a system is lucky enough to have a regulated monopoly, it will not give that monopoly up easily. Nursing homes have argued that certificate of need allows them to keep sufficient occupancy levels to cover their costs. This guaranteed occupancy is a boon for nursing homes, but hurts consumers. If a nursing home cannot maintain sufficient occupancy without certificate of need, it is likely a sign that the nursing home is not providing adequate quality.”
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