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Subtle ethical dilemmas in geriatric management and clinical research
  1. A J Rosin,
  2. Y van Dijk
  1. Department of Geriatrics, Shaare Zedek Medical Center, Jerusalem, Israel
  1. Correspondence to:
 A J Rosin
 Department of Geriatrics, Shaare Zedek Medical Center, Jerusalem, Israel;


Routine management of geriatric problems often raises ethical problems, particularly regarding autonomy of the old person. The carers or children may be unaware of the sensitivity of role reversal in dealing with the financial affairs; the need for a residential carer may compromise the old person’s privacy. Attending a day centre confers much benefit, but one must understand the old person’s resistance to change in the proposal of a new daily regimen. Similarly his or her autonomy must be the priority in planning for admittance to an old age home, and not the assumption that the family knows best. A common dilemma is the assessment of an old person’s competency in decision making, either about management of his affairs, or regarding consent to treatment, or participation in research. Because cognitive capacity is not always identical with competency, meaningful tools have recently been developed in which the emphasis is on the specific situation to be investigated.

  • ADAS-cog, Alzheimer’s Disease Assessment Scale-cognition
  • LS, legal standard
  • MacCAT-CR, MacArthur Competency Assessment Tool for Clinical Research
  • MMSE, Mini-Mental State Examination
  • ethics
  • old persons
  • management dilemmas
  • competency assessment
  • clinical trials

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