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Choosing Medical Care in Old Age: What Kind, How Much, When to Stop [Paperback]

Muriel R. Gillick (Author)

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Book Description

October 1, 1996

You are old, ill, in pain, and your doctor asks you what you want to do about it. You may be uncertain but you're definitely not alone. By the year 2020, some 50 million Americans will be over sixty-five, and as the nation ages we must all ask what we ought to do about the health and medical care of our elderly. Our response will have profound consequences, not just for individuals and families, but for society as a whole. This book helps us start to form an answer.

To make decisions about medical care in old age, we need to know more about the reality of being elderly and sick, and Choosing Medical Care in Old Age gives us the opportunity. Muriel Gillick, a noted physician who specializes in the care of the elderly and in medical ethics, presents a panoply of stories drawn from her clinical experience. These encounters, with the robust and the frail, the demented and the dying, capture the texture of the experience of being old and faced with critical medical questions. From the stories of older people struggling to make choices in the face of acute illness, stories that are often poignant and sometimes tragic, Gillick develops broad guidelines for medical decision–making for the elderly. Within this framework, she confronts particular concerns and questions. When are certain procedures too burdensome to be justified? What are unacceptable risks? Should family members serve as exclusive spokespersons for relatives who can no longer speak for themselves? Gillick's bold and personal prescription for medical care for the elderly calls for a change in the way medicine is understood and practiced, as well as for changes in the institutions that serve the elderly, such as hospitals and nursing homes. An intelligent and deeply compassionate inquiry into the difficult issues and real–life dilemmas raised by current practices, her book offers a first step toward those changes.


Editorial Reviews

Review

Gillick's personal and compassionate approach to medical decision making in old age is bound to spark controversy about patients' autonomy, proxy rights, rationing, and standards of care. Her ideas about institutional change strike at the structure and process of today's health care delivery system. I hope this book will be widely read, not only by clinicians, but also by ethicists, policymakers, and the general public and that it will stimulate the conversations that will ultimately lead to the social consensus Gillick feels is missing today when we choose medical care in old age.
--Katherine A. Hesse, M.D., M.S.W (New England Journal of Medicine )

A unique and fertile source of impressions from a seasoned clinician, grappling with the tensions between patients and policy.
--Sheldon M. Retchin, M.D (Journal of the American Medical Association )

Dr. Gillick is an advocate for her patients and other older persons...Additionally she is a realist; her ready recognition of the inherent ambiguities and uncertainties of prediction and prognosis that characterizes geriatrics--indeed, that infiltrate all facets of medical practice--only adds to her credibility. She does not hesitate in these pages to ask the hard questions. Her approach to difficult ethical circumstances is a model of compassionate reason for other physicians.
--Marshall B. Kapp, J.D., M.P.H (Journal of Ethics, Law, and Aging )

I enthusiastically recommend this book. It is a pleasure to read: clear, engaging, though–provoking. Gillick is not afraid to convey her own misgivings about her work as a geriatric physician, and these lead to her basic thesis, that all of us need to think about the kinds of decisions we will have to face when our parents and when we ourselves age. This is an excellent book.
--David C. Thomasma (Loyola University)

Review

I enthusiastically recommend this book. It is a pleasure to read: clear, engaging, though–provoking. Gillick is not afraid to convey her own misgivings about her work as a geriatric physician, and these lead to her basic thesis, that all of us need to think about the kinds of decisions we will have to face when our parents and when we ourselves age. This is an excellent book. (David C. Thomasma (Loyola University) ) --This text refers to an out of print or unavailable edition of this title.

Product Details


More About the Author

Muriel R. Gillick is a geriatrician, palliative care physician, and writer. She sees patients at Harvard Vanguard Medical Associates, a multi-specialty group practice in Boston and surrounding communities, and she is also a Clinical Professor at Harvard Medical School. Her scholarly work focuses on ethical issues near the end of life and is conducted at the Department of Population Medicine, Harvard Pilgrim Health Care Institute/Harvard Medical School.

As an undergraduate history major at Swarthmore College, she developed what would prove to be a life-long interest in German history, World War II, and the refugee experience. Her forte is writing stories based on real people and putting the narrative into a broader context. She used the same technique in "Once They Had a Country" as in her books on medical themes written for a general audience: "Choosing Medical Care in Old Age," "Tangled Minds," "Lifelines," and "The Denial of Aging."

Dr. Gillick is married and has three adult sons. She lives with her husband outside Boston.

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