AUTONOMY AND PATERNALISM IN GERIATRIC-MEDICINE - THE JEWISH ETHICAL APPROACH TO ISSUES OF FEEDING TERMINALLY ILL PATIENTS, AND TO CARDIOPULMONARY-RESUSCITATION

Respecting and encouraging autonomy in the elderly is basic to the pra ctice of geriatrics. In this paper, we examine the practice of cardiop ulmonary resuscitation (CPR) and ''artificial'' feeding in a geriatric unit in a general hospital subscribing to Jewish orthodox religious p rinciples, in which the sanctity of life is a fundamental ethical guid eline. The literature on the administration of food and water in termi nal stages of illness, including dementia, still shows division of opi nion on the morality of withdrawing nutrition. We uphold the principle that as long as feeding by naso-gastric (N-G) or percutaneous endosco pic gastrostomy (PEG) does not constitute undue danger or arouse serio us opposition it should be given, without causing suffering to the pat ient. This is part of basic care, and the doctor has no mandate to wit hdraw this. The question of CPR still shows much discrepancy regarding elderly patients' wishes, and doctors' opinions about its worthwhilen ess, although up to 10 percent survive. Our geriatric patients rarely discuss the subject, bur it is openly ventilated with families who ask about it, who are then involved in the decision-making, and the decis ion about CPR or ''do-not-resuscitate'' (DNR) is based on clinical and prognostic considerations.