Geriatric health system, economic profit and the debate on euthanasia

Three characteristic developments in modern western societies usually are c onsidered to be independent variables in the ethical discussion: 1. An explosion-like increase in medical and social expenditures following a rapid multiplication of old and multiply disabled people in this century . 2. The increasing economic importance of the "health industry", and 3. The "new" debate on euthanasia. All these developments are discussed con troversially. The volume of geriatric support is mostly considered to be in sufficient, but usually it is restricted by both, scarcity of resources as well as increasing demands to focus on "evidence-based medicine" (which mig ht exclude a lot of medical procedures in old age). The mutation of health systems from - originally - social activities to business branches more and more gives priority to economical based decisions in medicine, but otherwi se has advanced an increasing number of new health professions. The origin of the actual debate on euthanasia is the development and judici al certification of individual's self-determination in modern societies. Ho wever, euthanasia is still refused world-wide because it is considered to b e linked with a process of weakening basic ethical principles. The 3 seemingly independent developments certainly are facts in modern soci eties. They hardly can be influenced by the medical profession, being force d to conform to them. However, there are significant connections between th em. A geriatric health system, primarily denying individual demands and basic c onvictions of old people, contributes to an attitude of non-acceptance towa rds daily practice medicine. The same effect may result from the economic t ransformation of medicine when creating a system of self-perpetuating deman d (being characteristic for an "ideal" business branch) by "unlimited" prol ongation of life of the very old and highly disabled patients. The result from this development undoubtedly will be an increasing demand f or self-determination at the end of life, including medical assistance in s uicide and euthanasia, which cannot successfully be confronted with moral a ppeals. Alternatively, a basic correction of the geriatric health system must be in troduced mainly including psychodynamic factors in medical decision making, or euthanasia will be accepted by the majority, as already has happened in the Netherlands.