The medico-legal issues relating to geriatric care in general practice are much the same as those affecting any other medical speciality or age group. It is however important to understand that older patients often have multiple problems and multiple treatments, and so the risks to them and of the clinician making mistakes can be higher.
Notwithstanding, there are some important areas of medico-legal complexity worthy of discussion.
The first, and arguably most important point, relates to the issue of exclusion from treatment. There have been well documented cases when patients have been excluded from treatment on the basis of age alone and this has precipitated legal challenges.
Another problem exists when a clinician chooses to treat some patients but not others, based on their perception of the potential benefit. One of the reasons a clinician may not intervene in some elderly patients is that they may consider that the patient will not benefit from the treatment. Sometimes this is an easy decision, for example an elderly patient disabled with widespread cancer, coronary heart disease and osteoarthritis of the hip is unlikely to benefit from a hip replacement. However, a lot of decisions are not clear-cut and are open to debate.
The final area of complexity is the use of advance directives. These living wills can be made verbally or in writing, which in itself poses problems of legitimacy. There have been a number of high profile cases in which the issues of advance directives have been debated at length and the issue remains a complex problem.