Cardiac Disease in the Elderly: Interventions, Ethics, Economics

CARLO CONTI You are today confronting sensitive questions on the subject of "Cardiac surgery and heart diseases in old age" and I congratulate you on this. It is a brave and important step to discuss this multifaceted question which demands an answer and an explanation from many perspectives: From a medical perspective, there is the question of the medical feasibility and durability of treatment. From an economic angle we ask ourselves whether we can pay for everything that is medically feasible. From the patient's perspective there is the legitimate de­ sire and the justified need not to leave anything untried that might serve to sustain or improve the quality of life. The ethical perspective: is what is feasible really desirable? Should everything be done simply because it can be done? Is it ethically acceptable to set an age limit on an opera­ tion that in all probability will produce an improvement in the quality of life? And if so, where does this limit lie? Below it surgery is "worthwhile" but above it is not? No­ one in all seriousness and with a clean conscience will want to draw this line randomly or arbitrarily. That ap­ pears to us - quite rightly - morally unacceptable. The doctors' perspective: they are obliged by the Hippo­ cratic oath in principle to carry out all the treatments that are indicated and comply with the rules of the art of med­ ICIne.