Problem: Concern Is Growing That the Elderly Get Too Many Medical Tests Increasingly, questions are being raised about the over testing of older patients, part of a growing skepticism about the widespread practice of routine screening for cancer and other ailments of people in their 70s, 80s, and even 90s. Critics say there is little evidence of benefit-and considerable risk-from common tests for colon, breast and prostate cancer, particularly for those with serious problems such as heart disease or dementia that are more likely to kill them. "The most important thing on any referral is the date of birth," said [Washington radiologist Mark] Klein, who said he tries to talk some older patients and their doctors out of pursuing tests and treatments he considers overly aggressive. "The game is not finding things, it's can you improve mortality? And if you do find something, it's very hard for a doctor to say, ‘Don't do anything Telling someone that screening is no longer necessary can be dicey, as California family physician Pamela Davis discovered when she advised her robust 86-year-old mother to stop getting mammograms and routine colon tests. Her mother was incensed.

Sandra G. Boodman, Kaiser Health News, September 12, 2011 Do you consider this article useful and well balanced? In answering this question, consider the following quoted abstract. The costs of providing dialysis for patients 70 years and over are largely shaped by the treatment costs rather than by use of community health and social services. Though age above 80 and co-morbidity are associated with increased resource use, average treatment costs are not higher than estimates for dialysis patients in general. This suggests that there is no case for providing treatment to younger patients and denying it to elderly patients on grounds of cost. From R. P. Grün, N. Constantinovici, C. Normand, D. L. Lamping, and for the North Thames Dialysis Study (NTDS) Group, 2003, "Cost of Dialysis for Elderly People in the UK," Nephrology Dialysis Transplantation, 18, no. 10, pp. 2122-2127. Is this type of thinking the beginning of a slippery downhill slide that merely grows over time? Consider what is the magic age at which we should discourage more tests. There are 50-year-olds who look 70 and 70-year-olds who look 50. And there are some whose age is well hidden beneath their skin. Who are we to judge by one's age? Is this kind of thinking the beginning of the downfall of a compassionless society? As medicine becomes safer as to how surgeries are performed (e.g., robotic surgery), why should age be the criteria break point for who gets what?

1. Would you choose Dr. Klein in the news article to care for your loved ones? Would you want a physician who would decide your fate using age as a criteria for life? Do our constitutional rights diminish after age 70?

2. Could this type of thinking be a downhill spiral, the beginning of a new ethical theory, or does it fit into the category of one that already exists? Discuss your answer in light of the following ethical theories: normative ethics, consequential ethics, utilitarian ethics, deontological ethics, non consequential ethics, and ethical relativism.

3. Who should decide whether a test is valuable for a person over 40, 50, or 70?