[Cardiovascular ageing and ethics].
According to the results of the literature, the benefit/risk ratio of myocardial revascularisation techniques is much higher in terms of symptoms and quality of life in patients over 75 years of age with acute coronary syndromes, although it is generally accepted that the risks associated with these techniques are greater in this age group. However, the publications continue to report that inequality of access to these methods increases with age. The conclusions of these trials often denounce these practices ethically because of the loss of opportunity which these patients experience. When the results are examined more closely, the analysis which may be made of these differences based on the four founding principles of biomedical ethics lead to less definite conclusions. It is not always clear that the best medical approach in terms of ethics is to propose a massive management with myocardial revascularisation, because a medical decision does not always limit itself in ethics terms to the strict medical or, more precisely, the cardiological risk/ratio in the short-term. Before expressing a judgment on existing practices, it would be preferable to analyse the arguments, case by case, which lead to the decision not to apply the recommendations of the literature. It would be especially valuable to know what the patients think of themselves when confronted with these situations. A study using the clinical ethical method would certainly be of value in obtaining this data.
Fournier
V
V
Hôpital Cochin, Centre d'éthique clinique, 27, rue du Faubourg Saint-Jacques, 75674 Paris.
D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D002319:Cardiovascular System; D006801:Humans; D009204:Myocardial Revascularization / Q000941:ethics*