Ph.D Thesis

Ph.D StudentYakov Gila
SubjectEthical Aspects of Health Care of the Old Oncology Patient
DepartmentDepartment of Education in Science and Technology
Supervisors PROF. Gideon Alroy (Deceased)
PROF. Asa Kasher
MR Michael Moore (Deceased)
Full Thesis text - in Hebrew Full thesis text - Hebrew Version


This dissertation will describe a field study that was held at a large oncology center and aimed at locating and documenting ethical dilemmas experienced by medical personnel treating oncologic elderly patients.

According to the literature, elderly patients are prone to be a subject of discrimination in medical treatment; discrimination known as “ageism”, for methodological reasons, this study focused on autonomic status of the oncologic elderly patient. No overt discrimination towards elderly patients was detected. There were some indicators that could be interpreted as latent discrimination. However, the principal message is that, on the one hand, vigilance and cautiousness are required in treating ethically the oncologic elderly patients, in effort to provide the best treatment to the group of patients that, if compared to other age groups, is statistically predisposed to accompanying illnesses. And On the other hand, mindfulness of the elderly in general as a weak and fragile group of people at the end of their life cycle.

This study is defined as a case study. A qualitative approach was used, which included: interviews, observations and focus groups. The study population included multi-professional oncology team members.

The results of the analysis depict a complex reality that reflects the ethical dilemmas experienced by the medical personnel. The most significant issue, brought to a focus of the field study, is the autonomy of the elderly oncologic patient.

In addition, the informants indicate the dominant role of the elderly patient’s family. Examining actual daily proceedings this study portrays a more complex reality that will be discussed in the dissertation.

It is proposed to adopt an elderly patient’s general condition diagnosing tool known as Comprehensive Geriatric Assessment (CGA). Usage of this tool will assist medical staff in determining the degree of the patient’s autonomy and in acting accordingly.

In addition, following the findings of this investigation we propose an ethical model of behavior. Its purpose is to regulate the status of the elderly oncologic patient’s  relatives  as a  part  of  respect  for autonomy.

It is proposed to sustain a regular framework for dealing with ethical issues which arise from the daily practice - a framework that would be represented by various healthcare providers and would function on a regular basis.

The hereby proposed processes promote transparency and clarity in decision making and encourage creation of an appropriate ethical climate.