Ethically justified clinical strategies for promoting geriatric assent

Objective To develop ethically justified clinical strategies for promoting geriatric assent with a focus on the application of professional virtues. Method The concept of geriatric assent was extended to all geriatric patients incapacitated by cognitive impairments, including dementias, and practical clinical steps for promoting geriatric assent were developed. Results A four step-process for promoting geriatric assent is proposed by balancing the principles of beneficence and respect for autonomy within the context of the psychiatrist's virtues. These four steps include identifying the patient's long-standing values and preferences; assessing plans of care in terms of biopsycho-social safety and independence along with the patient's values and preferences; protecting remaining autonomy; and cultivating the professional virtues of steadiness, self-effacement, and self-sacrifice when making decisions that risk the patient's future health and safety. Conclusions In promoting geriatric assent, psychiatrists are obligated to support and directively counsel the patient's surrogate to adopt care plans that promote the patient's values and preferences to the extent possible. These clinical strategies for promoting geriatric assent should serve to enhance the patient's remaining sense of integrity and dignity. These strategies should also protect remaining health status and therefore protect remaining autonomy. Copyright (c) 2006 John Wiley & Sons, Ltd.