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Academia and the Profession |

Medical Management Decisions in Nursing Home Patients: Principles and Policy Recommendations

RICHARD F. UHLMANN, M.D., M.P.H.; HUGH CLARK, M.D.; ROBERT A. PEARLMAN, M.D., M.P.H.; JOSEPH C. M. DOWNS, M.D.; JOHN H. ADDISON, M.D.; and ROBERT G. HAINING, M.D.
[+] Article and Author Information

Grant support: Dr. Uhlmann is the recipient of Academic Award AG00265 from the National Institute on Aging.

▸Requests for reprints should be addressed to Richard F. Uhlmann, M.D.; Harborview Medical Center, 325 9th Avenue, ZA-87; Seattle, WA 98104.


Seattle, Washington


© 1987 American College of PhysiciansAmerican College of Physicians


Ann Intern Med. 1987;106(6):879-885. doi:10.7326/0003-4819-106-6-879
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The ethical principles of medical decision making are inherently the same for nursing home residents, who represent an increasingly large segment of the population, as they are for other adult patients. In practice, however, a number of considerations require specialized application of these principles in nursing homes. Notably, a large proportion of nursing home patients are at high risk for morbid and mortal events yet are incapable of expressing medical management preferences due to dementia and confusion. Policies and procedures regarding medical decisions for nursing home patients are needed. We present and discuss a policy for patient care in nursing homes based on recommendations of a national biomedical ethics committee. This policy, which may be adapted for use in specific institutions, explicitly discusses the principles of care and their application in nursing homes. It also encourages prospective decision making and provides advance care directives for patients and their decision-making surrogates to do so.

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nursing homes

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