A common dilemma is the evaluation of an old person's capability of decision making, both about management of his affairs, or regarding approval to treatment, or contribution in study. Because cognitive capability is not always indistinguishable with competency, meaningful tools have recently been developed in which the stress is on the precise situation to be examined.
The changed interactions among the elderly patient and his or her environment may bring about ethical dilemmas in the behavioral patterns as the result of the pressure of sickness and care giving. Dependence due to physical, emotional, or mental disability in the aged infirm person is often provoked by earlier and coexisting dysfunction. This has effect also on the family who may be responsible for his supervision, and also troubled with the old person's care, and there is often an insistent need for strengthening of the social help needed for this condition. Likewise, the weakness of elderly persons may present delicate ethical issues in the determination of their ability to agree to join forces in clinical research in old age. This paper discusses some of these dilemmas in the management of disability and in the practice of clinical research in old people.
These units revolve round the psychology of "I", the subjective insight of identity, and the "Me", the objective perception of the person by others. The question of personhood and what constitutes a "person" must also be addressed if infirmity and illness become dominant features of old age. In a debate defining personhood, it was noticed that the theory of psychological continuity and connectedness would be liable to understand the frenzied person as having a different individuality, because this condition is fundamentally one of disengagement. The sign of the loss of personality is often uttered by the relations: "This is not the father/mother that I have always known". In this situation, his dementia causes him almost to lose his unique sovereignty. According to Hughes, conversely, it is important to see the person as one who is "acting and interacting in a cultural historical context in which he is embedded" This vision of the person as a "situated embedded agent" could therefore involve that even if he suffers from dementia he is not involuntarily detached from his historical ancestry and, until or unless he reaches a vegetative phase of total ignorance of his environment, he should be considered as keeping hold of some measure of self-sufficiency.
Autonomy is a person's capability and chance to make decisions involving his/her own desires. In a self-governing culture, many sovereign people are self-directed, but not all people with autonomy are unavoidably autonomous. A wheelchair bound person for example, can hold the power to order someone to carry out his requirements, and present communication equipment