Intensive care for extremely elderly patients is expanding rapidly because of population aging and a trend toward more aggressive therapies. Yet, such care often delivers only marginal benefits for the oldest individuals, many of whom end up dying after lengthy periods of organ support. Taking a clinical perspective, this study examines the forces driving the growing use of critical care in advanced age, even though its potential drawbacks for patients, families, clinicians, and society are widely acknowledged. A theoretical examination of how the medicalization of aging and dying influences intensive care delivery for very old patients, using Ian Hacking’s notions of human kinds, interactive kinds, and natural indifferent kinds as the guiding philosophical lens. Age-related bodily changes heighten the risk of developing critical illness and of dying from it. However, age by itself is not considered a disease — despite some recent attempts to classify it as such. Seeing advanced age as a human, interactive kind accounts for the medicalization of aging and dying as an ongoing, self-sustaining cycle. Labeling the natural course of aging and dying as diseases creates a strong moral pressure to offer life-prolonging treatments to very old patients, irrespective of the doubtful net benefit. As a result, sticking strictly to this medically framed connection between illness severity and treatment intensity generates far greater uncertainty in clinical decision-making for elderly patients in intensive care units than for younger ones. Delivering appropriate care to very old patients with critical illness requires a broader clinical framework in which philosophical ideas and social theories enrich and extend purely medical and scientific understanding.
