infrastructure funding. Because significant funding for health services delivery studies comes from outside NIH, additional funds are requested from agencies traditionally supporting this research (e.g., the Health Care Financing Administration and the Agency for Health Care Policy and Research).

Ethical issues accompany all aspects of health care of older persons and are at the heart of research on this group. Areas of major importance in ethics and in the study of aging include the following: dilemmas regarding life-sustaining treatment, selection of therapeutic interventions based on age, distribution of health care resources, and the need to include older subjects in research. Prolonging life in some patients may not (or may) be desired by them or be appropriate; guidelines to establish, responsibility for these decisions often are problematic for elderly persons. Competing social needs, growing costs of care, and the enlarging population of sick and disabled older persons pose problems of resource allocation that require agreement on how to make such determinations fairly. Finally, there is a need to determine the most ethical way to do research on older persons who are institutionalized, frail, or cognitively impaired.

Funds should be provided to conduct analytical and empirical research on biomedical ethical issues in three priority areas:

Dilemmas regarding life-sustaining treatment

Allocations of health care resources

Participation in clinical research by frail elderly persons

These opportunities include:

• study of clinician-patient interaction regarding life-sustaining technologies;

• research into decision making for incompetent patients who lack advance directives;

• study of the role of institutional ethics committees;

• the identification of medical futility;

• study of resolution of disagreements between caregivers and patients or their families;