“Not the years in themselves count”: the role of age for European citizens’ moral attitudes towards resource allocation in modern biomedicine
- 225 Downloads
Against the backdrop of controversial bioethical and public health debates on the role of age in decisions on healthcare allocation, we examine the perspectives of European lay persons on ethical implications of age and aging for medicine and health care.
Subject and methods
The study uses a qualitative approach based on the content analysis of 29 focus group discussions (235 participants) held in 4 European countries (Austria, Germany, the Netherlands, and Sweden) between 2005 and 2012.
While lay persons unanimously reject chronological age as a criterion for resource allocation, they acknowledge that age can be an important factor in ethical decision-making processes in many different ways. In the discussions, they articulate biographical concepts and viewpoints (such as age roles, ideas of the course and prime of life, responsibilities between generations), framing questions of resource allocation with regard to a teleological perspective of a good life.
Participants introduce a biographical outlook on medical decision making while at the same time articulating different conceptions of aging and the life course. Public health ethics needs to find ways to incorporate this plurality of temporal perspectives on the good life.
KeywordsAge Resource allocation Ethics Qualitative research Lay moralities
We would like to thank the participants of our focus groups for their time and for sharing their views. We also would like to thank Nitzan Rimon-Zarfaty (Negev) and Lukas Kaelin (Vienna) for helpful comments on an earlier version of this paper. Finally, we would like to thank Silke Schicktanz (Göttingen) who was the principal investigator in all three projects.
Conflict of interest
The authors declare that they have no conflict of interest.
- Binstock RH, Post SG, Mills LS (1991) Too old for health care?: controversies in medicine, law, economics, and ethics. Johns Hopkins University Press, Baltimore, MDGoogle Scholar
- Bloor M, Frankland J, Thomas M, Robson K (2001) Focus groups in social research. Sage, LondonGoogle Scholar
- Callahan D (1987) Setting limits: medical goals in an aging society. Schuster, New YorkGoogle Scholar
- Callahan D, ter Meulen RHJ, Topinková E (1995) A world growing old: the coming health care challenges. Georgetown University Press, Washington, DCGoogle Scholar
- Daniels N (1988) Am I my parents’ keeper? An essay on justice between the young and the old. Oxford University Press, New YorkGoogle Scholar
- Emanuel E (1991) The ends of human life: medical ethics in a liberal polity. Harvard University Press, CambridgeGoogle Scholar
- Friese S (2011) Qualitative data analysis with Atlas.ti. Sage, LondonGoogle Scholar
- Harris J (1985) The value of life. Routledge, New YorkGoogle Scholar
- Levkoff S, Wetle T (1989) Clinical decision making in the care of the aged. J Aging Health 1:83–101Google Scholar
- Mayring P (2004) Qualitative content analysis. In: Flick U, von Kardoff E, Steinke I (eds) A companion to qualitative research. Sega, Berlin, pp 266–269Google Scholar
- Morgan DL, Scannell AU (1997) Planning focus groups. Sage, LondonGoogle Scholar
- National Health Service (NHS) (2014) NICE drugs for the elderly is unchanged. http://www.nhs.uk/news/2014/02February/Pages/NICE-drugs-policy-for-the-elderly-is-unchanged.aspx. Accessed 14 March 2014
- Ryan M, Gerard K, Amaya-Amaya M (eds) (2008) Using discrete choice experiments to value health and health care. Springer, Dordrecht, The NetherlandsGoogle Scholar
- Schweda M (2013) Zu alt für die Hüftprothese, zu jung zum Sterben? Die Rolle von Altersbildern in der ethisch-politischen Debatte um eine altersabhängige Begrenzung medizinischer Leistungen. In: Duttge G, Zimmermann-Acklin M (eds) Gerecht sorgen. Verständigungsprozesse über den Einsatz knapper Ressourcen bei Patienten am Lebensende. Universitätsverlag Göttingen, Göttingen, Germany, pp 149–168Google Scholar
- ter Meulen RHJ (1995) Solidarity with the elderly and the allocation of resources. In: Callahan D, ter Meulen RHJ, Topinková E (eds) A world growing old: the coming health care challenges. Georgetown University Press, Washington, DC, pp 73–84Google Scholar
- Torres-Gil FM (1991) The new aging: politics and change in America. Auburn, Westport, CTGoogle Scholar
- Willey J (2014) NHS ban medicine if you are ‘too old’ in new attack on Britain’s elderly. Daily Express. http://www.express.co.uk/news/health/460371/NHS-ban-medicine-if-you-are-too-old-in-new-attack-on-Britain-s-elderly. Accessed 17 March 2014