The Ethics of Deprescribing in Older Adults
Deprescribing is the term used to describe the process of withdrawal of an inappropriate medication supervised by a clinician. This article presents a discussion of how the Four Principles of biomedical ethics (beneficence, non-maleficence, autonomy, and justice) that may guide medical practitioners’ prescribing practices apply to deprescribing medications in older adults. The view of deprescribing as an act creates stronger moral duties than if viewed as an omission. This may explain the fear of negative outcomes which has been reported by prescribers as a barrier to deprescribing. Respecting the autonomy of older adults is complex as they may not wish to be active in the decision-making process; they may also have reduced cognitive function and family members may therefore have to step in as surrogate decision-makers. Informed consent is intended as a process of information giving and reflection, where consent can be withdrawn at any time. However, people are rarely updated on the altered risks and benefits of their long-term medications as they age. Cessation of inappropriate medication use has a large financial benefit to the individual and the community. However, the principle of justice also dictates equal rights to treatment regardless of age.
KeywordsPrinciplism Deprescribing Bioethics Medication withdrawal Inappropriate medication use Elderly
- Australian Institute of Health and Welfare. 2012. Dementia in Australia. Cat. no. AGE 70. Canberra, AIHW.Google Scholar
- Beauchamp, T., and J. Childress. 2012. Principles of biomedical ethics. Oxford: Oxford University Press.Google Scholar
- Hill‐Taylor, B., I. Sketris, J. Hayden, S. Byrne, D. O’Sullivan, and R. Christie. 2013. Application of the STOPP/START criteria: A systematic review of the prevalence of potentially inappropriate prescribing in older adults, and evidence of clinical, humanistic and economic impact. Journal of Clinical Pharmacy and Therapeutics 38(5): 360–372.CrossRefPubMedGoogle Scholar
- Jonsen, A.R., and S.E. Toulmin. 1988. The abuse of casuistry: A history of moral reasoning. University of California Press.Google Scholar
- Mill, J.S. 1961. Utilitarianism. London: Dent.Google Scholar
- NPS MedicineWise. 2015. National Prescribing Service Limited. http://www.nps.org.au/. Accessed 13 May, 2015.
- Schneider, A., T. Körner, M. Mehring, M. Wensing, G. Elwyn, and J. Szecsenyi. 2006. Impact of age, health locus of control and psychological co-morbidity on patients’ preferences for shared decision making in general practice. Patient Education and Counseling 61(2): 292–298.CrossRefPubMedGoogle Scholar