The Ethics of Deprescribing in Older Adults
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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 Informed consent is intended as a process of information giving and reflection, where consent can be withdrawn at any time.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
This work was supported by a Brocher Foundation residency (ER and RtM) and an early career researcher’s scholarship from the Brocher foundation (ER). The Brocher Foundation mission is to encourage research on the ethical, legal and social implications of new medical technologies. Its main activities are to host visiting researchers and to organize symposia, workshops, and summer academies. More information on the Brocher Foundation program is available at www.brocher.ch. The funder of this work had no involvement in the design or conduct of the study, collection, management, analysis or interpretation of the data, or preparation, review, or approval of the manuscript.
All authors significantly contributed to the production of this manuscript and qualify for authorship. All authors substantially contributed to the conception and design of the article, were involved in drafting (ER) or revising the draft critically for important intellectual content (PD, SH and RtM), and all authors have approved the final version for publication. All authors take public responsibility for the article.
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Conflict of interest
Nil conflicts of interest to declare.
- 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