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The Ethics of Deprescribing in Older Adults

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Abstract

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 Informed consent is intended as a process of information giving and reflection, where consent can be withdrawn at any time.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.

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Acknowledgments

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.

Author Contributions

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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Authors and Affiliations

  1. Ageing and Pharmacology, Cognitive Decline Partnership Centre, Kolling Institute of Medical Research, Sydney Medical School, University of Sydney, Level 12 Kolling building, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia

    Emily Reeve

  2. Faculty of Medical Sciences, Clinical Pharmacy & Pharmacology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, Netherlands

    Petra Denig

  3. Departments of Aged Care and Clinical Pharmacology, Royal North Shore Hospital and Cognitive Decline Partnership Centre, Kolling Institute of Medical Research, Sydney Medical School, University of Sydney, Level 12 Kolling building, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia

    Sarah N. Hilmer

  4. Centre for Ethics in Medicine, School of Social and Community Medicine, University of Bristol, Office Room G.04b, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK

    Ruud ter Meulen

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  1. Emily Reeve
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Correspondence to Emily Reeve.

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Reeve, E., Denig, P., Hilmer, S.N. et al. The Ethics of Deprescribing in Older Adults. Bioethical Inquiry 13, 581–590 (2016). https://doi.org/10.1007/s11673-016-9736-y

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