title: Ethical framework for medication discontinuation in nursing home residents with limited life expectancy.
abstract: A recent editorial by health economist Victor Fuchs summarized the current challenges with health care delivery in this way: “Most physicians want to deliver ‘appropriate’ care. Most want to practice ‘ethically’, but it is difficult to know what is ‘appropriate’ and what is ‘ethical’. This characterization is particularly true for medication use and deprescribing in elderly NH residents with limited life expectancy. Medical ethics sets 4 key principles (beneficence, nonmaleficence, patient autonomy, and justice) to guide practice. However, decisional conflicts will continue between providers and patients, and physicians will continue to struggle with the dilemma of balancing the primacy of patient welfare, values, and beliefs against the desire for promising, but often minimally beneficial and harmful, medications that threaten limited clinical resources. Despite these challenges, physicians should be able to perform systematic medication reviews and monitor discontinuation trials in their NH patients for whom this is consistent with their goals of care.
authors.affiliation: Division of Geriatric Medicine, University of Massachusetts Medical School, Worcester, MA 01605, USA. jennifer.tjia@umassmed.edu
authors.forename: Jennifer
authors.initials: J
authors.lastname: Tjia
authors.forename: Jane
authors.initials: J
authors.lastname: Givens
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003657:Decision Making; D017723:Drug Utilization Review; D004992:Ethics, Medical; D005260:Female; D006707:Homes for the Aged; D006801:Humans; D008017:Life Expectancy; D008297:Male; D028681:Moral Obligations; D009735:Nursing Homes; D010043:Outcome and Process Assessment, Health Care; D057240:Patient Preference; D019338:Polypharmacy; D028662:Principle-Based Ethics; D026712:Value of Life