title: The Ethics of Deprescribing in Older Adults.
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 Informed consent is intended as a process of information giving and reflection, where consent can be withdrawn at any time.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.
authors.affiliation: 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@sydney.edu.au.
authors.forename: Emily
authors.identifier: http://orcid.org/0000-0002-1405-999X
authors.initials: E
authors.lastname: Reeve
authors.affiliation: Faculty of Medical Sciences, Clinical Pharmacy & Pharmacology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, Netherlands.
authors.forename: Petra
authors.initials: P
authors.lastname: Denig
authors.affiliation: 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.
authors.forename: Sarah N
authors.initials: SN
authors.lastname: Hilmer
authors.affiliation: 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.
authors.forename: Ruud
authors.initials: R
authors.lastname: Ter Meulen
mesh_terms: D000367:Age Factors; D000368:Aged; D063506:Ageism; D026686:Beneficence; D001675:Bioethics; D003071:Cognition; D003657:Decision Making; D000069340:Deprescriptions; D011307:Drug Prescriptions; D004992:Ethics, Medical; D005190:Family; D006801:Humans; D057970:Inappropriate Prescribing; D007258:Informed Consent; D009014:Morals; D010358:Patient Participation; D026684:Personal Autonomy; D012935:Social Justice
keywords: Bioethics; Deprescribing; Elderly; Inappropriate medication use; Medication withdrawal; Principlism