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J Med Ethics 34:863-868 doi:10.1136/jme.2008.025247
  • Clinical ethics

Value judgements in the decision-making process for the elderly patient

  1. J Ubachs-Moust1,
  2. R Houtepen1,
  3. R Vos1,
  4. R ter Meulen2
  1. 1
    Department of Health, Ethics & Society, School for Public Health and Primary Care (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
  2. 2
    Centre for Ethics in Medicine, Department of Community Based Medicine, Faculty of Medicine and Dentistry, University of Bristol, Bristol, UK
  1. Miss J Ubachs-Moust, Department of Health, Ethics & Society, School for Public Health and Primary Care (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands; j.ubachs{at}hes.unimaas.nl
  • Received 25 March 2008
  • Revised 23 June 2008
  • Accepted 2 July 2008

Abstract

The question of whether old age should or should not play a role in medical decision-making for the elderly patient is regularly debated in ethics and medicine. In this paper we investigate exactly how age influences the decision-making process. To explore the normative argumentation in the decisions regarding an elderly patient we make use of the argumentation model advanced by Toulmin. By expanding the model in order to identify normative components in the argumentation process it is possible to analyse the way that age-related value judgements influence the medical decision-making process. We apply the model to practice descriptions made by medical students after they had attended consultations and meetings in medical practice during their clinical training. Our results show the pervasive character of age-related value judgements. They influence the physician’s decision in several ways and at several points in the decision-making process. Such explicit value judgements were not exclusively used for arguments against further diagnosis or treatment of older patients. We found no systematic “ageist” pattern in the clinical decisions by physicians. Since age plays such an important, yet hidden role in the medical decision-making process, we make a plea for revealing such normative argumentation in order to gain transparency and accountability in this process. An explicit deliberative approach will make the medical decision-making process more transparent and improve the physician–patient relationship, creating confidence and trust, which are at the heart of medical practice.

Footnotes

  • Funding: Maastricht University public funding.

  • Competing interests: None declared.

  • i In his model Toulmin also made use of qualifiers to indicate the strength of an argument made. For the purpose of our research this was not needed. In addition, a more detailed analysis is required to be able to qualify a claim made. The material as we use it in this paper does not provide these details.

  • ii We are aware of other structural arrangements of the Toulmin model allowing a more interactive approach (http://www-rohan.sdsu.sdu/digger/305/tpulmin_model). However, in this paper we choose to highlight the differences rather than the interactions of day-to-day practice, as the latter requires different research methods.

  • iii This distinction is also used by Brown in his model on ethical process.18