Health Outcome Prioritization in Alzheimer's Disease: Understanding the Ethical Landscape

Alex McKeown, Andrew Turner, Zuzanna Angehrn, Dianne Gove, Amanda Ly, Clementine Nordon, Mia Nelson, Claire Tochel, Brent Mittelstadt, Alex Keenan, Michael Smith, Ilina Singh

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND: Dementia has been described as the greatest global health challenge in the 21st century on account of longevity gains increasing its incidence, escalating health and social care pressures. These pressures highlight ethical, social, and political challenges about healthcare resource allocation, what health improvements matter to patients, and how they are measured. This study highlights the complexity of the ethical landscape, relating particularly to the balances that need to be struck when allocating resources; when measuring and prioritizing outcomes; and when individual preferences are sought.

OBJECTIVE: Health outcome prioritization is the ranking in order of desirability or importance of a set of disease-related objectives and their associated cost or risk. We analyze the complex ethical landscape in which this takes place in the most common dementia, Alzheimer's disease.

METHODS: Narrative review of literature published since 2007, incorporating snowball sampling where necessary. We identified, thematized, and discussed key issues of ethical salience.

RESULTS: Eight areas of ethical salience for outcome prioritization emerged: 1) Public health and distributive justice, 2) Scarcity of resources, 3) Heterogeneity and changing circumstances, 4) Knowledge of treatment, 5) Values and circumstances, 6) Conflicting priorities, 7) Communication, autonomy and caregiver issues, and 8) Disclosure of risk.

CONCLUSION: These areas highlight the difficult balance to be struck when allocating resources, when measuring and prioritizing outcomes, and when individual preferences are sought. We conclude by reflecting on how tools in social sciences and ethics can help address challenges posed by resource allocation, measuring and prioritizing outcomes, and eliciting stakeholder preferences.

Original languageEnglish
JournalJournal of Alzheimer's Disease
Early online date21 Jul 2020
DOIs
Publication statusE-pub ahead of print - 21 Jul 2020

Fingerprint Dive into the research topics of 'Health Outcome Prioritization in Alzheimer's Disease: Understanding the Ethical Landscape'. Together they form a unique fingerprint.

Cite this