Pre-diabetes in the elderly and the see-saw model of paternalism.
aged
applied and professional ethics
clinical ethics
paternalism
primary care
Journal
Journal of medical ethics
ISSN: 1473-4257
Titre abrégé: J Med Ethics
Pays: England
ID NLM: 7513619
Informations de publication
Date de publication:
11 2021
11 2021
Historique:
received:
11
06
2020
revised:
29
09
2020
accepted:
02
10
2020
pubmed:
6
11
2020
medline:
3
11
2021
entrez:
5
11
2020
Statut:
ppublish
Résumé
Pre-diabetes is a risk factor for the development of diabetes, not a disease in its own right. The prevalence increases with age and reaches nearly 50% of those aged over 75 years in the USA. While lifestyle modification and treatment are likely to benefit those with many years of life ahead of them, they are unlikely to benefit patients with a limited life expectancy. Despite this, some very elderly patients in the UK and elsewhere are being labelled as pre-diabetic. While ideal practice would be to carefully consider the impact of any potentially abnormal blood test before it is taken, this is not always possible in routine practice. In this paper, we discuss a pragmatic, ethical approach for clinicians managing pre-diabetic blood tests in very elderly patients. We argue that a 'see-saw' model of paternalism should be used in deciding which patients to inform that they can be labelled as pre-diabetic. Those patients that may benefit from the label should be informed, and those that will not, should not. Where the benefits/drawbacks are unclear, the result and its potential significance should be discussed in depth with the individual patient. We do not advocate withholding information from any patient. Instead we suggest clinicians use individual patient circumstances to contextualise the relevance of pre-diabetes to the patient and consider the benefits and drawbacks before informing them. This approach has the potential to be used for other pre-conditions and risk factors in addition to pre-diabetes.
Identifiants
pubmed: 33148775
pii: medethics-2020-106573
doi: 10.1136/medethics-2020-106573
pmc: PMC8562306
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
719-721Informations de copyright
© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: None declared.
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