Health outcome prioritisation is the ranking in order of desirability or importance of a set of disease-related objectives and their associated cost or risk. We analyse the complex ethical landscape in which this takes place in the most common dementia, Alzheimer’s disease.
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, 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 prioritising outcomes; and when individual preferences are sought.
Narrative review of literature published since 2007, incorporating snowball sampling where necessary. We identified, thematised and discussed key issues of ethical salience.
Eight areas of ethical salience for outcome prioritisation 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, (8) Disclosure of risk.
These areas highlight the difficult balance to be struck when allocating resources, when measuring and prioritising 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 prioritising outcomes, and eliciting stakeholder preferences.
- Alzheimer’s disease
- health priorities