Gender and age disparity in the initiation of life-supporting treatments: a population-based cohort study

Abstract

BackgroundThe relationships between age and the life-supporting treatments use, and between gender and the life-supporting treatments use are still controversial. Using extracorporeal membrane oxygenation as an example of life-supporting treatments, the objectives of this study were: (1) to examine the relationship between age and the extracorporeal membrane oxygenation use; (2) to examine the relationship between age and the extracorporeal membrane oxygenation use; and (3) to deliberate the ethical and societal implications of age and gender disparities in the initiation of extracorporeal membrane oxygenation.MethodsThis is a population-based, retrospective cohort study. Taiwan’s extracorporeal membrane oxygenation cases from 2000 to 2010 were collected. The annual incidence rate of extracorporeal membrane oxygenation use adjusting for both age and gender distribution for each year from 2000 to 2010 was derived using the population of 2000 as the reference population. The trend of extracorporeal membrane oxygenation use was examined using time-series linear regression analysis. We conducted joinpoint regression for estimating the trend change of extracorporeal membrane oxygenation use.ResultsThe trends of extracorporeal membrane oxygenation use both for different gender groups, and for different age groups have been significantly increasing over time. Men were more likely to be supported by extracorporeal membrane oxygenation than women. Women’s perspectives toward life and death, and women’s perception of well-being may be associated with the phenomenon. In addition, the patients at the age of 65 or older were more likely to be supported by extracorporeal membrane oxygenation than those younger than 65. Family autonomy/family-determination, and the Confucian tradition of filial piety and respecting elders may account for this phenomenon.ConclusionsThis study showed gender and age disparities in the initiation of extracorporeal membrane oxygenation use in Taiwan, which may be accounted for by the cultural and societal values in Taiwan. For a healthcare professional who deals with patients’/family members’ medical decision-making to initiate life-supporting treatments, he/she should be sensitive not only to the legality, but also the societal and ethical issues involved.

Ethics in extracorporeal life support: a narrative review

“…In healthcare systems based on private health insurance, resource allocation might depend on the payer’s willingness to cover the costs, which could result in unequal access to ECLS [ 1 ]. To ensure that the most vulnerable patients are protected, in times of scarcity ECLS resources should be prioritised at a national health policy level, guided by pre-existing rationing plans [ 20 , 22 – 24 ].…”

Ethik der Reanimation und Entscheidungen am Lebensende

“…B. gegenseitige Abstimmungen zwischen Behandlungsunternehmen, berücksichtigt wurden [112][113][114]. In einer Literaturstelle wurden relevante Fragen zur Fairness des Begriffs gestellt, wenn die Möglichkeit für einen unbewussten Bias besteht, der auf sozioökonomischen und demografi-schen Faktoren wie dem sozialen Status, der Angst vor Rechtsstreitigkeiten oder dem Gesamteindruck des Patienten beruht [115][116][117]. Die Beurteilung von Aussichtslosigkeit ist zeitabhängig und kontextbezogen und beinhaltet oft auch religiöse oder spirituelle Überzeugungen [118,119].…”

Physician-Assisted Suicide in Dementia: Paradoxes, Pitfalls and the Need for Prudence

“…It can be argued that this principle is not absolute with regards to end-of-life decisions ( Fontalis et al, 2018 ), and that, when viewed from a different philosophical perspective, euthanasia or PAS may not be an ethically viable response to a “fear of disintegration” ( Gastmans and De Lepeleire, 2010 ). Likewise, autonomy-based arguments may be rejected in non-Western cultures, particularly those in which filial piety and respect for the elderly are valued ( Ting et al, 2017 ), or where autonomy is subordinate to community-based values ( Nie et al, 2015 ). Second, it is difficult to evaluate whether an individual patient’s wish for PAS is truly “autonomous” or is the result of coercion, either by family members, by professionals, or by broader socio-economic pressures.…”