Kathrin Knochel¹, Tanja Henking², Marie-Christin Fritzsche³, Anna-Henrikje Seidlein⁴, Sebastian Schleidgen⁵, Jasmin Sieben⁵, Orsolya Friedrich⁵

¹Clinical Ethics, TUM Hospital, School of Medicine and Health, Technical University of Munich, Institute of History and Ethics of Medicine, School of Medicine and Health, Technical University of Munich

²Institute for Applied Social Sciences (IFAS), Würzburg-Schweinfurt University of Applied Sciences

³Institute for the History and Ethics of Medicine, School of Medicine and Health, Technical University of Munich

⁴Institute for Ethics and History of Medicine, University Medical Centre Greifswald

⁵Institute for the History and Ethics of Medicine, School of Medicine, University of Cologne

Background:Time is a central dimension of life and, consequently, of health and illness. Gaining additional life expectancy is a therapeutic goal that (often implicitly) underpins the decision to prescribe treatment. The dimension of time presents relevant points of reference at various levels in the decision-making process, which have so far received little attention.

Research question: Against this background, the study examines the roles that time plays in the context of determining indications and the value judgements that may be associated with these roles.

Method: An interdisciplinary, primarily literature-based analysis examines and ultimately discusses which dimensions of time may have what significance for the concept and practice of determining indications.

Results: The following levels and dimensions of time are discussed as potentially relevant to the determination of medical indications:

1. Lifespan and remaining time as a therapeutic goal: The gain in varying amounts of lifespan achieved through medical interventions is assessed differently by professionals. This assessment may be shaped by various value judgements.
2. Time as a dimension of illness: The timing and dynamics of a disease (onset, course, crises) can influence the determination of indications.
3. Time in the context of gaining insight: Time can influence the availability and reliability of information and thus the assessment of efficacy and prognosis. In cases of prognostic uncertainty, time could be a relevant decision-making factor due to the acquisition of information and the observation of disease progression and efficacy.
4. Time in the decision-making process: The temporal dimension of medical decisions is evident in the decision-making process itself, particularly in shifts in treatment goals and in the influence of time pressure on the decision, which may manifest itself at specific points or unfold over time.

New technologies have the potential to make information available more quickly; for example, AI-supported information on prognoses that was previously obtained through monitoring of the course of the disease. This could make time a further relevant factor in the context of digitally supported diagnosis.

Conclusion: Time constitutes an important dimension in the indication and decision-making process. Its influence should be clarified more clearly in conceptual terms so that it can then be better identified in clinical care and taken into account in decision-making processes.