Julia F. L.^König1,2, Birthe Aufenberg³, Gereon Brei³, Sabine Sommerlatte⁴, Wolfgang Greiner³, Jan Schildmann⁴, Eva^Winkler2,5, Katja Mehlis²

¹ National Centre for Tumour Diseases (NCT), NCT Heidelberg, a partnership between the DKFZ and Heidelberg University Hospital; Department of Medical Oncology, School of Medicine, Heidelberg University

² Institute for Medical and Data Ethics, University of Heidelberg; School of Medicine, Heidelberg University Hospital

^{3 School} of Health Sciences, Health Economics and Health Management, Bielefeld University

⁴ Institute of History and Ethics of Medicine, Centre of Excellence in Health Sciences, School of Medicine, Martin Luther University Halle-Wittenberg

⁵ National Centre for Tumour Diseases (NCT), NCT Heidelberg, a partnership between the DKFZ and Heidelberg University Hospital; Department of Health Equity and Justice, German Cancer Research Centre (DKFZ) Heidelberg

Financial considerations can influence medical decisions – particularly in cancer care, where patient numbers are rising and treatments are costly. In order to allocate resources appropriately, it is necessary, on the one hand, to understand how financial considerations affect medical decisions and, on the other hand, to assess these effects. This paper examines how temporal aspects alter the ethical assessment of financially influenced decision-making situations in oncology. It is based on a qualitative interview study in which n=21 decision-making situations were identified in which financial considerations influenced medical decisions. In n=13 decision-making situations, the analysis showed that temporal aspects have ethical implications for the assessment: How much time must patients spend in a medical institution? How quickly should a diagnosis be made, and for what reasons might it take longer? How can a balance be struck between rapid access to new medicines and a lack of cost coverage? These temporal and time-related aspects not only structure the decision-making process but also shape the moral assessment of well-being, responsibility and fairness.

Using these selected decision-making scenarios, the aim is to present and contextualise both financial influences and temporal aspects. It will be demonstrated that temporal aspects have ethical implications when assessing the impact of financial considerations on medical decisions in cancer care. For example, cost-intensive (molecular genetic) diagnostics delay treatment decisions and the initiation of treatment, reimbursement structures can slow down access to treatments (e.g. off-label use), and some resources are weighed against their efficiency in terms of life expectancy due to their high costs (costly treatment with a questionable cost-benefit ratio).

This paper argues that time must be considered as an ethical category when assessing the influence of financial factors on medical decisions, in order to promote patient well-being and to enable fair and responsible allocation decisions in cancer care. This paper aims to elucidate various dimensions of time in this context and to offer initial reflections on the assessment of these time-related ethical implications.