Ageism, Autonomy, and Justice in Healthcare and Clinical Research: A Structured Narrative Review of Bioethical and Legal-Governance Implications Beyond Chronological Age

Abstract

Ageism in healthcare and clinical research becomes a bioethical and legal-governance problem when chronological age is used as a proxy for clinically relevant heterogeneity. This structured narrative review integrates empirical, review-level and normative literature to distinguish legitimate age-sensitive reasoning, grounded in individualised assessment, from age-as-proxy shortcutting, where age substitutes for frailty, function, cognition, multimorbidity, treatment burden, communication needs and patient goals. The review examines effects on care pathways, autonomy, informed consent, rehabilitation, research inclusion and accountability, and argues for safeguards including multidimensional assessment, autonomy-preserving communication, supported decision-making, pathway audit and inclusive research governance.