ISSUE 1656Tuesday 7 December 1999
 
Analysis: Euthanasia is a job for executioners not doctors
By Prof Sir John Grimley Evans


 


WE hear increasingly of patients being given second-rate treatment, or having beneficial treatments withheld, because they are above an arbitrary age. Prejudice against older people is common in British society but it influences health care more in some districts than in others.

Deplorably, it is difficult for citizens to find out what is happening in their locality because they lack access to the necessary figures. The catalogue of complaints published recently by Age Concern leaves little doubt that the problem is pernicious and widespread.

Doctors and other health professionals are trained not to let personal prejudices affect the care they offer to patients. Most of those who institute or condone ageism do so because they think they are performing a public duty in keeping down NHS costs.

A London meeting last week heard that the General Medical Council is unclear whether ageist practice should be regarded as unethical behaviour by a doctor, as would racism or sexism. Why should the GMC be in any doubt? It is no business of doctors to decree that some citizens are less equal than others.

Ageism in the NHS has been condemned by ministers, but they missed an opportunity when targets for health care of older people that might have prevented ageist practice were struck out of the Green Paper on Our Healthier Nation.

Ageism is morally wrong because it treats a patient not as an individual but as a member of a group. For an individual patient, benefit from a treatment depends on physiological condition. The risk of physiological impairment increases with age but there is wide individual variation in the rate of ageing.

Many people in later life function within ranges normal for young adults; chronological age and biological age do not necessarily match. Specialists in intensive care find that if an adequate range of physiological functions are fed into an equation to predict outcome, age ceases to be relevant.

Using membership of a group to withhold treatment from an individual would cause outrage if grouping were by social class or ethnicity, which are also associated with differences in health care outcomes.

Grosser forms of ageist prejudice are being claimed, including accusations that elderly patients are being killed by starvation orders imposed by nurses. One hopes these will turn out to be based on misunderstandings, but the fact that misunderstanding can arise over such basic issues of patient care indicates a faulty system.

End of life decisions about patients in hospital should be made at consultant level and consultants should be personally responsible for discussing them with patients and relatives.

Issues surrounding food and fluids, forced feeding of patients who have dementia or anorexia, whether treatment is prolonging life or spinning out the misery of a death, are particularly worrying matters that need to be thought out afresh each time they arise. But euthanasia, if it ever comes, will be a job for public executioners, not for doctors.

People aged over 65 comprise more than a quarter of the electorate, but British politicians count on older people being too supine to vote tactically, as the elderly have done so effectively in America.

By civilised European standards the NHS is under-funded to the tune of 25 per cent or more. While that continues, people who do not make their presence felt politically must expect to be left at the bus stop. Pensioners of the world unite!

  • Sir John Grimley Evans is professor of geratology, University of Oxford.

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