Education and debate

The rationing debate: Rationing health care by age: The case against

^a Division of Clinical Geratology Nuffield Department of Clinical Medicine Radcliffe Infirmary Oxford OX2 6HE

	Introduction

Older people are discriminated against in the NHS. This is best documented in substandard treatment of acute myocardial infarction and other forms of heart disease, where it leads to premature deaths and unnecessary disability. The care for older people with cancer is also poorer than that provided for younger patients.

Age discrimination in the NHS occurs despite explicit statements from the government that withholding treatment on the basis of age is not acceptable. Ageism is mostly instigated by clinicians but condoned by managers. Fundholding general practitioners have a financial incentive to deprive older patients of expensive health care, but there is no ready way to find out whether they do so. Whatever its full extent, the documented instances of age discrimination, together with the occasional published apologia for ageism, show that the morality of age based rationing should be a matter of public concern.

	Need to assess individual risk

. . . [Full text of this article]

	Ethics, ideology, and the law

	The founts of ageism

Exploitation of the weak
Professional ignorance
Prejudice

	The power of economics

	The "fair innings" argument

	Conclusion

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