Education And Debate

Protecting elderly people: flaws in ageist arguments

BMJ 1995; 310 (Published 06 May 1995) Cite this as: BMJ 1995;310:1179
1. Michael M Rivlin, research studenta
1. a Department of Philosophy, University of Leeds, Leeds LS2 9JT
• Accepted 3 February 1995

Some form of rationing is necessary in medicine, and to use age as a criterion for rationing seems initially appealing. Many of the criteria currently being used for deciding the distribution of funds depend on subjective judgments. Age, however, is objective and therefore negates the need for value judgments. Justice and fairness, it is sometimes suggested, require that finite resources should be directed at young people, who have not had a chance to live their lives, rather than at elderly people, who have already lived most of theirs. The adoption of ageist policies, however, may not result in the implied savings unless care is also withdrawn. Furthermore, ageist policies, which deny elderly people treatment on the sole grounds of their age, are both unfair and discriminatory and should therefore be resisted.

The demographic explosion1 that will take place as a result of an aging population poses enormous ethical and economic problems. An indication of the size of the problem is that in the United Kingdom the proportion of people over the age of 65 is expected to increase from 18% in the current population to 30% by 2030.2 By the year 2050 in the United States an estimated 15 million people will be over the age of 85 alone, compared with 3 million in 1990.3 The cost to society of dealing with an elderly population will be substantial. For example, Dworkin states that $80 billion was spent treating patients with Alzheimer's disease in the United States alone in 1991.4 (Does Dworkin mean that the money was spent on treating or caring for patients, an important distinction as I shall argue later.) Hacker reports that in the United States “spending on hip fractures, for example, is projected to increase from$1.6 billion in 1987 to as much …

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