Doctors refuse to operate on 80 year old man

BMJ 1998; 317 doi: (Published 05 December 1998) Cite this as: BMJ 1998;317:1548
  1. Georgina Kenyon
  1. Sydney

    The case of a man aged 80 who was denied a heart valve replacement by two public hospitals in Australia has led to claims of ageism and rationing in the country's public health system.

    John Quinn, from Sydney, New South Wales, required a mitral valve replacement and was denied treatment by two Sydney hospitals. The operation was conducted instead at a private hospital, with Mr Quinn's family paying the bill.

    The Quinn family wrote to the government, wanting assurance that their father was not denied surgery on the grounds of being too old. Age, however, was the reason, according to Associate Professor Peter Thursby, the president of the Australian Medical Association, who said that “tenuous clinical grounds are being increasingly used to avoid doing surgery on elderly patients.”

    In Australia, rationing occurs on two levels, says Professor Don Hindle, the national director of the Australian Hospital Association, which mainly represents public hospitals.

    Firstly, the government decides hospital budgets, but not how the money affects access to care. Secondly, clinical teams in hospitals create processes that ration certain operations for certain groups of patients. “This may not be formal or coordinated, but it may be both,” says Professor Hindle. Some specialties and clinical colleges have designed guidelines for patients and operations. For example, the national kidney association has guidelines for renal failure and whether a patient should be given a transplant or maintained on dialysis.

    Generally, however, clinical teams have a set of point scoring criteria for prioritisation on the basis of life expectancy. If patients have a low life expectancy they are either placed low down on the waiting list or told that they are unlikely to be accepted as they will not benefit as much as others.

    Associate Professor Thursby said that there are three kinds of surgery a public hospital will not do unless it has been agreed with the chief executive officer: cosmetic surgery; a group of operations that include varicose veins with no complications and tonsil surgery; and surgery on elderly patients such as John Quinn.

    The current Liberal prime minister, John Howard, denies that rationing occurs.

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    John Quinn: surgeons' refusal to operate led to claims of rationing

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