Should age based rationing of health care be illegal?
BMJ 1999; 319 doi: https://doi.org/10.1136/bmj.319.7221.1379 (Published 20 November 1999) Cite this as: BMJ 1999;319:1379
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The NHS is ageist? Are you sure? Walk round the wards, look round the
outpatients department, read an operating list, glance in the GP's waiting
room. What do you see? Old people, that's what. Lots of them. The NHS
basically treats old people. Nothing wrong with that, they're usually the
ill ones. Ageism? No way!
Competing interests: No competing interests
All over the country health services are groaning under the weight of
ever-increasing workloads, pushed upwards, in many instances, by
skyrocketing public expectations fuelled by the utterances of self-seeking
politicians. Levels of stress among health professionals are ratcheted up
even further by demands for more accountability, publication of audit
data, clinical governance, the ever-expanding 'blame culture' etc, all in
an environment where resources are nowhere near adequate to deal with the
workload that we already bear. Now we are being told by Michael Rivlin
that it would be a great idea to make age discrimination in health care
illegal. I am sure none of us would disagree with the principle behind
his argument, but does he have any idea what kind of a can of worms he is
opening? The problems which he dismisses so breezily as 'grey areas'
could, in fact, result in a large number of legal actions against doctors
who are simply trying to do an extremely difficult job in balancing the
countless demands on our services. It's no good saying that if a doctor
acts properly and in good faith any legal action against him/her is likely
to fail: does Michael Rivlin have any idea how stressful defending such an
action could be even if one were acquitted?
Can we please try first of all to get a grip on this extraordinary
cloud-cuckoo-land vision of the NHS which people are being sold by
politicians, i.e. that they can have whatever they want, when they want
it, but without the patient or the taxpayer putting up any more money?
Until we do that I'm afraid we will never be in a position to make a
sensible exploration of ideas like Rivlin's.
Competing interests: No competing interests
Grey Power
Rivlin mischievously suggests aged-based rationing should be made
illegal. What are the realities of enforcing a doctor to ignore the
Elderly's differing needs or his own common sense on pain of criminal
prosecution? The lawyers, once again, would be the only winners in such a
scenario.
With my feet firmly on the ground in general practice I would decline
to refer a 60 yr old for fertility treatment and accept a consultant's
decision that with few hearts available for transplantation my 75 yr old
patient could not be prioritized.
Rivlin erroneously suggests that extrapolation of the Race Relations
Act could similarly "protect" older patients. A 30 yr old is not the same
as an 80 yr old and it would be folly to see them as such.
Perhaps first rationing should be made illegal, maybe after a
minister acknowledges it exists.
David Carvel
MRCGP DRCOG
Competing interests: No competing interests