We hear a lot about the right of people to “die with dignity.” Such discussions usually occur in the context of malignant disease or other major progressive illnesses such as motor neurone disease. In a week in which a report has focused attention on the care of elderly people (see BMJ 2006;332: 746), it is surely worth highlighting the problem of undignified death in those who simply have multiple pathologies related to ageing and whose quality of life has deteriorated to a point where they seem to have little, if any, enjoyment left in carrying on. The collective blindness that nursing homes, hospitals, and general practitioners have to this problem leads to a series of defects in the care of such people. It is a form of elder abuse that is becoming increasingly common.

There needs to be a sort of “Do not attempt aggressive medical treatment” order that could be applied to frail people in the community

Frail …