TREATING THE OLD IS A CHRISTIAN DUTY
by Anthony Fisher, O.P.
("Church Times", 6846 (29 April 1994), 10.)
THE UNITED KINGDOM is down near the bottom of the league table of developed
countries on healthcare spending as a proportion of its annual income.
Remarkably it still manages to offer more or less universal cover. The main
reasons for this are that our healthcare workers are less well paid and
provide their patients with fewer and cheaper treatments. But even were
Britain not so niggardly with its NHS budget, allocation decisions would
still inevitably arise. There will never be enough resources to do
everything that might improve health and extend life.
Age-based rationing has long been practised in Britain. Whether or not
there is any formal policy, older people are much less likely to receive
heart, kidney, blood-clot or cancer treatments than patients the same age
in the U.S. or on the Continent and than younger patients at home. But
should they?
ONE GOOD REASON for age-based rationing might be a clinical one: that older
people will not (on balance) benefit from a particular treatment, or will
not benefit from the treatment as much as younger people. But age is a very
rough rule of thumb.
Older dialysis patients have a better survival rate than younger ones and
their quality of life is at least comparable. In cardiological
interventions there is little difference between young and old patients.
Yet the elderly are denied treatment in many programmes supposedly because
of their poor prognosis.
A better reason for treating the elderly differently might be that
they have had 'a fair innings', i.e. a life-span beyond which it is
unreasonable to strive, or at least to expect others to make significant
contributions to assisting one to strive. Whether or not we ever feel we
are ready to die, there comes a time when we would longer regard death as
'premature' and when it is prudent to prepare self and others for that
eventuality. No-one can expect to live on this earth for ever; for
Christians this would be not hope but despair.
Healthcare systems are established to serve certain, admittedly often
ill-defined, ends. Giving everyone a fairly good chance of a reasonable
length of life in fair health is one: when that has been assured the
system, heavy pressed with various competing demands, might reasonably
taper off its care. The elderly consume a disproportionate amount of the
healthcare pound and younger people commonly have responsibilities (such as
the care of children and contributions in the workplace) that warrant some
preference. Age-rationing is not necessarily discriminatory in the way that
race, sex or religious qualification might be, because all people are
subject to ageing, and so all would be entitled to the same care over a
life-time. It can be argued, therefore, that age-rationing does not deny
equal access or opportunity.
BUT PEOPLE CAN have good reasons to want to live for longer than average.
They might simply love life, or want to finish their <magnum opus>, see
their first great-grandchild born, bury their dependent spouse... Hoping
for a longer than average life-span might reflect no shortfall in
temperance, courage or concern for the common good.
The primary function of a healthcare system and of the healthcare
professions is the care of the sick, just as such, whatever their age. And
since it is the elderly who have made the greatest contribution to the
establishment and funding of the health system (as well as many other
social contributions) they can reasonably expect the next generation to
meet their healthcare needs. To deny them care simply by virtue of their
age could be plain ingratitude.
AGE-RATIONING GOES AGAINST the egalitarian ideal which informs the
Christian response to need, much of secular social welfare, and Hippocratic
medicine. Britain already undervalues its elderly members and increasingly
shows signs of ageist prejudice: the elderly are abandoned to institutions,
depreciated by fashion and the media, inadequately provided for, their
wisdom and experience ignored. In greying Britain age-rationing might
reflect and generate further prejudice against an already vulnerable and
relatively powerless group. As average age and healthcare costs throughout
the West continue to rise, there will be pressure to abandon and euthanaze
the elderly, comatose and handicapped to cut costs. That is a temptation we
should resist now.
Healthcare in a Christian culture is a symbolic expression of respect
for the dignity of every person, of special concern for the vulnerable and
powerless, and of solidarity with all who suffer. Virtues such as piety,
filial affection and duty, respect for and gratitude to elders--these too
are worthy of cultivating. The Good Samaritan did not stop to ask whether
the victim was over 65 or was likely to have a high enough quality of life
or make a sufficient social contribution in the future. High quality
healthcare for the elderly can be a powerful parable demonstrating and
teaching important virtues and values, just as abandoment can tell of
prejudice and a failure of compassion.
WHATEVER WE DECIDE as a community (and it would be good if it was as a
community, rather than professionals and planners alone), we should be open
about what we are doing. Telling old people "nothing more can be done" for
them, when what we really mean is "sure, there are treatments which would
benefit you, but we can't afford them or we want to put our resources
elsewhere" is, to be frank, lying. Justice and compassion are not all that
are at stake in age-based rationing decisions: so are piety and honesty.
Anthony Fisher OP is a Dominican friar researching a doctorate on
healthcare rationing at Oxford University.
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