Treating the Old Is A Christian Duty

Author: 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 , 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.