I HAVE always hated those cartoons where the grim reaper, scythe in hand, raps on somebody’s door. Imagine, then, that a letter has dropped on your mat from the local GP’s surgery. It urges you to consider signing a form called Do Not Attempt to Resuscitate, or DNAR, should you be hospitalised with coronavirus. Reading this, most of us would feel that the reaper was already over the threshold and briskly sharpening his blade. So much for making some of the most vulnerable and lonely in the community feel safe and valued during this crisis.

Age Concern has been taking calls from pensioners who have received letters like this and are panic stricken. The wording is apparently so “cack-handed” – the charity’s phrase – that recipients are misinterpreting it to mean they will not receive any medical help if they contract the virus.

This is not what the letter says, but it would be an easy mistake to make. Even if it were clear, it would still be upsetting. Signing a DNAR is almost as sure an indication that the end of the line is fast approaching as requesting the last rites. Often it is signed by those with power of attorney for elderly relatives who are no longer of sound mind. Brutal though it looks when expressed in cold print, the intention behind it is compassionate.

At a certain stage of ill-health, the process of resuscitation can be harsh. It unnecessarily prolongs suffering rather than allowing someone who has suffered a cardiac arrest to slip away peacefully. In some circumstances, especially where the patient is extremely frail, resuscitation is the worst of all options. Hard though it is to accept, the prospect of death can come as a relief to some for whom there is no hope of recovery, and who are simply longing to be gone.

But for many who received this bald DNAR request, that is not the case. Instead of being asked to speed up and simplify medical bureaucracy, they needed reassurance that, should they fall ill with Covid 19, they will be treated like anyone else. The only grey area is over what they wish done in the event they require resuscitation. In their thoughtless and insensitive mail-shot, doctors presumably have pre-selected those for whom they think a DNAR is in their best interests. But what a way to go about it. It brings to mind Treasure Island and the sinister Black Spot pressed into pirates’ hands, signifying their imminent demise.

Even worse is the case of a care home where some residents, who were mentally well, learned staff had signed these forms on their behalf. I would not wish to be the manager should anyone’s otherwise robust existence end prematurely because of a legally binding instruction they knew nothing about.

What all this points to is troubling. There has been much trumpeting about the ways in which communities are pulling together under lockdown, growing stronger and kinder because of the strain on those who are least able to help themselves. Despite this, however, there is an insidious undercurrent to some discussions, a faint suggestion that the aged are in danger of being perceived as a nuisance, a drain on limited resources that are better used for the young. The tenor of recent government guidelines appears to hint that when people reach a certain vintage they should expect less heroic or interventionary treatment, and accept that if things take a turn for the worst, their time is up.

When new guidance was issued to medics by the former Chief Medical Officer Catherine Calderwood last week, Dr Donald Macaskill, chief executive of Care Scotland, was perturbed at its implications: “Nothing in this document gives me confidence that we will not be putting our clinicians in a position where they have no option but to decide on the basis of age.”

Life-saving equipment and highly trained medical staff are undoubtedly in limited supply. When intensive care beds and ventilators have to be rationed, then the decision of who benefits most will have to be made. Who would envy a doctor faced with such a bleak choice?

But it would be a terrible indictment of our society if the exigencies of this emergency fostered the sense that old is synonymous with surplus. If the word “pensioner” is in danger of becoming a life-threatening label the long-term legacy of this disease will be far worse than the number of fatalities. It will have buried one of the primary principles on which modern civilisation is based.

The idea that individuals automatically become obsolescent after a certain age is repugnant. So too that their worth diminishes with each year. Who has the authority or right to say that one person’s life is more valuable than another? The more I see of friends in their eighties and nineties, the more I understand the old joke: Who would want to live to 100? Someone who is 99.

One of the reasons this pandemic is so intense is because we have long recognised the importance of seniors. Modern medical advances have been expressly designed to allow much of the population to reach and enjoy advanced age, even if they do rattle occasionally with their daily regimen of pills.

Before going to university I worked for a year as an auxiliary nurse in a small hospital, on the male and female geriatric wards. It was a revelatory experience. Some of the patients had dementia, a few were permanently bed-bound, but there was not one of them who could not find some enjoyment and pleasure each day, or who did not retain much of their personality. It was an inspirational lesson that one of the finest achievements of society is to take such loving care of those whose best years are behind them, and for whom the future is measured in months, weeks, or simply hours.

It is not for the state to determine who lives and dies. Every day doctors quietly make these calls, for reasons of humanity, and we must trust their judgement. When they need to discuss matters of life and death with relatively healthy patients, however, they would do well to remember that up to the very end, we all will rage against the dying of the light, and rightly, properly so.

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