It’s been a good couple of weeks for septuagenarians and octogenarians and it had nothing to do with pensions. The feelgood factor started with 80-year-old Paul McCartney’s astonishing performance at Glastonbury. In hope rather than expectation, I enquired of my wife whether I looked as youthful as Macca. I’ll let you know the answer once she stops laughing.
Around the same time, Mick Jagger, a spring chicken at 78, was strutting his stuff at sell-out concerts in Hyde Park. From a distance and in poor light, Sir Mick and his fellow Stones could pass for men half their age. The granddaddy of them all, Bob Dylan, is half way through the Rough and Rowdy Ways World Tour to be completed when he’ll be a mere 83.
The longevity and energy of the likes of McCartney, Jagger and Dylan are proof that the date on someone’s birth certificate says very little about her/him. Assumptions about age-related health and fitness are outdated. Many 70 and 80-year-olds are healthier and fitter than many 20, or even 30-year-olds. On average, today’s healthy 70-year-old can expect to live a further 10 years. Our squash club recently hosted a competition that included an over-80s category, and happily, none required first use of the club defibrillator. Yes, on the surface golden oldies are a good news story, but are we storing up longer-term problems for our already overstretched health services?
As far back as 500BC, Euripides wrote that he hated men “who prolonged their lives” and who should “quit this life, and clear the way for youth”. In 2014 the Royal College of Surgeons took a somewhat different line, sounding an alert about the “elderly being denied lifesaving operations”.
Professor Peter Lloyd Sherlock of the University of East Anglia has long campaigned for the end of age discrimination in medical care. He was particularly critical of the good health and wellbeing dimension of the UN’s Sustainable Development Goals, accepted by its members in 2015. In its first version, Goal 3 committed members to cut premature deaths from cancer, stroke, diabetes and dementia by one third by 2030.
Professor Sherlock’s difficulty was the definition of “premature”. Those over the age of 70 were not considered to have died prematurely and therefore fell outside the scope of that particular goal. Writing in The Lancet, Professor Sherlock and others stated the goal “unjustifiably discriminated against older people” and undermined “cherished, fundamental principles of universality and health as a right for all”. Additionally, The Equalities Act of 2010 made such discrimination illegal.
Since then, Covid has placed unprecedented pressure on all health services, increasing the possibility of age-related rationing of treatment and of surgery in particular. The incidence of breast and prostate cancers is highest amongst the elderly. Surgery for both peaks amongst those in their mid-60s but falls away markedly thereafter. You’re over 75 and require a hip or knee replacement? Good luck with that.
There are of course, ethical as well as resource considerations. If two patients, one aged 25 and another 75, require the same scarce piece of kit, who is likely to be prioritised and on what grounds? It’s unlikely the medics will toss a coin. The decision is more likely to be swayed by the patient’s date of birth.
Whether you think that is fair or not, is likely to depend on your age. A case can be made for prioritising the younger person, but as the population ages and resources are stretched ever thinner, we need to have that ethical debate.
For example, how can health care be distributed equitably without pitting the young against the old? Was Euripides wrong when suggesting elderly lives are less valuable and fulfilling than those of the young? Is the right to health care and surgery eroded by age and, if so, what are the implications for fundamental human dignity? Instead, should access to treatment be influenced by biological rather than chronological age? Who makes those decisions and against what criteria?
Sure, these are uncomfortable issues for those of us already pigeon holed as elderly, but they’re not going away. They need to be addressed urgently and transparently. Otherwise, as demand grows, we face the much greater ill of rationing by stealth.
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