Age Discrimination at its Best: Should Chronological Age be a Prime Factour in Medical Decision Making?

摘要

This paper briefly reviews the papers in this special section of HCA and makes the point—a point which should be obvious—that statistics are useful only as guidelines but tell one nothing about the individual patient in front of you. Chronological age merely shows what is true of most but decidedly not of all patients in a particular age group. To ration on the basis of age alone is unfair to the individual denied treatment and damaging to the community because it disturbs the solidarity which comes about because most members of the community feel that the community has obligations beyond those of not directly harming them; indeed, what produces solidarity is the feeling that members of a community will do their best to come to each others help. Rationing on the basis of age alone denies people of equal treatment under the law and—when it comes to the elderly—is a type of age discrimination. It is pointed out that what matters is a patient’s disease and not his/her age. A permanently vegetative person 8 years of age is a much sadder occurrence than it would be at age 90—but the critical fact is that both are permanently vegetative. Age cuts both ways—it is irrational to spend hundreds of thousands of dollars, untold amounts of time, energy and devotion to the 520 gm infant with a gr IV diffuse haemorrhage whose chance of leading a sentient life is close to zero and to hesitate before using a diagnostic MRI on a patient who is 90 but fully alert and enjoying life. It is concluded that age as an independent variable in the allocation of resources is ethically highly problematic.