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Last Updated: Monday, 9 May, 2005, 10:32 GMT 11:32 UK
Should there be health restrictions for aged?
Patients in Britain should be refused treatment because of their age in some cases, say government advisers.

The National Institute for Health and Clinical Excellence suggests discrimination is appropriate where age affects the benefits or risks of treatment.

However, the institute rejected including other social and lifestyle issues such as obesity and smoking as factors.

Charities representing older people have described the recommendations as outrageous.

Do you feel that there should be age restrictions for access to healthcare? Have you or a member of your family been affected?

This debate is now closed. Thank you for your comments.

The following comments reflect the balance of opinion we have received so far:

This topic was suggested by Martin, England
Should the NHS deny or provide reduced treatment levels to different categories of patients?

Here we go again - inhumane proposals on how the Brits are to treat the sick. Perhaps there are also people who support Doctor Duggan from Stevenage who withdrew a child from his patient list because the child adversely affected his pay. Is it no wonder that Britain has a Health Service that is the shame of Western Europe.
Paul S Johnson, UK

Smokers and the obese should be forced to pay the excess on their medical bills as these people are more likely to suffer with cancers as well as lung and heart diseases.
Ben, Nottingham

The way I understood it, they were only talking about using age as a factor in deciding on the treatment. It doesn't make sense to give someone a drug or treatment which isn't going to work. I made doctors take my age into consideration when they were seeking appropriate treatment for me, and I was only 26 at the time. That's not wrong is it?
Kate, Manchester

This is disgusting, our senior citizens deserve to be treated with respect and dignity, not like some old nag destined for the knacker's yard. This advice is a criminal and the advisors should be ousted from their posts PDQ. It makes one ashamed to be British
Chris Duggan, Swansea, Wales

This is discrimination against our elderly
Daniel, Kent

This is discrimination against our elderly! If anything, we need MORE health care for the aged!
Daniel, Kent, UK

What have we become? How can we even think such a thing. Just the thought that we would suggest allowing older people to die is beyond shame. God should decide when we die not some pompous ass in a white coat.
George Laposay, Warrenton, VA USA

Health care is a life issue. This means for the whole of our life, not just a part of it. I am amazed that anyone could try to implement this kind of discrimination. Care, compassion, a sense of community, they not come into the equation too.. What exactly do these people eat for breakfast.....

I see you are marching down the road to the elderly having a duty to die.
Richard T. Ketchum, USA

Apart from being the most likely group to need it, they've paid their contributions all their working lives
David Williams, Melbourne, Australia

Is this a political ploy for Labour to win a fourth term in office, since most Tory voters are extremely elderly this would be like discriminating on grounds of political views? But seriously no one should be refused treatment, although any additional risk factors should be explained to the patient so they can make their own mind up about treatment. The point of the National Health Service is free healthcare for all, we should be proud of that ideal and not abandon it to pinch a few pennies.
Colin Wright, UK

A few years ago our government introduced a National Service Framework for older people. This was to stop age discrimination in the NHS. In effect, NICE is now suggesting that these rules be broken. It is an outrageous suggestion, and should lead to the dissolution of NICE as an outmoded and irrelevant body.
Michael Bird, Rossendale Lancashire

I believe a similar scheme was tried some years ago by one of our EEC neighbours. You start off by targeting one group of people and then continue until you have a tall, white, blonde haired, blue eyed master race. I don't think the idea went down very well outside of Germany.
Terry Hughes, Crewe, Cheshire

Absolutely not! Apart from being the most likely group to need it, they've paid their contributions all their working lives.
David Williams, Melbourne, Australia

We would not refuse to treat prisoners and murderers on the grounds they are no use to society
Aileen Butler, Lowestoft
Treatment should be available to everyone. The choice not to have treatment should be made by the individual, whatever the age. We would not refuse to treat prisoners and murderers on the grounds they are no use to society, so leave our old folks alone.
Aileen Butler, Lowestoft

I have worked all my life and have no intention of stopping doing so until I retire. I am 45 this year and I have worked for 28 years, never used the NHS but paid tax and national insurance. Yet Stu wants to refuse me treatment on the NHS because I smoke. Can I have my money back to get private treatment if I need it in the future? No I can't, yet all those complaining about smokers are happy for me to pay for their treatment on the NHS.
Walter, Catterick

What happened to the NHS caring from the cradle to the grave? I understand with age there are risk factors, however a patient should be provided with those risk factors. Then it should be their choice to choose if they wish to go ahead. That should count for any age. As for smoking, drinking and obesity: help should be given too as they are usually due stress factors, which that person have in their every day lives, usually out of their control too.
Tricia, Newcastle

This is what happens with socialized health care. When the government takes over, health care is rationed and some people will be on the short end of the stick. When health care becomes nothing more then a welfare handout, the value of a human life becomes less important then the cost to a government bureaucrat.
Daniel B Rego, Irvine, California, USA

Doctors and patients alike must use their common sense
Elizabeth, France
What's next? If we have medical treatment according to age, then we'll have medical treatment according to gender, skin colour, religious or political beliefs, etc. Doctors and patients alike must use their common sense when offering or accepting treatment, appropriate information and communication is essential though.
Elizabeth, France

It defeats the purpose of healthcare. Who is most likely to need it? The very young and the very old.
Kaye, NYC, USA

To Stu re: his comment about smoking. Smokers already heavily subsidise the NHS due to the enormous tax levied against them so his argument is not only intolerant but a nonsense.
Claire, London

In Canada, many watch Britain's efforts with medical care closely, as our national health system is modelled on the UK's. It is alarming to see that fiscal reasoning seems to be the driving criteria. In the United States women consume about 75% of the medical services. It stands to reason that females should have a medical surcharge. As for smoking, smokers die younger saving the state a small fortune in medical expenses. If we are to use a monetary model for healthcare, they should get a rebate on their health contributions.
Dave, Yellowknife, Canada

In most of the developed world, the healthcare systems just aren't sustainable in their current situations
Carolynne Burkholder, Vancouver, BC, Canada
In most of the developed world, the healthcare systems just aren't sustainable in their current situations. With the ageing baby boomers, radical changes to health care must take place in order to keep from bankrupting our governments. In the future, I expect that more and more patients will be refused treatment, due to prioritizing according to age and other factors that predict the risk involved in the procedure. It may not be fair, but it is an effective solution to the crisis of the health care system.
Carolynne Burkholder, Vancouver, BC, Canada

I would just like to see those who deserve decent health care get it. Those who commit crimes refuse to work and contribute little or nothing to society should be at the back of the queue. The same applies to those who smoke, take drugs or who are mortally obese. That would soon sort some of this country's health problems out - 'sorry we can't treat you as you smoke, you will have to pay'- fantastic!
Stu, UK

Only in theoretical cases where the treatment is 100% ineffective for people in the particular age group. Reduced probability of success should not be reason enough to refuse treatment.
Colin Wright, UK

This suggestion is nauseating and leads to a situation where those causing harm to themselves may continue to enjoy treatment while those who need it and happen to be aged are considered less worthy of help. This is a foul solution to the pensions crisis!
Scott Hegley, UK

It does not say anything about not treating people just because they are old
Julie, Stockton
From the comments here I don't think anyone has actually read what these recommendations are. The point is not to offer a treatment where its efficiency is reduced due to age - this may be old or young! It does not say anything about not treating people just because they are old. However it is being used to create yet another media storm in a teacup.
Julie, Stockton

Absolutely not! Adopt the American way and treat up until death. This ageism lark has gone on for long enough.
Ged, Newcastle

And this is happening under a Labour government. Disgraceful.
Oliver, UK

What a disgraceful suggestion. This would be the start of a slippery slope. What next? Enforced euthanasia for anyone 'lucky' enough to make it to 85?
Ali Asgur, London, UK

Three years ago, when my father was 63 he became seriously ill. The NHS had the ability to fix him, but the resources were being directed to younger people. I had a clear conversation with the Consultant in the Intensive Care Unit, where she told me that I had to accept "this was the way of things nowadays". I did not accept it then and my mother and my sisters had to fight very hard to get my father the treatment he needed. He is now very well, very fit and healthy.
Tracey, Surrey, UK

For essential treatment age is not the relevant determinant
Kevin Miller, Penshurst, England
The NHS must prioritise the demands being made upon it. For essential treatment age is not the relevant determinant. Decisions must be based upon the benefit to be gained by the patient in terms of both extended quality and quantity of life. There will be some elderly patients for whom the benefit is too little to justify the cost. The same will also apply to some who are heavy smokers or who are grossly overweight.
Kevin Miller, Penshurst, England

Surely it is the current elderly who are the fully paid up membership of the NHS. They should all expect to get appropriate adequate returns for their life's efforts.
David Billingham, Leicester

It depends on one single factor - the clinical judgement based upon the term benefits to the patient. Should such treatment significantly prolong a life and/or improves quality of life, then yes. The hard facts of life however tell you that life is finite, and if there is suffering and pain involved the factors concerning quality of life and expectancy need to be ethically reasoned.
Mike, London, UK

How on Earth can age affect the benefits of treatment? Age is a number not a medical condition. Only medical condition should be the determinant. What a shabby recommendation.
David Ball, Wokingham, UK

Resources are not limitless and funds have to be prioritised
G Florentin-Lee, London
It's a simple question of rationing. We'd all want an NHS with limitless funds to employ countless staff and provide ample qualities of the best, most expensive medicine for everyone. However, the simple fact of the matter is that unfortunately, resources are not limitless and funds have to be prioritised. It all comes down to limited resources vs. unlimited wants I'm afraid, and unless people want to pay more taxes that's not going to change any time soon.
G Florentin-Lee, London

How can we tell how "old" a person really is? Some current 70 year olds could live for another 40 years whereas some may only live another year even with the best care. No one can predict when someone is actually going to die apart from we know it will happen to us all eventually! The proposal seems very close to "ethnic cleansing" of the elderly to me.
Zoe, Reading

We could save billions if we take their pensions away too! What an absolute outrage. The same elderly people paid National Insurance and tax all their working lives. They lived and fought through the two big wars in order to maintain our freedoms and to live in a country where all are equal. This group of 'experts' should be sacked immediately. I am 31 years old.
Chris, UK

Am I right in thinking that if someone intentionally and wilfully abuses their body for example by drinking, smoking and overeating the NHS is bound to pick up the complete cost of their care, but an older person who may well benefit from treatment is excluded on age grounds? Old age happens to us all and is inevitable; however self abuse is not.
Sheena, Poole

This does not only apply to elderly people, my mum needs a knee replacement amongst other things and she is only in her forties. They won't give her it because she is too young.
Lizz, Erskine, Scotland

Next they will be stopping people entering hospitals because they are to ill, or not anywhere near ill enough.
Steve Penn, London

Why did this decision not come out long before the elections? Was it because it would have an adverse affect on the votes by older people?
Letitia McRae, Nottingham

I have been paying my NI contributions for over 30 years and had very little out of them. If I am refused treatment on age grounds later then I want my money back.
Roger, Stockport, England

If treatment has a reasonable chance of success that is what counts
Abby O'Neil, Daventry
Chronological age should not be the decider. Some people are "old" at 50, while others are still gung-ho and full of life at 90. If treatment has a reasonable chance of success and will improve a person's quality of life, that is what counts.
Abby O'Neil, Daventry

As far as I can see, Daniel Buchan is the only person who has understood the NICE recommendations. There is no 'cut-off age'. This is not about diverting resources to people with a longer life ahead of them. This is simply about certain treatments not being as effective on people of certain age groups.
Geoff Briggs, London

Most respondents seem to be missing the point here. Risk and benefit should always be considered when deciding on treatment. Age can be a factor in both. Surely all factors should be considered when deciding if treatment is likely have a net benefit that justifies the cost. Assisting such decisions is the remit of NICE and seems perfectly reasonable to me.
Paul, UK

People should not be denied treatment because of their age. Assuming a reasonable chance of recovery, healthcare should be available to all. On the other hand people whose lifestyle choices (i.e. obesity and smoking) limit their chances of recovery should not be given priority.
G O'Broin, Oxfordshire

The elderly created the world we live in today
Steve Ingram, Amesbury, Wilts
Why is the NHS so limited with resources when the government closed all military hospitals and supposedly placed the extra resources into local hospitals? If they didn't do this, what has happened to all of that extra finance and equipment? The elderly created the world we live in today and I feel embarrassed to be part of a generation that is prepared to turn their backs on them and yet quite happily live under the umbrella that they have provided.
Steve Ingram, Amesbury, Wilts

Surely the point of healthcare is to enable you to reach and enjoy old age. Why would you want to stop it once you get there?
Gareth, Lancashire

Treatment under the NHS is already restricted on the basis of age. I know someone whose GP would not refer her to a consultant re a knee replacement because she was 'too old'. It just so happened that when she saw a consultant re an arm injury he decided that she was eligible for the knee replacement her GP did not want her to have.
Sharon, London

Whichever way I look at this issue the same question sticks in my mind - are we really about to become an officially ageist society?
Paul Biggs, UK

Issues surrounding the elderly become more worrying on an almost daily basis
Fay, Hull, England
I think issues surrounding the elderly become more worrying on an almost daily basis. Having witnessed, and am currently witnessing the disgraceful way elderly relatives have been treated by nursing staff in our local hospital, it seems like 'Logan's Run' is closer than I thought.
Fay, Hull, England

The NHS has limited resources. If you had to choose to provide a heart transplant to an 85 year old or a 15 year old, who would you select? I know what I would do.
Emma, UK

I know that this attitude has prevailed for a while. My mother was given nothing in hospital after she had been on treatment for hypertension for several years and she was also addicted to tranquillisers for decades, both prescribed by GPs. Inevitably her blood pressure just rose until the inevitable end. Was she considered a 'bed-blocker'? I see no reason why the elderly should be treated differently than anyone else. After all they have contributed more than the young.
Marlene, Nelson, England

Neil Kinnock once said in a speech following the re-election of a Tory government: 'I warn you not to get sick. I warn you not to be old'. Seems like it's gone full circle and it would be unwise to fall sick or be old under New Labour.
Colin, London, UK

We should be trying to improve quality of life
Anon, UK
I'm a nurse working with critically ill, post-operative patients. I believe that by attempting to prolong life at all costs we miss the point. We should be trying to improve quality of life and treatment often leads to more suffering particularly in the very old. I would also add that the generations now over 80 have had the longest life spans of any generation in history; it is a law of diminishing returns to concentrate so many of NHS limited resources in a futile attempt to keep them alive at the expense of others with so little benefit in terms of quality of life and expectancy. We have forgotten that dieing is both unavoidable and natural.
Anon, UK

I feel people are missing the point somewhat. The point is not to reduce the amount of care given to the elderly. The point is not to offer treatments where the efficacy is severely reduced due age related factors or not to use treatments that pose a greater risk to the patient's health due to their age. Seems sensible to me.
Daniel Buchan, London

Perhaps New Labour is about to launch a private health plan initiative and this announcement is just to get us all in the right frame of mind.
Gerry Noble, Salisbury, UK

With the rising cost of healthcare in Western nations due to the ageing populations and increased demand for new medical technology these are stark choices we must make. Simplified, do we treat a pensioner or a sick newborn? There simply are not enough healthcare dollars/pounds to go around. Fancy paying more taxes everyone? I thought not.
William, Melbourne Aus/ ex Manchester

When did health officials graduate to Gods?
Julie Roberts, Stoke-on-Trent
What an appalling idea! Pensioners have paid their contributions through their working life the same as everyone else and are entitled to be treated. What kind of society are we living in if we refuse treatment just because they may not live to see the benefits? When did health officials graduate to Gods?
Julie Roberts, Stoke-on-Trent

I don't smoke or drink - but would never hold back care from those who do. And nobody chooses to be overweight in our 'thin is beautiful' society - there are usually underlying reasons for eating disorders. No - once you start restricting care on arbitrary grounds, it's a short step to ethnic cleansing. I am horrified at the National Institute. Risks must be considered but benefits to the patient can't be judged by a government body.
W. Duff, Scotland

Could this be the perfect way to fill the pension gap? Deny care and old people will die when they are no longer economically active. Further they will pay more inheritance tax as they will not live so long as to spend all their money. Seems this country is rocketing backwards not forwards. I wonder why this report was not published at the start of the election campaign?
Donald Inglis, York, England

People of all ages pay towards a healthcare system in hope that one day no matter what age they are they will receive the help and support they need to overcome illness and injury. What a frightening thought that someday someone won't help you get better or ease your suffering because of your age. So what age are they going to start discriminating at?
Katrina, London

Age itself should NOT be a factor
Elizabeth Lloyd, Gateshead, UK
Age is a much less consistent factor in determining risks than other lifestyle issues might be. Age itself should NOT be a factor; clear assessment of risks based on factors such as general health, blood pressure, weight (e.g. in elective surgery BMI is very important) should be. Age might have an effect on these, but so would other things. Obesity and smoking should be taken into account where they affect the risk factors.
Elizabeth Lloyd, Gateshead, UK

Everyone gets old and will have paid their National Insurance for years to ensure they have full, free medical care. I think the wrong decision has been made and withdrawal of care should be applied to those with preventable problems caused by lifestyle. If the patient chooses a lifestyle which inevitably causes ill health, and refuses to change their ways, they should be made to pay for the consequences, literally!
Matt, Derby

My father died in February this year at the age of 84 after fighting chronic illnesses for many years. The treatment and care he was given could not have been better, and age-related risks were always discussed openly with him, so that he could decide whether or not to go ahead. For a government department to suggest that patients should be refused the chance to decide on whether to take a risk is tantamount to playing God.
Mike Smith, Leeds

This is a can of worms. It makes sense to restrict some major operations on the grounds that, say, a very elderly person will only get a few extra years of life - but who is "very elderly"? How many years extra justifies the expense? This should be between patients and their doctors, and never general policy.
Sue, UK

Why should there be age restrictions on healthcare? It's the older generations that can least afford to pay and if they have made NI payments all their life they should get free healthcare.
Paul Warren, Stourbridge, West Midlands

I do not think that the aged should be discriminated against in terms of healthcare. However, if you smoke, drink heavily or are overweight then certain operations and treatments should be denied you. Smoking and heavy drinking related illnesses are self-inflicted, as are the majority of weight problems, and health-conscious taxpayers should not be made to pay for any condition arising from such indulgences.
Caroline, UK

It is unreasonable for the rest of the population to be expected to support an aging population
Phil, Brighton, UK
A limit should be placed on the amount of healthcare over 70's can receive, after which they are expected to make a contribution. It is unreasonable for the rest of the population to be expected to support an aging population who demand, and receive, a significant proportion of our country's resources.
Phil, Brighton, UK

To Phil in Brighton. You should be ashamed of yourself. Those old people 'over 70' went through a world war so that you could be free to speak out like you have. Our old people have made a terrific contribution, we all owe our freedom to them and we all should make sure they are fully cared for in their last years.
Pat M , Peterborough

Lifestyle factors should be taken into account, not age. Drink or drug abusers, or lifelong smokers, who have chosen to endanger their health, should not rank higher than OAPs! This is deeply unfair and against the guiding principles of the NHS and the welfare state: "from each according to his ability, to each according to his need".
Judy, Newcastle, UK

It is people who are now old who have been keeping this country going over the last 60+ years in taxes. It's outrageous to suggest that they shouldn't be treated! They could however be clearly advised of the pros/cons, then left to make their own decision. I also agree that smokers should not be denied treatment - after all, they pay for it thrice over with tax on tobacco!
Joseph, UK

The logic seems a bit lacking here. A person pays tax and national insurance for 49 years and is then deemed too old to justify the cost of medical treatment, while an obese teenager who has never worked, contributed nothing, and is, at least in part, responsible for his or her condition is worth treating. An extreme example but the principle is the same. I can see that other health factors could have a bearing, such as not giving a terminally ill cancer patient a new heart, but on age grounds, no.
Kathy, UK

Setting an arbitrary age for denying treatment is impossible. Some 70 year old are very infirm while some are fitter than people half their age. At the same time we must remember that we are all going to die. Doctors must have the freedom to say "enough is enough" and not be forced to attempt the impossible.
Peter, Nottingham

Decisions based on other discriminating factors are used all of the time
Matt, Telford, UK
It's never going to go down well with those it would affect but decisions based on other discriminating factors are used all of the time. Maybe too many are given false hope by treatment when life should take its own course. If age is to be a factor however, then smoking and over-eating surely should be too.
Matt, Telford, UK

This is a dreadful proposition. Growing old is not a lifestyle choice, we have no option. Smoking, drug or alcohol abuse and overeating are. No-one should be denied medical care on the grounds of their age. Naturally it is a balancing act. If the operation or treatment required would cause further harm or damage then, as in all cases, the pros and cons of going ahead need to be considered by all concerned. Who decides the age limit and who is too old to receive treatment?
D. Porter, Deeside, Flintshire

At 56 I suppose you could say I have a biased view! If there is risk associated with treatment then that should be explained and the individual should then be able to make a choice. The benefits bit is more difficult. Whose benefit? The individual or the NHS? Who decides and how? This could be a very slippery slope down into a "oldest gets treated last" policy for NHS resources.
Terry, Epsom, Surrey, England

You have no choice in what age you are but you have every choice if you smoke, drink or are overweight. These are the factors that should be taken in to consideration, not something that you have no control over.
Adrian Mugridge, Chester, UK

To Adrian. Should people who get injured playing sports or participating in other "risky" activities not be excluded too in this case? Everyone should get the same level of healthcare. Period.
Ian, UK

To Ian. I don't particularly agree with Adrian's suggestion either. However, it should be pointed out that those participating in sport are likely to be far healthier overall and therefore far less of a strain on the NHS, even if they do get a few injuries here and there.
Mark Robinson, UK

I agree with Mark that sporting injuries are more likely to be caused to 'fit people', but have you been into A & E on a Saturday evening?? The number of injured sportsmen when I last was there was staggering. All those people chose to play rugby, football, ski, jump out of airplanes etc. A lot of obese people (or too skinny!) do not necessarily make a 'choice' to be fat.
Diane, Sandy


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