For Christmas my daughter bought me Jodie Picoult’s moving novel ‘My Sister’s keeper’, the story of a girl who is genetically selected to be born as a bone-marrow donor match to treat her older sister Kate’s leukemia. Kate relapses as a teenager and a decision has to be made about whether she should have a kidney transplant from her ‘donor’ sister. An ethical dilemma for all, but as far as Kate is concerned, there is no discussion about her age, only whether it’s worth the risk considering her poor health.
Today’s report from Macmillan Cancer Support and the National Cancer Intelligence Network (NCIN) on the reality of long-term survivorship from cancer of those over 65 years is contrasted with the larger numbers of survivors in the EU than in the UK. For the over 65’s in the UK, our five year survival rates are lower than in comparable countries. It would seem that the adage “what do you expect at your age?” is alive and kicking in too many hospitals, where the nature of a patient’s cancer and their fitness for treatment is given secondary consideration.
Most commentators still think that age should be a consideration. Having worked with older people for 20 years I would disagree. Fitness for treatment and the nature of the cancer should be the top considerations, never age. The huge variation in well-being of the over 65s would make any fixed age-based decision completely arbitary. More so, if we open the door to age inequalities – making relative decisions based on how old someone is – the economic pressure of an ageing population means that we will inevitably become more utilitarian. A decision based on age harms us all, because it reinforces the idea that your worth is relative to your abilities, your independence and the time period for which you have already lived.
Jeremy Hunt rightly highlighted last autumn our national shame that so many older people are lonely; he talked about the ‘reverence and respect’ that he had seen for older people in Asian countries. I too have seen this in my visits to sub-Saharan Africa: older people are esteemed, yielded and listened to. We demean our society when we treat older people as inferior.
This subject isn’t going to go away. The organisation that rations our medicines, NICE, are about to start a consultation on how to allow for ‘societal benefits’ as they consider their equation for establishing the cost-effectiveness of new medicines. Last year they turned down all but one new cancer drug, hence the medical and political imperative for the Cancer Drugs Fund. And this was the concern behind the press headlines two weeks ago, stating that older people will be denied drugs as society has less to benefit from an older person compared with someone of working age.
I have already stated publicly that age should not be a consideration in the methodology of assessing new medicines, and the same goes for any treatment. If we are of value because of our humanity, then that is not age-dependent. If we start to make our value conditional on our abilities, then we embrace relativism. We would be opening the door to the discrimination that follows, wielded by those who have the most power, and we would end up with a culture of fear.