Age ‘important’ factor in deciding who gets treatment during pandemic – academic

Age is an “important factor” when making the “terrible choice” of who will receive scarce resources during a pandemic, an academic has said.

In a debate on whether it is wrong to prioritise younger patients with coronavirus, Arthur Caplan, Professor of Bioethics at NYU Grossman School of Medicine in New York, argued that age is a “valid criterion” when supported by data.

Writing in the BMJ on Wednesday, Prof Caplan said age had played a role for decades in limiting access to care when rationing life-saving treatments, such as access to renal dialysis and organ transplants.

But he said that even in conditions of extreme scarcity “it would be discriminatory to simply invoke age to exclude those in need from services”.

Prof Caplan said that the key ethical question was whether age by itself was ever a “morally relevant factor” in deciding who gets care when rationing is unavoidable.

However, if the goal is to save the most lives with scarce resources, then age may matter if there is a diminishing chance of survival with increased age, he added.

Hospital ward
A simulation technician takes part in medical training inside a ward at the official opening of the new Dragon’s Heart Hospital, built at the Principality Stadium, Cardiff (Ben Birchall/PA)

Prof Caplan said: “Indeed, the relevance of old age as a predictive factor of efficacy — combined with the powerful principle of healthcare affording equality of opportunity to enjoy a life — makes age an important factor in making the terrible choice of who will receive scarce resources in a pandemic.

“Ageism has no place in rationing, but age may.”

But Dave Archard, Emeritus Professor at Queen’s University in Belfast, said that there were three reasons why age should not be used to decide who should and should not receive potentially life-saving treatment.

He said that a simple “younger than” criteria was unsatisfactory because it cannot be said an 18-year-old is preferred to a 19-year-old on the grounds of one year’s difference in age.

This would be not much better morally than tossing a coin, or a crude “first come, first served” principle using the time of arrival at a hospital to determine whether care is given, he added.

Prof Archard said that while the “fair innings” argument – that everyone should have an opportunity to lead a life of a certain duration – had intuitive appeal, there was no agreement of what a fair innings amounted to.

He added: “Someone who has had her fair innings may yet have much to give the world than another, who has not, may be unable to offer.”

To discriminate between patients in the provision of care on the grounds of age is to send a message about the value of old people, he said.

Prof Archard said that such discrimination publicly expresses the view that older people are of lesser worth or importance than young people.

“And it would be hard not to think — even if it was not intended — that a cull of elderly people was what was being aimed at,” he added.

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