Abstract
Dr Loefler's careful essay on the preferential treatment of children in matters of health (JRSM 2007;100:110-111)1 will by now have led to a great deal of argument, much of it emotional, polemic and unhelpful. A comparable analysis of attitudes to treatment at the end of life would surely be no less controversial. But, nevertheless, rather than seeking to lessen or abolish discrimination in favour of children, would the species not be better served by discriminating against the sick elderly, or-let us go the whole way-the elderly in general? Children do of course at first consume inordinate resources, to the cost of which they are initially unable to contribute. But the imbalance is quickly redressed in favour of their contributions when they cease to be children. This usually remains true for a long period until the balance turns once again against them. Then the disequilibrium becomes steadily more negative and, what is worse, has no predictable end.
The proposal may cause discomfort or appear outrageous. But the taboo was partially broken long ago, with the introduction of Advance Directives and Do Not Resuscitate (DNR) orders. (A recent Google search produced over 500 000 references to DNR, almost 30 000 of them in association with the NHS.) Of course, many elderly people themselves come to conclude that their quality of life (and/or that of those around them) is no longer good enough to make their continuing existence worthwhile. If they continue to use up an increasing proportion of medical and paramedical resources that they no longer enjoy, should they not be allowed, or even encouraged, to dispense with them?
Footnotes
Competing interests None declared.