Bias against older patients is morally wrong, say charities
DENYING the elderly access to intensive care units is “discriminatory, ageist and morally wrong”, a coalition of charities for older people has warned.
Decisions over which Covid-19 patients receive priority treatment should not be made solely on age or care home residence, they claimed, amid accusations that to do so would be “unfair and completely unacceptable”.
Their call comes after The Daily Telegraph reported that a major London NHS trust said that “very poorly patients with coronavirus may need to be on a ventilator for extended periods,” adding that “for some patients this would not be in their best interests”.
However, Imperial College Healthcare NHS Trust denied that people were being denied care due to capacity problems after a senior consultant said ventilators and intensive care for coronavirus patients were being limited to those “reasonably certain” to survive.
The nine signatories of the open letter include Caroline Abrahams, the Age UK director; Deborah Alsina, the chief executive of Independent Age; Donald Macaskill, the Scottish Care chief executive; and the commissioners for older people in Wales and Northern Ireland.
Speaking as organisations and individuals supporting older people and protecting their rights, they state that: “Any suggestion that treatment decisions can be blanket ones, based on age alone or with a person’s age given undue weight as against other factors, such as their usual state of health and capacity to benefit from treatment, would be completely unacceptable.
“For many years we have known that chronological age is a very poor proxy for an individual’s health status and resilience – something we all see among the older people in our lives.
“To ignore this and to revert to an approach based solely or mainly on age would be, by definition, ageist, discriminatory and morally wrong.”
Governments across the world are developing ethical guidelines and decision tools to help doctors prioritise patients for hospital admission and treatment.
The letter’s signatories said they were “joining together to say that if and when our own governments across the UK do similar work it is vital that they all continue to uphold fundamental human rights principles”.
They added: “There is no reason to abandon this long-established good practice now; in fact the current health emergency makes it more critical than ever that we keep it.”
They said assessments should be made on a case-by-case basis through honest discussion with the patient, their family and relevant professionals.
It comes days after the National Institute for Health and Care Excellence issued guidance to NHS intensive care doctors on how to decide which patients should get critical care.
The guidance provides an “algorithm” to help doctors decide who should be admitted to critical care and who should not. It does not categorise potential patients by age but instead asks doctors to score patients on a ninepoint “clinical frailty scale”.
The scale ranks patients from one (very fit) to nine (terminally ill) . Those scoring less than five (mildly frail) who want critical care are considered well enough to benefit, subject to underlying conditions and the severity of their illness.
Those scoring over five are put through a process where doctors must decide if critical care is “appropriate”.
Anecdotally, charities are aware of suggestions in some areas that care home residents will not be admitted to hospital with Covid-19, and only in exceptional circumstances for other reasons.
Doctors have also told how older Covid-19 patients stand limited chances of access to ventilators, which are in short supply and often needed for around two weeks per patient.
Ruthe Isden, the Age UK head of health influencing, said: “To discriminate against people on any basis which is unjustified is morally wrong. This is about upholding people’s fundamental human rights. We shouldn’t be making decisions based on age alone.”
' Any suggestion that treatment decisions can be blanket ones would be completely unacceptable’