Human Exceptionalism

Medical War Against the Elderly: British Medical Journal Reveals Undertreatment of Elderly Stroke Patients

The UK’s medical war against the elderly (especially the frail) seems undeniable. First, there was age-based rationing at the NHS. Then, a nurse whistle blower lost her nursing license for publicly telling the truth about elder neglect at a hospital. Now, the British Medical Journal reveals that elderly stroke patients are often short-shrifted on what should be a routine medical treatment for stroke. From the press release (here’s the abstract:

Older people are less likely to receive drug treatment after a stroke compared to younger people, despite the fact that treatment is equally effective, finds a study published on bmj.com today. There is also some indication that women may be less likely to receive treatment than men, but patients’ social and economic circumstances are not linked to differences in treatment, the findings show…

After a stroke, patients should receive a combination of drugs to help prevent another stroke. This is known as secondary drug prevention. The drugs used are blood pressure and cholesterol lowering drugs, and anti-clotting drugs. Previous studies have suggested that elderly people, socially disadvantaged people and women are less likely to receive medical interventions compared to younger, affluent people and to men. So researchers based in London decided to test this theory for stroke treatment…

Rates of secondary drug prevention were generally low–only 25.6% of men and 20.8% of women received treatment. This did not vary by socio-economic circumstances. However, older patients were substantially less likely to receive cholesterol lowering treatment (26.4% of patients aged 50-59 received treatment compared with 15.6% of patients aged 80-89 and just 4.2% of those aged 90 or more).

We’re not even talking about rationing of high end technology here, but basic and inexpensive drugs.

Some of this seems to reflect inadequate education about the benefits of these medicines. But the “substantially” lower rate of treatment, apparently based on age, is very revealing. And while the recent posts I have done on this issue have been about stories in the UK, there is no way that the problem is restricted to the British Isle.

I think we need to look to cause as much as effect. This study and the story of the nurse illustrate the subversive impact of the bioethical “quality of life” ethic–that is fast supplanting the Hippocratic “equality of life” approach–on medicine. The bioethicists might respond by denying they support discrimination–they see themselves as liberals, after all (although they really are not)–only “rational” withholding of high tech and expensive care based on the bioethical principle of distributive justice. But this excuse ignores the impact of ideas and how they can impact actual practice in the trenches. As a logical species, we take accepted premises where they lead. In this situation, the idea that ill elderly patients have less value based on quality of life, causes people to perceive such people as different from other patients, resulting in divergent health care provision. So much for respecting our elders.

The only antidote to the poison we have swallowed is human exceptionalism–the understanding that each human being has equal value based simply and merely on being human.

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