By David Hunter

The McMillian Cancer trust has published a report described on the radio as I drove to Manchester this morning as a damming and shameful report about the NHS and discrimination. The report alleges that more than 14 thousand elderly cancer sufferers are allowed to die in the UK because of age based discrimination.

The radio show was of course call in based, and featured a number of callers who were horrified by this and when asked whether age or money should matter in regards to treatment asserted that of course it shouldn’t and that it was sad that efficiency was being used as a criteria for controlling access to medical care.

I’m baffled by this claim since it is obviously madness. Since we don’t have unlimited medical resources (and wouldn’t even if we revised our society to maximise spending on medicine). We could always spend more on increasingly low yield diagnostics, treatment and prevention, and if we adopted the above practice then we ought to, to the detriment of social care, education, public transport except insofar as these contribute to health.

So prioritisation is necessary, which raises the question of how we should do it? And would it necessarily be terrible to prioritise on the grounds of age?

There are at least three common arguments that might justify current practice, the fair innings argument, age working as a proxy measure for potential to benefit from treatment or as a proxy for the likely length of benefit. Without going into detail of these arguments nor endorsing them, it seems unfortunate that this kind of practice is so obnoxious to the public given that there are popular arguments for them in the literature. (although not obnoxious enough to generate a 500 comment long diatribe against the authors for example…)

I think there is something disingenuous about arguing that we ought to increase health spending without considering the flip side of where the money is going to come from. In effect it treats health costs as being paid for from a magic fountain, without considering the true costs. So if we want to avoid this “discrimination” where should the money come from?