RTTS-1 Cancer cure rationing

May 19, 2000

I am quite prepared to believe that the National Health Service does not do what it ought to treat the elderly. Nevertheless, the assumption in Steve Farrar's report ("Cancer treatment ageism", THES, May 12) that there should be no discrimination on grounds of age in treating any condition is worth a second look.

First, any sum of money we consider it is appropriate to spend on health will never be enough to meet all needs. That being so, there will be cases where more years of life can be saved by spending resources on treating children, for example, than the elderly.

Second, we can take the philosopher John Rawl's perspective and imagine all patients, elderly or young, about to restart their lives without knowing what medical trials and tribulations they might have to face. If we ask them to choose society's spending pattern for health, it is not at all clear that they would choose one that made no distinction of age in deciding who should be treated.

Finally, the inequality implied in the article is in terms of expected future years of life. In terms of expected total years of life, an untreated elderly cancer patient is already better off than a treated young one.

Stephen Senn

Professor of pharmaceutical and health statistics

University College London

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