In the debate over government control of health care in the United States, critics looked at the UK system and its death panels, which drew an arbitrary line on when to stop treatment. Their recent efforts led to such an outcry that the government has said they were ending the incorrectly named Liverpool Care Pathway and its policy of subtle euthanasia.

Most ethicists in the UK have been in favor of letting government rather than doctors determine patient care but an Emeritus Professor of medical ethics at Imperial College London talking at this year's Euroanaesthesia meeting titled will at least argue that a patient's age should not in itself be considered an ethically relevant criterion for deciding 'where to stop' treatment.

US doctors have historically fought for every patient - that and no cap on salaries for medical professionals the way countries with socialized health care have is why the cost of US health care is high. But as US medical schools increasingly produce new doctors in a 'teach to the protocol' environment and they start their careers under more government control, the US should see a switch to the UK's 'fair innings argument'- which says that taxpayer-funded health care should be preferentially deployed to younger patients who have not yet lived full lives. Older patients won't be fought over as strongly as they are now.

Gillon argues against it, saying, "If societies do wish to pursue such 'ageist' policies then they should do so only do so after widespread consultation and the enactment of democratically established laws according to which patients condemned to be denied life-prolonging therapies on grounds of age alone should have a legal right of appeal!"

The moral criteria that are relevant can be summarized, he argues, as the likelihood of achieving a beneficial outcome for the patient, at the cost of a minimized and acceptable risk of harm, in the light of the patient's own views and values where these are ascertainable, and also in the context of fair consideration of competing claims on available resources. 

"However, co-morbidity and age may in some circumstances justifiably have a bearing on these criteria," concludes Professor Gillon. "For example co-morbidity may adversely and substantially influence the probability of a beneficial outcome; and some old people may be less inclined than when they were younger to accept the risks and discomforts of major surgery even if it might prolong their lives."

Unlike in the UK, they still have a choice. Let's hope it stays that way.