Give the old a choice

Oldies beware. We are not merely being disproportionately targetted by the coronavirus. We are also being disproportionately targetted by the Government and by some medical policy makers.

Ken Clarke, that wise, and independent-minded old Tory owl, recently had a go at the Government for considering whether the over-70s should be locked down for another year, while younger folk were gradually allowed to walk free. He warned of a pensioners’ revolt. Some older folk would simply ignore such harsh, selective regulations, he said. (What do you know? They might make take up their zimmer frames and make a break for the park, the pub or even Clarke’s favourite haunt; Ronnie Scott’s jazz club.) He hinted he might be among their rebellious number. If so, I would be happy to join him for a pint.

But there is worse. There has been speculation that — if the ventilator shortage is not resolved, or if the number of Virus patients entering hospital rises once again — the full range of life support services, including access to those scarce ventilators, might be offered first to those who are most likely to benefit from them, rather than those in most severe or urgent need. This reverses usual clinical  priorities.

Not surprisingly many doctors are suffering a crisis of conscience about the possibility of being asked to say who among their patients they should sentence to almost certain death and who should be given a final chance to live. This they say is not a medical decision. It is a moral, ethical, or — in the real world — inevitably a political decision. So it needs rules.

This debate should worry the elderly, for if they — we — are infected, we are often in most urgent need, but are apparently less likely to respond positively to the full range of treatment. Thus we would be likely to find ourselves shoved to the back of the queue. You could say that, in a time of crisis, there is a rough justice here. To use the cliches: those in their 70s or 80s have had “a good run for their money”. Patients half their age would in contrast be “cruelly cut off in their prime” if denied, or made to wait for, crucial treatments.

It’s a no-brainer then?

Perhaps. But calling in politicians — however benign and logical their motivation — to set rules to decide matters of life and death has an unpleasant smell of eugenics about it. You may remember the Nazi programme to do away with those they defined as the old and sick, the mentally or physically handicapped, and others whom they dismissed as “useless eaters” and “unworthy of life”. Of course there is a world of difference between deciding priorities for treatment, and ordering categories of people to be killed in institutions which one brave German pastor described as “death hospitals”. But even so…

The Goverment is already drawing up a list of over a million old people whose vulnerability means they  need extra “shielding”. This sounds warm hearted enough. In reality “shielding” means the most severe and rigidly enforced form of lockdown for the rest of this year or longer. For some in their 80s this would be a life sentence. Or more accurately perhaps, a death sentence. They would simply die of “natural causes” — old age, exacerbated by loneliness and depression — before their doors were unlocked. Moreover, such a list could all too easily easily become the core of an automatic, tick box, rules-based denial of treatment in hospital.

So what is to be done about selective lockdown and the possibly necessary rationing of treatment? Here is a two-part solution. It may sound extreme, even brutal, but is actually humane. It is based on individual moral responsibility, a concept central to our society. I for one would buy into it.

We know that elderly people have declining immune systems, so they are rather more susceptible to infection that the rest of the population. (Though, if infected by Covid-19, they are significantly more likely to become gravely ill.) But, crucially, if infected, they are no more likely than a younger inflected person to pass the virus on. So why not place them under exactly the same restrictions as other people, and let them decide whether they wish to go out for exercise or shopping?

Secondly, we know how unpleasant and invasive the ventilator is, and how often it fails to save the lives of older patients. Why not ask all older virus patients — perhaps all virus patients — when they enter hospital, whether they wish to be placed on a ventilator as a last resort, or whether they would prefer to let nature take its course and leave the scarce ventilators for those who would benefit more from them? And honour their decisions.

We still celebrate the courage and self sacrifice of Capt Lawrence Oates, seriously frost bitten and delaying his comrades, on the final days of Scott’s doomed Antarctic expedition. He walked out of their tent to certain death with the following remark. “I am just going outside and may be some time.” It was, Scott recorded in his diary, “The act of a brave man and an English gentleman”.

I know that the words brave, English and gentleman often raise a snigger these days — especially when they occur in the same phrase. But we could well find that the virus has given them a renewed potency.