I know this is a bit of a contraversial one, but it's interesting.

I saw a program on TV the other day that stated in Malaysia the government will not pay for medical care of a person once they reach the age of 80 years of age, because they have 'lived a good life' and the resources are better spent on younger patients.

Most money spent on healthcare of a person is spent in their last year of life.
'Health and aging' are seen as the same portfolio but is this a mistake? Aging is not a disease. In our inability to cope with death, are we trying to 'cure' the aging process, an impossible goal?

Question: Is it ethical to put valuable resources into providing healthcare for people who are over 80?

Why not cancel the healthcare of many other groups who are net losses to the public purse such as Aborigines or people from lower socio-economic classes, too?

I'm all in favour of good health care for the aged, even for those 75 and over

arry wrote:

Question: Is it ethical to put valuable resources into providing healthcare for people who are over 80?

Good question, and one with interesting ethical challenges.

I think it can be ethical. Any medical budget is limited and it is the role of the Government, which represents the society, to select those areas in which to fund or not to fund. Every dollar spent on the over eighty year old people, mean one dollar less to be spent of the under eighty year old people. Perhaps the mortality of babies is very high in Malaysia and they are diverting funds from aged people to obstetrics or something. We don't know of course, but as I said "it can be ethical."

I do not think Australian society today would see such an approach as ethical for Australians, at least not today. I would not support such an approach to medical funding in Australia either, but I cannot say it is not a good approach for Malaysia.

To those who state categorically it is wrong, I would appreciate your comments to help me understand how tax dollars can be ethically optimised across a society. I reckon allocating funds for medical support is a no win task and not one I would like. I applaud the Malaysian Government for making a tough decision, as I do the Chinese Government when they introduced the one child policy and reduced the probable population of China by 400 million.

OK, the implementation may not be perfect, but it is good to see Governments make tough decisions after considered debate (I assume there was considered debate ... most politicians are closer to eighty (and richer) than the average person on the street) based upon what they see if best ethically for their nation. Much better than being diplomatic, but taking little effective action.

All healthcare systems have to make tough cost-benefit decisions in the allocation of resources to fund treatment.

However, doing this on the basis of age strikes me as unacceptably blunt. There may well be people aged over eighty for whom a relatively modest expenditure on healthcare offers an excellent prospect of substantial health advantages. Conversely, there are certainly many people under the age of 80 who suffer from such serious health problems that further health interventions offer very little prospect of benefit.

It seems to me the salient factor is not how old someone is, but how much they may benefit from the suggested treatment. That depends on a good deal more than their age.

But even this can’t be the sole factor, at least if we understand “how much they will beneft” to mean “by how much their life will be extended”. If prolonging life were the only or major criterion in resource allocation decisions, then we would allocate no resources to palliative care, which strikes me as extraordinarily inhumane.

Couldn't agree more, Peregrinus, we can pride ourselves (to a certain degree) on how we look after our aged citizens. There are a few things that rankle however; having reached the age of 75 I am now required to have an annual health check to retain my license. I currently have a heavy vehicle license but at 80 will have to undergo a yearly driving test as well and this is fair enough because as one gets older re-action times slow down and eyesight with glasses isn't all that it could be etc.

However, as you point out, health is not only a function of age and many people below 75 years of age are in poorer health than many over 75s, so why not a yearly health test for all licensed drivers?

I belong to the very best health fund : Veteran Affairs Gold Card

I guess it comes back to the coset-benefit trade-off. There’s a cost, borne by someone, to health checks. Does the risk posed by declining health require us to pay the cost of annual testing over a lifetime? Or does that risk only rise to the point where the cost of annual testing is justified later in life?

Or, to put it another way, if we are going to spend that amount of money on improving road safety, is spending it on annual health checks for all drivers going to give us the best return in terms of improved safety? Would we actually get a better return if we spent it on more driver training, or better road signs, or whatever?

I think also we can distinguish between the kind of discrimination which says “if you are over 80, we need evidence of your health”, and the kind which says “if you are over 80, you can’t drive because so many over-80s are in poor health”. Even requiring a health check does put a certain barrier in the way of getting a licence, whether in terms of cost or of the inconvenience of finding the time and making the arrangements, but for most people it is probably a barrier they can surmount.


Hopefully it will provide care that will keep you driving for many years to come!

I'll be 69 this year and I have no problem with stopping tax funded health care at 80. A friend in the U.S. is 98 and just got new knees from the government I think that's ludicrous.

Patrick,

Your friend might be like John Cherry, a Kentucky gunmaker, who was reputed to be around 130 when he died. There is a photo of him in the book 'The Caplock Rifle' and he sure looks old.

It's a pretty fair assumption that your friend won't wear out his new knees but with all the other waste of tax payers' money (insert country of choice) what's a few thousands of dollars matter if it improves the last years of someone. Here in NSW it'd be money well spent compared to the continuing tax funded 'Transport Studies' that a child with his first toy train set can see won't work.

I have had a look on the web and can't find any reference to the reduction of services for the aged in Malaysia. This doesn't negate the original question, but I am hoping to better understand if health care funds for the aged are reduced in Malaysia, where are the funds allocated to? Then we can better discuss the ethical aspects of the decision.

http://www.idrc.ca/en/ev-28476-201-1-DO_TOPIC.html
Implications of ageing in Malaysia
As in many countries of the region, economic development, medical advancements, accessibility to medical and social care and knowledge of nutrition have put more years into life, while the present and future challenges are recognized to be to put quality into these added years. For Malaysia, coping with population ageing can be a great challenge, as there are many competing issues that appear to deserve more urgent attention than that of improving the well-being of older persons. Indeed, the Eighth Malaysia Plan 2001–2005 does not have a separate chapter on the elderly, hinting that ageing has yet to become a national priority. Although Malaysia still has time on its side, ageing must attain the priority it deserves due to its multiple and complex social and economic implications.

And I see the word "inhumane" has cropped up. I sort of know according to the dictionary, it has a positive connotation, but I must confess, whenever I see this word used to justify something, I cringe because in my view, humanity is inhumane in practice. I guess, I'm just a bit cynical about what makes people do things.

Any more info on the background to the stated question?

I must say that arry’s account of what he saw on television struck me as fairly surprising. Obviously I didn’t see the programme he saw, but a policy stance of the kind he suggests would be internationally controversial. You’d expect it to be widely discussed. But, like Airzone, I don’t find any trace of it on the web.

Here (http://ageing.oxfordjournals.org/cgi/re ... /5/444.pdf) is an article on the challenge of providing health services for older people in Malaysia; it makes no mention of such a policy. On the other hand, it dates from 2003; the policy could be a later innovation.

Yet the stereotype of Asian cultures is that they are respectful of the aged, valuing their experience and wisdom. Asians are perhaps the last culture that we would expect to discard their elders on the basis that they are, essentially, used up. True, it’s only a stereotype, but stereotypes generally get to be stereotypes by having some kernel of truth buried in them.

What could well be happening is that Malaysia is facing a demographic challenge. Rising prosperity, improvements in nutrition and improvements in primary health care could be leading to a relatively rapid increase in life expectancy, with the result that the proportion of older people in the Malaysian population is projected to rise rapidly in the coming decades, with a corresponding fall in the proportion of younger (taxpaying) people. (Many European countries are facing a similar challenge, but for a different reason; falling birthrates. Australia faces yet another version of the same challenge because of a tail-off in immigration, relative to population.)

What may be happening is that Malaysia needs to commit to spending a lot more on the healthcare of older people than it currently does, because demand is inevitably going to rise, and there may be political argument about how, and to what extent, and at whose expense, this is to be accomplished.

Those who feel that not enough is being done to recognise and face up to this challenge may well characterise the position as one of refusing to spend money on healthcare for older people; others might describe it quite differently.

These are all great angles to look at the problem. I think that as a society we hang on to life too tightly, for the young and old alike. We should be less inclined to save someone at all costs and accept that life is a gift and impermanent. Where there is life, there is death. Having just unexpectedly lost my father at 74(he was diagnosed with stomach cancer and died within 16 weeks), I was shown by him to be thankful for what life you had- gratitude- and to accept its unalterable impermanence- grace. I miss him terribly but I wouldn't have wanted him to battle it out with interventionist medicine. The way he accepted his death was a gift to all that were around him. I no longer fear death and I am grateful for each day I wake up. We need to change our perception of life and death- they are one. It's like people suing for every and anything- they somehow think that life owes them. It's a bumpy journey and we never know when it will end.

Probably there are other things in the budget that are less important than keeping people alive, and if not in the Malaysian government's budget, then in someone else's.

It's a pity that choice has to be made with these sorts of limitations - there aren't enough resources here, even though there's an excess over there.

Mind you, I reckon we should all go and live in virtual reality, whenever "they" [insert future scientist here] invent it: we'll take up less of the planet, make less pollution, and we'll be immortal.

I think that it is ethical to continue funding for healthcare to people over 80. People over 80 are just as important as younger people. They are just as deserving of good health as people younger than them. People over 80 should be able to live as long as possible.

I think an important question with this Malaysia ruling is whether it's more important to pay for a younger person's health care or an older person's healthcare, if you had to choose between them? That's what Malaysia is saying, that they think it's better to spend the money on younger people.

I think if you can afford both, you should spend the money on both the younger and the older person. I think Malaysia shouldn try to afford older people's health care, instead of giving up and saying that they only have money for younger people. There are things that can be done to increase the funds for older people's healthcare.

However, if you have to pick between a younger person's healthcare expenses and an older person's health care expenses, I'd have to say that a younger person's health care expenses should come first, maybe, because they have more life in them. I may be wrong, but this is only if you have to choose- most of the time, you can do both. So, that's what I think.