COMMENTARY

Even Very Old People Deserve Aggressive Medical Care

Arthur L. Caplan, PhD

Disclosures

February 18, 2020

This transcript has been edited for clarity.

Hi. I'm Art Caplan. I'm at the NYU Grossman School of Medicine, where I'm the head of the Division of Medical Ethics.

Some of you may have heard some discussion over the past few years about whether age should be taken into account when giving people access to aggressive healthcare for serious problems. Some people—Ezekiel Emanuel, for example, at the University of Pennsylvania—have suggested that we need a cut-off of 75 years, beyond which we start to cut back on the kinds of medical interventions that individuals can access.

That position has been echoed by earlier writers. Daniel Callahan suggested that society should agree that pursuing healthcare for everyone forever was unaffordable; therefore, we should have an age cut-off. I think he had posited a cut-off of age 65 years.

Well, an interesting paper was recently published by surgeons at Stanford University who deal with lung cancer. They showed that among patients with early-stage lung cancer, those who were relatively healthy at age 90 years experienced significant benefit from surgery. Of these, 33% lived much longer, with a good quality of life. In addition, about 20% of patients benefited from drug treatment, as opposed to those who didn't do anything and who died quickly.

It seems to me that we want to guide our decisions about access to healthcare not by biases about being too old or treatments being too expensive, but first and foremost, we want to ask whether there is benefit. Does it work? Is it going to help the individual? This paper seems to indicate that even at age 90, for early-stage lung cancer, there are people who could benefit from aggressive care.

Admittedly, not every 90-year-old is going to want it. Some 90-year-olds may say, "I'm going to forgo that. My time has come. I don't want any more treatment. I don't want to go through any more surgeries."

But as we also know, more and more anticancer treatments are drug-based, not surgically based. They're not cheap, but many of them are going to prove efficacious for some of those elderly people.

It's wrong to set an age limit based only on the notion of a fulfilled life or someone having had the chance to live a complete life. If you can make it to age 90 and you still love your family, have your hobbies, or are still working, you should have the choice about whether to take more treatment for life-threatening diseases that you face.

I understand that you may also say, "I'm done, and I don't want to do anymore." I have no objection to that, as long as it's a choice informed by data—not by bias, by bigotry, or by ageism.

The data ought to drive the things that are offered and then we should dispute whether or not we can afford everything that might be available to the very old. However, we should not decline, disguise, or fail to disclose the opportunities that might be out there when the data show that real benefit is possible.

I'm Art Caplan at the Division of Medical Ethics at NYU. Thanks for watching.

Arthur L. Caplan, PhD, is director of the Division of Medical Ethics at New York University Langone Medical Center and School of Medicine. He is the author or editor of 35 books and 750 peer-reviewed articles as well as a frequent commentator in the media on bioethical issues.

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