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Logo of bmjThis ArticleThe BMJ
BMJ. 2007 October 20; 335(7624): 791.
PMCID: PMC2034736

NICE guidelines create ethical dilemmas in care of elderly people, says report

A report that looks at problems affecting elderly people around the world has warned that the United Kingdom's policy of prescribing drugs on the grounds of cost effectiveness is damaging the human rights of older people.

The report, by the International Longevity Centre, warns that the National Institute for Health and Clinical Excellence has created “new ethical dilemmas about allocation of scarce resources” for older people.

It says, “Prescribing drugs according to cost effectiveness may be the opposite of the rights based approach: decisions can condemn patients to deteriorate before the drug will be prescribed, as is the case with Aricept [donepezil] for dementia patients.”

The report also called for the government to act on a recent House of Lords test case, which ruled that private care homes fall outside the scope of the Human Rights Act (Y L v Birmingham City Council and others, HL 20 June 2007). The act covers only homes run by local authorities.

The report says, “The legal chess game may in the long term be the best way of producing a durable result, but in the meantime vulnerable people are left in a wholly unacceptable limbo.”

Frances Butler, vice president of the British Institute of Human Rights, urged the government to plug the loophole.

“This is a serious defect because nine out of 10 care home places are provided by private companies or by charities. Residents cannot properly obtain protection of their human rights when the people who are breaching them do not have human rights responsibilities.”

Ms Butler also urged the government to legislate to protect older people from unfair age discrimination in the health service and other public bodies.

“Women are not invited to breast cancer screening when they reach their 70th birthday. This must make women over 70 think that the government does not consider their health to be worth anything anymore. Age should not be used as a blanket proxy for risk. A more sophisticated scheme is needed,” she said.

Sally Greengross, chief executive of the International Longevity Centre in the UK, said that older people were treated like a “race apart.”

“Far too many elderly people are suffering from malnutrition in care homes and hospitals. Why? Because they're frail, old, tired, and feeble, and they need help to eat. There's no one to give them that help, and that's an absolute disgrace,” she said.

The report hailed the 2001 national service framework on older people's services for setting standards throughout the health service and tackling age discrimination. The framework has urged that policies for charging for care should be “demonstrably fair” but, says the report, “this aim has no force of law and is difficult to challenge.”

Ms Greengross is also a commissioner on the Commission for Equality and Human Rights, which began operating at the beginning of this month. The commission will tackle equality on the grounds of race, sex, sexuality, disability, faith, and age, but she described age as the “junior partner” in that list.


Human Rights in an Ageing World: Perspectives from Around the World is available at

Articles from The BMJ are provided here courtesy of BMJ Publishing Group