Coleman's 12th Law
Some patients will always be treated more equally than
Today it is the
elderly who are treated least equally.
When I was a medical student
I was a member of a well-meaning organisation called, I think, the Medical
Association for the Prevention of War. At a conference I attended I remember
being shocked to the core to discover that one doctor had observed that in riots
in one American city, hospitals had given precedence to the treatment of injured
police officers to the detriment of seriously injured demonstrators. Incoming
patients were not treated according to their need, but according to the clothes
Sadly, it seems that wherever there is a hospital there will
Apart from obvious geographical inequalities (patients in
some areas receive far better care than patients in more poorly served areas)
there are many examples showing that even on a national scale health care is not
distributed fairly or evenly among those who need it. The problem is that
politicians, administrators and doctors invariably spend money on those who are
perceived to have power. Those who are regarded as powerless may be denied even
basic care. So, for example, while infertility treatment is widely offered to
those who need it governments happily close down long stay psychiatric care
hospitals without providing any alternative. Those who are able and willing to
promote their own needs (either in the media or directly to politicians) will
always receive more than those who are not so fortunate. This is particularly
true wherever socialist medicine is practised. In Britain the constantly ailing
National Health Service, ostensibly designed to provide equal care for all, is
grotesquely biased towards the photogenic and towards those noisy and demanding
liberals who can make sure that their demands are met at the expense of the rest
of the community. The mentally ill, not as good at arguing their case as those
young media women demanding yet more resources for breast cancer, get forgotten.
Celebrities will wear pink ribbons to remind us of the needs of breast cancer
patients but how many would proclaim their interest in bowel cancer - a much
bigger killer? Making a decision between closing a breast cancer unit or closing
a special needs school won't tax a politician for long.
there is no doubt that the patients who are treated with least respect are the
elderly. They get an even worse deal than the mentally ill - and that, believe
me, is saying a lot.
In the summer of 2006, for example, British
newspapers carried the appalling story of a 91-year-old woman who spent her last
four days without food or fluids after hospital staff decided not to provide her
with either. When the woman asked a nurse for a cup of tea she was told she
couldn't have one. The woman's family obtained a High Court injunction to try to
force the hospital to treat the woman. But, nevertheless, a pathologist
concluded that the woman had died as a result of lack of foods and
Such stories are increasingly commonplace.
doctors who behave like this are simply doing what the Government wants them to
do. To ruthless politicians the elderly are a drain on society; they have to be
paid pensions, they use up expensive medical services and they pay very little
in the way of taxes.
It is traditional, in mammalian species, for
wisdom to be passed from generation to generation. The elderly have much to
offer to the younger generation. In return for this knowledge, and in respect,
the young care for their elders with care, compassion and
So, for example, the situation of underground water
sources will be remembered by older elephants. This knowledge can save the herd
during a drought. Younger elephants are so aware of the value of their elders,
and so in awe of them, that when older elephants are slaughtered by poachers the
young, orphaned elephants suffer from severe behavioural problems. They fail to
find enough food for themselves, they don't know what to do or where to go and
they end up running amok, killing farmers and raiding their crops. They fight
one another. They become yobs. Without access to their elders the young
elephants are doomed to conflict.
Much the same thing happens with
Young lions recognise that older lions can help with the complex
cooperative hunting strategies which lions use to catch their prey. And so older
lionesses, incapable of hunting and, because of missing teeth doomed to die if
not cared for, will live out their old age supported by the younger
Chimpanzees care for their elderly too. Elderly chimpanzees are
given food and groomed by the other members of their society. Older male
chimpanzees aren't subjected to the sort of aggression other males must expect,
and their own rather feeble aggressive behaviour will be tolerated without
retaliation by younger males.
Old age brings respect in much of the
animal world. But not for humans.
In our modern society we pay respect
only to youth, technology (whether useful or not), money (however acquired) and
fame (whether deserved or not). The abuse of the elderly is ignored, even
tolerated, in a way that the abuse of children would never be.
age is not for cissies.' Bette Davis
More older people die
during winter in UK than in any other European country - including those which
are colder. This is due to poor housing, poor diet, poverty, not enough state
support, neglect, depression caused by loneliness, and a general feeling of
being unwanted and uncared for.
The system wants you dead as soon as
you stop working and paying tax. And the system now decides what happens. People
don't control the system.
In America in April 06, an 82-year-old
woman was arrested and fined £80 for crossing the road too slowly in Los
Angeles. She was walking with a cane and just couldn't get across the road
before the lights turned red.
I do hope they remembered to give the
policemen an award for bravery.
There are around 600 million people
in the world aged 60 or over. But this will double by 2025 and reach 2,000
million by 2050.
When she was in her early '80s my mother was in a
small cottage hospital which wanted to throw her out. They said they wanted the
bed for another patient. My mother was incapable of moving any limb. She could
do nothing for herself. She was so confused that she didn't recognise me when I
`We've got a shortage of beds,' said the matron. `Your mother
will have to go home.' She told me that I had to attend a meeting.
meeting was held in a fully-equipped but entirely empty ward.
No one but
me saw the irony in this.
Ageism is accepted now in our society. It
is the only `ism' which is deemed to be politically
`The doctors told me that my mother was dying,' wrote a
`They convinced me and my brother that they should shut off her
ventilator and let her die. But a few minutes after they had shut off the
ventilator my mother woke up and wanted to know what was for tea. She danced at
her 89th birthday party the following week.'
I have great sympathy for
the writer of that letter. My own mother was written off by the teaching
hospital where she was a patient. She was comatose and although they admitted
that they didn't know what was wrong with her, they decided that she was
terminally ill and should be left to die. Only our insistence that they keep
providing her with fluids via an intravenous drip kept her alive. Who, I
wondered aloud, gave doctors, nurses and administrators the right to make this
sort of judgement? I insisted that the instruction be removed.
months later my mother had recovered enough to join my father, myself and my
wife at a dinner to celebrate their 65th wedding anniversary. I photographed her
with a glass of red wine in her hand and a big smile on her face. Curiously none
of the doctors who had described her as terminally ill, and who had abandoned
her as beyond care, have shown any interest in her astonishing recovery.
I have often wondered why doctors seem to hate old people so
In the end I came to the conclusion that it is because they cannot
stop them dying.
And the death of a patient is, to a doctor, the ultimate
insult; the final sign of professional failure.
Both the Government
and the medical profession have repeatedly announced that old people will, on
occasion, be denied normal medical treatment and will be allowed to die.
It is now standard practice for elderly patients (in some hospitals the
cut off point may be as low as 60 or 65) to be denied medical help if they need
resuscitation or emergency, life-saving treatment. In some hospitals the elderly
are deliberately starved to death so that they don't take up valuable beds for
Old people are treated in a way that would not be tolerated if
they were members of a religious group or ethnic group.
For example, in
the paragraphs above try replacing the word `elderly' with the word
I can't see any Government happily encouraging newspapers to run
headlines like: `Politicians Instruct Hospitals To Let Jews
Now that nurses have been given authority to prescribe drugs
even more old people are spending their final years in a drug induced
In hospitals and nursing homes everywhere elderly patients are
being subdued and sedated with tranquillisers and sleeping tablets.
much easier to run either type of institution if the inmates spend most of their
Politicians have made things considerably worse by giving
nurses legal authority to give old people drugs without their permission or
The result of this is that hundreds of thousands of
elderly people spend their final years unaware of what is going on around them;
forcibly drugged into State approved senselessness.
Makes you ashamed to
be human doesn't it?
A friend of mine who is a doctor tells me that
every time he visits his mother (who now resides in an expensive nursing home)
he finds her asleep. Each time he visits he demands to see the drug records. He
finds out that his mother has been drugged and insists that the medication be
withdrawn. For a few days his mother becomes alert and awake. Then, when they
get fed up of her asking to be given a cup of tea or taken to the toilet, the
staff start sedating her again.
My mother was lying in a hospital
bed. She had been (wrongly) diagnosed as suffering from terminal cancer. She had
been in a coma for several weeks and had only recently woken up and started to
take an interest in her surroundings. She was still unable to move or feed
herself. She had a catheter fitted and was being nursed on a special vibrating
bed because of bed sores. Despite the diagnosis and her physical condition the
hospital once again decided to discharge her from hospital in order to free a
bed and save money. I was again summoned to a meeting. This time there were nine
(nine) health service employees present. There was one doctor, one nurse and
seven people whose jobs I didn't quite catch. They looked like administrators.
Seven of them. They all carried files of paper. I suspect that the cost of the
meeting (and the preparations for it) would have paid for quite a few patients
lives to be saved.
`According to the hospital consultant my mother is
terminally ill with cancer,' I reminded them.
`Yes,' said one of the
administrators. `But she's not finally terminally ill.'
The emphasis was
on the word `finally'. I swear the administrator smiled as he delivered what he
clearly considered to be a clever coup de grace.
As it happens the
diagnosis was wrong.
But what sort of administrator invented the phrase
`not finally terminally ill' as an excuse for throwing a sick patient out of
In the UK if old people have money and can afford to pay
for their own nursing home care they will be discharged and expected to spend
their resources paying for their own care.
If they don't have money they
will simply be sent home to look after themselves as well as they
Two social workers/bureaucrats/inquisitors were questioning a frail
old lady in a hospital bed. The woman was clearly confused and demented. The two
inquisitors had been sent to question her to assess her fitness to be sent back
home. I listened to their questioning and wrote down their questions and the
answers immediately afterwards.
`You have a son don't you?' said the
first inquisitor, the one holding the clipboard.
The old woman looked
`You have a son.'
`What does he do
for a living?'
`What's his job?'
The old woman
thought for a while. `Teacher,' she said.
The inquisitor nodded
patronisingly. `Splendid,' she said. Without making any attempt to find out
whether or not the answer was correct she wrote something on the form she was
The inquisitor then asked my friend's mother what her husband
had done for a living before he retired.
The elderly lady clearly didn't
`He was a teacher,' she said.
`Do you have a fridge at
home?' asked the inquisitor.
The old woman looked bewildered.
fridge,' repeated the inquisitor rather impatiently.
`What's that?' asked
the old lady, looking very confused.
`A big white thing that keeps food
`I don't know.'
`I'm sure you have,' said the inquisitor.
She turned to her companion. `She'll have a fridge won't she?'
expect so,' nodded the companion, though the old lady clearly didn't know what a
fridge was, let alone whether or not she had one.
`We will put you down
as having one,' the inquisitor said, as though doing her a favour. `It's good
for keeping frozen food.
' The inquisitor with the clipboard ticked a
box. The two women then signed the form and stood up.
They had officially
declared that the old lady was neither confused nor demented.
didn't you just chuck her out of the window?' I thought. It would be quicker for
everyone and just as kindly.
Twenty minutes after the inquisitors had
left the woman's son arrived. When he had found a vase for the flowers he had
brought he sat down by his mother's bedside.
I went over to him,
apologised for interrupting and asked if I might have a moment of his
He stood up and walked with me into the dayroom. I told him about
the visit I'd witnessed.
`They want to send my mum home,' said the man.
`She's 82 and lives alone in a terraced house. They said they'd assess her to
see if she's capable of looking after herself.'
`Can I ask you if you're
a teacher?' I asked.
He laughed. `A teacher? Me?' He laughed again. `Who
told you that?'
`Your mother told the inquisitors that you're a
`She gets confused,' said the man. `Most of the time she
doesn't even know who I am. I'm a car mechanic.'
`Is your father a
`Did she say that?'
He shook his head
sadly. There was a tear in the corner of one eye. `They were married for nearly
60 years,' he told me. `He was a taxi driver. He died eighteen months
`They're going to send your mother home,' I told him quietly. `They
think she's capable of looking after herself.'
`She's doubly incontinent,
she's diabetic and she doesn't recognise anyone,' said the man, quietly
desperate. `My wife and I live in a one bedroom flat. We can't look after her.
They can't send her home.'
But they could. And they
When the film of my novel Mrs Caldicot's Cabbage War
was released in 2003 the reviewer in British newspaper The Sunday Times
described the film's target audience as `undemanding oldies'.
I sent the
following letter to the Editor:
To Editor, Sunday Times Letters
The review of the film Mrs Caldicot's Cabbage War in The
Sunday Times last week was disgracefully ageist. Your reviewer dismissively
and patronisingly described the movie's target audience as `undemanding oldies'.
Would you have printed `undemanding women', `undemanding homosexuals' or
`undemanding blacks'? I suspect not. I wrote the novel Mrs Caldicot's Cabbage
War (on which the film is based) to draw attention to exactly this sort of
Rather to my
surprise, my letter was published.
But, as far as I know, the journalist
guilty of such outrageous ageism was not disciplined.
My wife and I
decided to take my parents out for a meal to celebrate a birthday. Both were
aged 85 at the time and both could only get about in wheelchairs.
arrangements for a local taxi firm to send a special taxi capable of carrying a
passenger in a wheelchair.
Instead, the taxi firm sent an ordinary taxi
which was, of course, quite useless. The driver couldn't care less.
decided we would wheel my parents to the nearest hotel or pub for lunch. But the
only place that was open had no access for wheelchairs.
desperation, we wheeled them to a local chip shop for a bag of chips each.
Although my parents are resident in a nursing home in a seaside town which is
packed with nursing homes and elderly residents we discovered that the kerbs had
not been made wheelchair friendly. So we had to bump both chairs up and down
countless steep kerbs.
By this time it was, of course, raining
Since there was no wheelchair access to the chip shop we ate our
bags of chips on the pavement in the rain.
As we did so a group of local
youths passed by. They laughed and jeered.
The more vulnerable a
patient is, and the more he or she needs care, the less he or she is likely to
receive it. Especially if he or she is elderly.
My wife and I were
visiting a friend at a nursing home. As we approached the main building we saw
an old man stumble and fall. We made sure that he was not injured and then
struggled to help him to his feet. Two employees (hired to care for the elderly
people living in the nursing home) stood looking out of a window and laughing at
In the UK the General Medical Council guidelines
for doctors are simple and easy to understand. `Doctors,' they say, `must not
allow their views about, for example, a patient's age, disability, race, colour,
culture, beliefs, sexuality, gender, lifestyle, social or economic status to
prejudice the choices of treatment offered or the general standard care
provided. Patients who are dying should be afforded the same respect and
standard of care as all other patients.'
It is clear from this, when
compared to my own experience and that of many of my readers, that the majority
of British hospital doctors are in breach of General Medical Council principles
and are, according to the General Medical Council's own guidelines, unfit to
At the end of the day most doctors and nurses don't give
a damn whether you live or die. And if you're over 65 everyone wants you dead.
Remember that. It could save your life one day.
Coleman's Laws by Vernon Coleman, published by EMJ Books. Coleman's
Laws is available from the shop on this website and from all good bookshops
everywhere - on and offline.
Copyright Vernon Coleman 2007