Coleman's 12th Law Of Medicine

Some patients will always be treated more equally than others.

Vernon Coleman

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 they wore.

Sadly, it seems that wherever there is a hospital there will be prejudice.

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.

These days 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 fluids.

Such stories are increasingly commonplace.

The egregious 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 consideration.

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 lions.

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 females.

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.

`Old 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 visited.

`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.

The 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 acceptable.

`The doctors told me that my mother was dying,' wrote a reader.
`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.

Eighteen 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 much.

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 too long.

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 `Jews'.

I can't see any Government happily encouraging newspapers to run headlines like: `Politicians Instruct Hospitals To Let Jews Die'.

Now that nurses have been given authority to prescribe drugs even more old people are spending their final years in a drug induced stupor.

In hospitals and nursing homes everywhere elderly patients are being subdued and sedated with tranquillisers and sleeping tablets.

It's much easier to run either type of institution if the inmates spend most of their time sleeping.

Politicians have made things considerably worse by giving nurses legal authority to give old people drugs without their permission or authorisation.

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 hospital?

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 can.

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 puzzled.

`You have a son.'

`Thank you.'

`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 filling in.

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 know.

`He was a teacher,' she said.

`Do you have a fridge at home?' asked the inquisitor.

The old woman looked bewildered.

`A fridge,' repeated the inquisitor rather impatiently.

`What's that?' asked the old lady, looking very confused.

`A big white thing that keeps food cold.'

`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?'

`Oh I 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.

`Why 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 time.

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 teacher.'

`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 teacher?'

`Did she say that?'

I nodded.

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 ago.'

`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 did.

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 Page
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 rampant ageism.
Yours sincerely
Vernon Coleman

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.

We made 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.

We 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.

So, in 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 heavily.

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 our struggles.

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 practise.

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.

Taken from 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