Some might argue that there is something very wrong with a social system that plans to introduce measures which effectively prejudice its most vulnerable members. And yet the reforms under discussion by the Department of Health could see the National Institute for Health and Care Excellence (NICE) being forced to set stricter rations on the NHS, potentially denying life-saving treatment to the elderly.  

 In a move to increase efficiency and value for money, plans have been made public to introduce the idea of “wide societal benefit” as an important factor to be included in determining the purchase of new drugs. The news has already been met with widespread criticism accusing the policy of being “barking mad”.

Sir Andrew Dillon, the head of NICE, expressed deep reservations with the whole proposal arguing that it may justify priority being given to groups with wage-earning capacity at the expense of those who are retired. His belief is that such a “hard-nosed” way of doing things fails to capture the continued economic value of the elderly who often contribute by helping their families with childcare or remain active members in their local community.

The proposed policy loosely assumes a controversial ‘fair innings’ rationality. This is the idea that everyone is entitled to enjoy a certain limited number of healthy years during their lifetime, assisted by the state. Those who fail to receive this are being dealt an injustice while those exceeding the prescribed limit are thought of as “living on borrowed time”.

It is this austere approach to the question of social justice that has people like Sir Dillon feeling uncomfortable, now even more so because the proposed reforms would almost certainly hit an already vulnerable group.

In 2008 78-year-old Kenneth Warden was diagnosed with terminal bladder cancer and told that he was too old to be considered for treatment on the NHS, including palliative care to ease his suffering. His daughter intervened paying for private treatment which resulted in him making a full recovery.

Such cases are not isolated occurrences but reflect an existing demographic where elderly patients are continually denied treatment for cancer and various other conditions because of their age, and without further assessment of their particular survival chances. The fear is that this will now only get worse.  

Despite the backlash a fair innings view may have some merit. Born of the fact that most social systems are bound to have imbalances with respect to efficiency and distribution of resources, the idea of defining conditions for optimal distribution carries some practical weight. However, what seems objectionable in this instance is the indiscriminate manner in which policy makers have apparently addressed a sensitive subject matter.

The late economist Alan Williams maintained the need for greater precision in fair innings approaches. He believed that although age could be used as a factor in determining the specifics of a fair innings policy, other particulars including social class, gender and life-style are equally relevant since they often reveal significant disparities which need to be addressed in order to produce a better welfare system.   

 Recently, the official retirement age which stood at 65 has been lifted with no formal requirement to quit. The average life expectancy is increasing to 82.8 years for women and 78.8 for men according to the Office for National Statistics. Is it fair for instance, to deny a recently retired 75-year-old man from a working-class background treatment because a 45-year-old unemployed single mother is dying of cancer? These are extremely difficult questions and any changes in policy should begin by carefully examining and assessing the range of data applicable to different types of social groups before determining the limits of fairness.

If sacrifices must be made and someone will inevitably lose out, should it be the already vulnerable? If your inclination is to say “no”, then you are also saying no to the fair innings argument as it currently stands and a “yes” to a different idea of justice where life should remain a choice as much as possible instead of a contingent circumstance.

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