Commentary

Extract

That the United Kingdom has comparatively low figures for acceptance of patients over the age of 55 for renal replacement therapy is remarkable, because, on a comparative basis, the United Kingdom is not a poor country and many U.K. nephrologists were pioneers in the technical and medical development of he-modialysis. While most nephrologists in the United Kingdom agree that age per se is not a valid criterion to be used for excluding patients, the “hard” use of age as a rigid line demarcating those to be treated from those to be denied treatment predominates. Professor Halper has made a very thorough analysis of which factors at the macroallocative as well as the microallocative level are responsible for this. It would have been of interest to know how the health system in the United Kingdom deals with other categories of elderly, severely ill patients (e.g., patients with malignant diseases), for whom immediate surgery may be life-saving, but the long-term prognosis is questionable. Are such patients also denied treatment in the United Kingdom because of age?