Introduction
A recent WHO declarationFootnote 1 reports that over 95% of COVID-19 related deaths in the European Region (currently the epicentre of the pandemic alongside with North America) occurred in people older than 60 years. Elaborating on these figures, we want to make a clear statement to reinforce the protection of each nation’s older adults and to promote intergenerational equity and solidarity. This message deserves to be fully understood in light of the potential discrimination against older people in the current public debate regarding the allocation of scarce medical resources during the present pandemic.
Priority setting in healthcare, i.e. “the task of determining the priority to be assigned to a service, a service development or an individual patient at a given point in time” [1], is unavoidable, because the demand for healthcare exceeds resource availability, particularly in pandemic circumstances. However, even under conditions of resource scarcity, priority setting processes should not compromise the basic human rights to health and wellbeing of any stratum of the population, especially that of older people and other vulnerable groups. Yet, there is a real risk that the immense pressure on resources exerted by the COVID-19 pandemic may result in the prioritisation of key services across different age groups based on actual or future contribution to society, or on other utilitarian criteria.
In this context, older people may be seen as a particularly large and vulnerable group, and one which plays a less active role in society, especially from an economic point of view. Therefore, in an attempt to optimise resources, older people might be considered as having a priori less rights to high-quality healthcare than younger generations, who tend to be seen as less vulnerable and more active members of society. On the contrary, we want to emphasise that resource scarcity and utilitarian calculus should not undermine older people’s rights to receive high-quality healthcare: societies have a moral imperative to protect and respect the dignity and autonomy of older people [2]. Moreover, in line with philosophical accounts which regard ‘vulnerability’ as valuable [3], we also wish to highlight that older people can enrich societies.
We are not claiming that age parameters should not be considered while facing the allocation of scarce sources. Our aim is to strongly oppose the idea of setting an a priori age cut-offs to decide who should get access to healthcare, as such ideas discriminate against older people. We believe that, especially during the COVID-19 pandemic, there is the need to focus on this issue, since there are some initial signs of such discrimination. Thus, we wish to show how these discriminatory phenomena can cause severe negative outcomes not only from the moral standpoint of respect for dignity and autonomy of older people, but also from the utilitarian perspective of achieving the greatest good for the greatest amount of people.