ABSTRACT
Some years ago, an elderly patient on my list was admitted to hospital when the warden in her sheltered accommodation called an ambulance after she collapsed. She was in her late 80s, a widow and very frail. A furore over ageism in medicine was at its height and, perhaps as a result, she was admit ted to a coronary care unit and received the highest possible standard of care, including fibrinolytic treatment delivered according to the latest evidence-based guidelines. She made a good recovery and was discharged home, apparently well, a week later. I went to see her and found her to be very grateful for the care that she had been given but profoundly shocked by a course of treatment that she perceived to be completely inappropriate. She explained to me that not only her husband but almost all of her generation of friends and acquaintances were already dead, that her physical frailty pre vented her doing almost all the things that she had previously enjoyed and that she had no desire to live much longer. No-one had asked her about any of this or attempted to discover whether the effective and therefore recommended treatment for her condition was appropriate in her particular case. 1 She died three weeks later while asleep in bed. The considerable costs of her earlier treatment had been futile, distressing and wasteful.
