Bioethics Forum Essay

One Way to Combat Ageism in Healthcare

After a suicide attempt, a 71-year-old woman arrived in the intensive care unit in shock but breathing on her own. A DNR request, scribbled on a napkin, was found next to her. Should her DNR request be honored?

This case was shared on the group chat of our Master’s of Bioethics class by the patient’s physician. A classmate responded: “At 71, she should be allowed to die if she really wants to. I would feel differently about a 16-year-old or even a 40-year-old.”

We assumed our classmate’s intention was to honor the patient’s wishes, but it is ageist to determine the type and extent of treatment a patient receives based solely on age. Ageism is embedded in healthcare. A widely referenced study estimates that 1 in 5 older adults experience ageism in healthcare. The United Nations has identified ageism as a barrier to adequate medical care. Although many U.S. medical schools include aging and geriatrics in their curriculum, ageism is so normalized it often goes unnoticed.

We — Lucy (age 27) and Risa (age 67) — believe that intergenerational friendships are a powerful way to combat ageist bias and prevent us from viewing patients as stereotypes rather than individuals.

We met in the bioethics program, arriving at opposite ends of our careers, united by a commitment to bioethics. Risa is a recently retired dermatologist; Lucy is a recent university graduate and yoga teacher in marginalized communities. We discovered shared interests that bridged our 40-year age gap — swimming, ice-skating, and homemade chicken noodle soup — and both have had life-changing family experiences. Lucy’s father died of sudden cardiac arrest at an ice rink equipped with a defibrillator that no one knew how to use. Risa’s husband was saved by a defibrillator 24 years ago.

As our friendship deepened, so did our discussions about the DNR case. Lucy had never thought to question Risa’s value based on her age — if anything, it made her perspective more compelling — so she was surprised by her classmate’s perception that a 71-year-old should be regarded so differently from a 40-year-old. Risa recalled advocating for older patients who wanted aggressive treatment for their skin cancers when other physicians had dismissed them as too old. Several studies confirm that older patients are less likely than younger patients to be offered procedures, even when they would be of equal benefit.

Among clinicians, intergenerational interactions occur regularly during training and in work settings, but intergenerational friendships are not the norm. The necessary hierarchy between teachers and trainees hinders opportunities to form genuine friendships across age lines. One way to foster these connections is to collaborate outside the clinical setting on initiatives based on shared values — through medical societies, patient advocacy work, educational meetings, or continuing coursework.

We are not suggesting that age should never inform medical decisions. Age can provide insight into longevity, quality of life, and the reasonableness of ongoing care. An 80-year-old considering a complex heart valve replacement may weigh recovery and quality of life very differently than a 40-year-old facing the same procedure. Age must serve as one of many factors — not the determining one.

Responses in our class to the DNR question were varied. Some classmates wondered if they were biased against older patients; others focused on the ethical importance of honoring a DNR. Privately, the two of us agreed that appropriate care should be determined by capacity assessments, review of medical and mental health history, ethics consultation, and possibly legal advice — rooted in a comprehensive, holistic understanding of the patient. In the end, the patient was placed under involuntary commitment, permitting physicians to provide lifesaving treatment for her shock while psychiatric evaluation was arranged.

Being friends with someone older helps younger clinicians see all patients as people deserving dignity and respect, and to recognize age-related bias before it shapes clinical decisions. Being friends with someone younger offers older colleagues new perspectives shaped by different social and cultural contexts. Intergenerational friendships will enrich your life — and foster the empathy and perspective necessary to provide compassionate, effective, and ethical care.

Lucy Panko, MSc, holds a Master’s of Bioethics from Harvard Medical School. She conducts research on psychiatric and end-of-life ethics. She is also a yoga educator and mental health advocate. LinkedIn Lucy Chaya Panko

Risa Jampel, MD, MSc, is a board-certified dermatologist with a Master’s of Bioethics and is involved in projects at the National Cancer Institute, Harvard Medical School Center for Bioethics, and Johns Hopkins University. LinkedIn Risa-Jampel