Refusing elderly patients treatment or drugs can sometimes be justified, says the watchdog for UK’s National Health Service. “Where age is an indicator of benefit or risk, age discrimination is appropriate,” says a paper from the National Institute for Clinical Excellence. The paper attempts to be even-handed about the sensitive topic of age discrimination, although the first obvious target is the elderly. Free IVF treatment need not be given to older women over 39 because success rates taper off after that age, it says. On the other hand, flu vaccinations are not recommended for the young, although they are a priority for over-65s.

A lobby group for the elderly, Age Concern, rejected the proposal. “These draft guidelines are muddled and if applied could be a real step backwards in the fight against ageism,” said its head, Gordon Lishman.

The paper also argued that people suffering from self-inflicted illness caused by “unhealthy lifestyles” such as smoking or drinking, could legitimately be denied treatment — “if the self-inflicted causes of the condition influence the likely outcome of the use of an intervention”.

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