Cai Heath

Background Age equality was enshrined in UK law by the Equality Act of 2010, which defined age as a protected characteristic and age discrimination unlawful, unless objectively justified. To date relatively little attention has been paid to how this legal requirement is interpreted and applied in healthcare. Such a lack of clarity raises significant legal and ethical questions regarding how age affects access to and provision of care. This scoping review aims to address this gap. It examines how age and age groups are considered in healthcare policies and decision-making processes and how age equality duties are understood and implemented in practice. Methods The scoping review draws on national and regional policy and decision-making documents, and relevant academic literature. It has two main objectives: first, to examine the explicit and implicit ways age influences healthcare provision. Second, to assess how different age-groups are represented or omitted in healthcare decision-making processes that determine access to care. Attention is given to age-based distinctions and omissions, their stated justifications or their absence in policy, and healthcare decision-making. Results Our findings indicate that despite legal protections, age equality is not yet consistently embedded in healthcare policy or practice with significant unresolved ethical tensions in approaches to age-equality. We identified gaps between stated policy commitments and implementation, limited attention to age-related inequalities and little clarity on when such inequalities may constitute inequities or raise concerns about unlawful discrimination. These include a lack of evidence for systematic monitoring of age-related inequalities and potential inequities, and lack of practical guidance to support healthcare decision-makers in meeting their equality duties. Conclusions It remains unclear whether and how key ethical tensions in the pursuit of age equality are resolved by decision-makers. To support a more consistent and transparent approach to age equality in healthcare, efforts should focus on strengthened decision-making processes and clearer operational guidance. The routine use of age-sensitive equality impact assessments across services could enable a more systematic identification of age-related health inequalities and inequities that may be overlooked across the lifecourse.

The workshop, Coercing for Health: Transdisciplinary Approaches to the Ethics of Coercive Public Health Policies was held at the University of Oxford on July 3rd and 4th, 2024. This paper provides both a summary of the workshop proceedings and reflections and directions for future research on coercive public health measures. The workshop consisted of four key parts: defining coercion; history and legal analysis of coercion; public health ethics perspectives on coercion; experiences of coercive public health measures. According to our reflections, some important questions remaining for further research include: what is the difference between coercion and enforcement? Who gets to define and address coercion? How do structural factors affect health and experiences of coercion? We encourage others to continue to work on this important area, to ensure the ethically acceptable and thoughtful implementation of any future coercive measures in the sphere of public health.