Three papers in this issue show good results for cardiac surgery in the elderly.1-3 These papers remove one objection to the practice of according to the elderly an equality of concern, respect, and protection in the care afforded by a public health care system, namely that such treatment is futile or the next best thing to futile.

An important question that must be settled before anything useful can be said about such surgery is the question of whether people’s legitimate moral claims are age related in any way? There are three obvious ways in which it might be thought that moral claims could be age related.

One is that the strength of the claims might be thought to vary with elapsed time, that they might diminish (or increase) in proportion to the amount of lifetime an individual had experienced or “consumed”.

The second concerns not lifetime lived, but lifetime in prospect. It is often thought that moral claims vary with life expectancy, in proportion to the amount of life an individual has left or (more likely) is reasonably expected to have left. This will always be related to elapsed time but may also arise through illness, injury or indeed genetic constitution.

Finally many think that moral claims are legitimately varied by quality of life considerations—for example, …