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Martin Bright is right to draw attention to the indignities suffered by elderly people not only in hospital but in society as a whole (Comment, last week). However, he displays a lack of understanding in his reference to 'Do Not Resuscitate' decisions, and does a disservice to the patients whose dignity he seeks to preserve. Resuscitation attempts are instituted when a patient suffers a cardiac or respiratory arrest. It may involve cardiac massage, applying electric shocks to the heart and inserting tubes into the airway to provide artificial ventilation. In certain situations there is a reasonable chance of the patient surviving. There are however many situations when clinical experience teaches that resuscitation attempts are futile. Under such circumstances to attempt resuscitation is distressing and simply prolongs the process of dying. The decision to not resuscitate does not equate with a decision to not treat a patient, though increasingly doctors feel pressured into attempting resuscitation even when they know it is going to fail. In so doing they are turning dying into a medical event and denying the patient a dignified and peaceful death.M.K.

BensonConsultant Chest PhysicianChairman of Hospital Ethics CommitteeOxford Radcliffe HospitalsOxford Martin Bright outlined his grandmother's sad experience at Bath Hospital but it would be wrong if this were now to be regarded as the norm. In October last year, I suffered a severe heart attack which was dealt with efficiently and sympathetically at the same hospital. A second heart attack the following day was handled equally promptly. The wards I stayed in were comfortable and well nursed. Even the food was palatable. An additional problem I experienced was dealt with by the urology department in a thorough and considerate manner. I am 69, and many of the patients in the wards were older - so I can vouch for the approach of the Royal United Hospital in Bath towards older patients.

Alun Morgan Bath The Health Secretary's 'pledge to protect older patients' is meaningless unless accompanied by extra resources and manpower. When an elderly person is left lying in his or her own excrement, or on a trolley in a casualty ward for 48 hours, this is a terrible thing. But it is not because the staff have a deep-seated hatred of everyone over the age of 60. It is because the system is simply overwhelmed. I know of no nurse or doctor who would not condemn this. As far as withholding treatment from the elderly, this happens when there are not enough resources. Nearly every intensive treatment unit in the country is regularly faced with more than one patient requiring the last empty bed. If the choice is between a 40-year-old and an 80-year-old, the answer is inevitable. This is an issue which the public needs to face up to - either it can accept the current situation, or it has to pay for a system where everyone gets equal treatment irrespective of age.