There are many ways to get sick, many ways to crumble and crash. We are hearts and lungs and kidneys and skin, blood vessels, liver and brain. And we are so much more than this . . .

In this essential Quarterly Essay, doctor and writer Karen Hitchcock explores the humane treatment of the elderly and dying through some unforgettable cases. With honesty and deep experience, she looks at end-of-life decisions, acute care of the frail and the demented, big pharma, over-treatment and attitudes to ageing and death among doctors, patients and their families. Hitchcock reveals a creeping ageism, often disguised, which threatens to turn the elderly into a 'burden' – difficult, hopeless, expensive and homogenous.

Thanks to health-dollar hysteria, the elderly are the only group of medical patients for whom we are trying to limit treatment, hospital stays, interventions and expense. We are justly seeking ways to determine when medical care may be futile, harmful or against a patient's wishes, but this can easily morph into limitations on care that suit the system rather than the patient.

Hitchcock argues that we need to plan for the new future when more of us will be old, with an aim of making that time better, not shorter. And that we must change our institutions to fit the needs of an ageing population.