In this moving and controversial Quarterly Essay, doctor and writer Karen Hitchcock investigates the treatment of the elderly and dying through some unforgettable cases. With honesty and deep experience, she looks at end-of-life decisions, frailty and dementia, over-treatment and escalating costs.

Ours is a society in which ageism, often disguised, threatens to turn the elderly into a "burden" - difficult, hopeless, expensive and homogenous. While we rightly seek to curb treatment when it is futile, harmful or against a patient's wishes, this can sometimes lead to limits on care that...