The bottom line here: "We cannot continue on the present course of
open-ended health care for the elderly" - resources are too scarce,
the costs too great, the benefits too questionable. What limits
might be set on aggressive medical care for the elderly, and what
should take its place? The answers and suggestions posed here are
likely to provoke discussion and debate. Callahan (Abortion: Law,
Choice and Morality) offers in his first work in some years a
controversial suggestion: "using age as a specific criterion for
the allocation and limitation of health care." He proposes that by
one's late 70's or early 80's, the natural end has come: "one's
life possibilities have on the whole been accomplished; one's moral
obligations to those for whom one has had responsibility have been
discharged; and one's death will not seem to others an offense to
sense or sensibility, or tempt others to despair and rage at the
finitude of human existence." Callahan adds a stipulation that such
a death not be accompanied by unbearable pain, and has thus laid
out a biographical, rather than a biological, definition of a
natural end-point. And it is after this end-point, he feels, that
medical care should be oriented towards the relief of suffering,
rather than resisting death. To support such a new approach, our
understanding of aging and of medicine, and their interaction, will
all have to change. Callahan believes that the primary goal of the
aging ought to be to serve the young and the future by being "moral
conservators of that which has been" and proponents for the future.
At the same time, medical care should seek to improve the quality
of life, rather than extend its longevity; and we should abandon
medical programs that primarily benefit the elderly, pouring
resources into this one small - soon to be gone - segment of the
population. The natural lifespan will have to be understood as
having an acceptable end boundary, rather than an enemy to be held
off at all costs. Callahan is, as before, logical and persuasive;
it is clear that he wants to incite discussion, rather than prove a
particular set of specifics. Provocative, well-based arguments from
a respected voice. (Kirkus Reviews)
Sparking controversy in medical, social and professional circles,
the nation's most respected medical ethicist strikes at the heart
of America's growing health care crisis--the care of the aged. The
New York Times Book Review calls Setting Limits "A pivotal work . .
. the benchmark for future moral, medical and policy discussions of
aging".
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