Cofounder and director of The Hastings Center, the
biomedical/ethical think tank on the Hudson, Callahan faults
underlying assumptions for the crisis of health care in America.
These assumptions ate embodied in statements by the World Health
Organization that "Everyone has a right to a standard of living
adequate for the health and well-being of himself and his family. .
." The problem is rights, Callahan avers; in a nation as strongly
individualistic as America, desires become needs become rights. The
pursuit of health becomes an end in itself, employing all the
latest tools and tricks of high-tech medicine with the aim of
curing all disease and postponing death. Such beliefs are folly,
Callahan says, and when they are compounded by unwillingness to
pay, have succeeded only in driving up the national cost of health
care to the 1989 figure of $550 billion - while other programs,
notably education, are left to stagnate. Callahan's solution
demands a radical change in values. People must learn to set
limits, live with "reasonable" health, make decisions based on
quality of life, better equity, and expectations that a better,
more balanced society will come from "wise" choices. Callahan is
finn on the need for a universal health-insurance system and
opposes all solutions based on making systems more cost-conscious
and efficient. They will fail, he says, as long as they ignore the
structural dynamic of an aging society, belief in medical progress,
and public demand. No question about it, Callahan's strong medicine
will go down badly with many individuals and groups - older
Americans, those with rare disorders, AIDS patients, and
politicians on either the right or the left. Nor does Callahan seem
to see the point that much biomedical research is driven not to
cure disease but out of curiosity to understand the living
organism. He seems to be saying that we don't need to advance
because we have already reached an adequate life span. This
foreclosing of the future is unbecoming in one so disposed to
rewriting the American social, political, and moral agenda. (Kirkus
Reviews)
From the author of Setting Limits comes a challenging exploration
of the proper goals of medicine in our rapidly changing society--a
work destined to spark debate and influence policy for years to
come.
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