of full and natural lives. I protest that presumption because "natural life span" and "tolerable death" are not gender neutral. Providing health services to the very old has been devalued, in part because medical intervention can dehumanize the natural end to one's natural life span. I wonder if that absence of value is not also due in large measure to the fact that there are few male competitors for these services. Couldn't we believe that, like other items in women's social history, when men move to evaluate something that is peculiarly the province of women, it then becomes devalued?
Given this social and moral context, woman's old age is not affirmed by setting limits; it is made invisible. Given this context, the deaths of older women will engender rage and despair. Given this context, appealing to an age standard will make the deaths of women premature in the fullest sense of the word. Not only will their deaths be sad, they will be a tragedy and an outrage.
I am especially grateful to my colleague Ferdinand Schoeman for the many helpful suggestions he made about various aspects of this discussion.
The gender ratios are important for the further reason that they indicate that more women than men will be living alone in old age. Although more than one-third of all elderly disabled men living in their communities were cared for by their wives, only one in ten elderly disabled women were cared for by their husbands (Special Committee on Aging, 1985).
An obvious concern, and the concern that underlies Callahan's interest in examining medicine's goals for an aging society, is that the projected increase in the size of the older population implies correlative increases in the demand for health care resources and the provision of services to the elderly. In addition, elderly persons are more likely than other adults to be poor.
Moreover, the economic statistics are especially grim for elderly women. According to a study published in 1985 by the United States Senate's Special Committee on Aging, of those persons between the ages of 65 and 69, white males had a median income of $12,180 per year as compared to a median income of $5,599 for elderly women. Because they live longer than their male counterparts, elderly women average a longer period of retirement than elderly men and must, therefore, rely on private and public sources of income longer than elderly men. Not surprisingly, nearly three-quarters of the population of the elderly poor are women ( 1985, 2).
Although at present only about five percent of the elderly live in nursing homes, close to seventy-five percent of all nursing home residents have no spouse and are institutionalized because they have health problems that significantly limit their ability to care for