Bioethicist Revives Elder Healthcare Rationing

Article excerpt

In 1987, bioethicist Daniel Callahan published his book, Setting Limits: Med- ical Goals in an Aging Society, in which he described older Americans as "a new social threat," and as "a demographic, economic, and medical avalanche . . . that could ultimately (and perhaps al- ready) do great harm." Callahan's pro- posed remedy for this perceived threat was to deny what he called "life-extending" healthcare for Americans older than the "late 70s or early 80s."

Now, 20 years later, Callahan has revived his views in a forum with a wider reach than that his book. New York Times columnist Jane Gross focused her November 13, 2008, column, "The New Old Age," on a Callahan essay entitled "The Economic Woes of Medicare" in which, after dismissing the value of other possibilities for cutting Medicare costs, he declares, "[T]here is nothing of importance left to do other than to reduce benefits. That move would mean denying elderly patients both what they might want and need. ... I doggedly believe we will, one way or the other, have to set limits on health care for the elderly, even if a specific age limit will not do."

LIMITS ON CARE

Callahan has been dogged in his view that there should be limits on healthcare for the aged, even the young-old. In his 2000 article, "Death and the Research Imperative," which appeared in The New England Journal of Medicine, he argued that the only deaths that are "premature" are those that occur before age 65. Accordingly, he proposed that the National Institutes of Health not fund research on diseases that predominantly kill people ages 65 and older. Callahan has recognized that most gerontologists would call him "ageist." At the same time, he has vilified gerontologists and other advocates for the aged because they have "modernized" old age. In Setting Limits, he criticized gerontologists because their agenda has been "to project the process of aging as utterly diverse and individual, the aged as varied (like any other age group), and old age as a time of renewed vigor, growth, self discovery and contributions to the community; a time of vigorous engagement, not disengagement."

As Callahan sees it, this "modernization project" undertaken by gerontologists has had several adverse consequences. First, it robs old age of deep and substantive social meaning and significance. Second, its emphasis on individualism weakens our sense of mutual obligations. Most important, in terms of the social threat that Callahan perceives, the modernization of old age purveyed by gerontologists makes it difficult for older persons to find a meaningful societal context for decline, suffering and death. He has written, "Those same forces of modernization which would have them pretend that aging does not occur, or can with sufficient energy be brought to heel, work against giving the aged their own unique and valued role. This can be achieved only through recognition that old age is the last phase of life; that it cannot go on for long and that death is on its way. …