WHAT SETTING LIMITS
DanielCallahan's Setting Limits
Nora K. Bell
In his recent and controversial book, Setting Limits, Daniel Callahan has put forth a provocative thesis: that "intergenerational equity" might require us to rethink some of the traditional goals of medicine as they affect care that is provided to the elderly. Specifically, Callahan suggests that the increasing numbers of the elderly, coupled with medicine's increased technological capabilities, create the potential within medicine for "an unending medical struggle against aging and death" that is, perhaps, not properly one of medicine's "deepest ends" or goals.
As Callahan states, his "first and most fundamental" purpose in writing Setting Limits is to:
stimulate a public discussion of the future of health care for the aged. . . . My approach will not generally be a pleasing one. It puts to one side the kind of relentless optimism that has been the mainstay of medical advancement and its economic underpinning. It rejects the conceit that we can have anything we want if we put our minds to it and are willing to pay for it. . . . This book, by contrast, is a call for limits, . . . for a willingness to ask once again how we might creatively and honorably accept aging and death when we become old, not always struggle to overcome them. ( 1987, 23-24)