Daniel Callahan - What Kind of Life: The Limits of Medical Progress
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This is a provocative call to rethink Americas values in health care.
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What Kind of Life : The Limits of Medical Progress
author
:
Callahan, Daniel.
publisher
:
Georgetown University Press
isbn10 | asin
:
0878405739
print isbn13
:
9780878405732
ebook isbn13
:
9780585202549
language
:
English
subject
Medical care--United States, Medical economics--United States, Medicine--Research--United States, Medical ethics--United States.
publication date
:
1995
lcc
:
RA395.A3C324 1995eb
ddc
:
362.1/01
subject
:
Medical care--United States, Medical economics--United States, Medicine--Research--United States, Medical ethics--United States.
Page 1
What Kind of Life
Page 2
Also by Daniel Callahan
Abortion: Law, Choice, and Morality
The Tyranny of Survival
Setting Limits: Medical Goals in an Aging Society
The Troubled Dream of Life: In Search of a Peaceful Death
Page 3
What Kind of Life
The Limits of Medical Progress
Daniel Callahan
Georgetown University Press, Washington, D.C.
Page 4
Georgetown University Press, Washington, D.C. 20007 1990 by Georgetown University Press. All rights reserved. Originally published by Simon & Schuster, 1990. Printed in the United States of America. 10 9 8 7 6 5 4 3 2 1994 THIS VOLUME IS PRINTED ON ACID-FREE OFFSET BOOK PAPER.
Library of Congress Cataloging-in-Publication Data
Callahan, Daniel, 1930 What kind of life : the limits of medical progress / Daniel Callahan. p. cm. Includes bibliographical references and index. 1. Medical careUnited States. 2. Medical economicsUnited States. 3. MedicineResearchUnited States. 4. Medical ethics United States. I. Title. RA395.A3C324 1995 362.101dc20 ISBN 0-87840-573-9 (pbk.) 94-34440
Page 5
For Sidney and for John C. Bennett Agnes Bourneuf John T. Edsall Otto Guttentag Marion Cahill Heffernan
Page 7
Contents
Preface
9
1. From Explosion to Implosion: Transforming Healthcare
17
2. On the Ragged Edge: Needs, Endless Needs
31
3. Hopes, Vain Hopes: The Pursuit of Efficiency
69
4. Health and the Common Good: Setting Societal Priorities
103
5. Health and the Individual Good: The Primacy of Caring
135
6. The Delicate Balance: Limits and Aspirations
159
7. Devising a Political Strategy: Can We Get There from Here?
185
8. To Kill and to Ration: Preserving the Difference
221
9. Modernizing Mortality: Medical Progress and the Good Society
251
Appendix: Selected Healthcare Data
265
Acknowledgments
279
Notes
281
Index
305
Page 9
Preface
As a child in the 1930s, I spent a good deal of my time in the offices of doctors and the operating rooms of hospitals. For reasons I never learned, I was subject to recurrent infections, which went from my arms or legs to my lymph nodes. The only cure in those days was to lance the nodes and allow them to drain. Time and again I was dragged, screaming and struggling, to an operating room where an ether mask was forced over my face; the sense of smothering was palpable. I awoke, vomiting, to face weeks of bed rest and the painful daily changing of bandages.
I mention this not to indulge in the bittersweet pleasure of exchanging illness stories, but to mark how much our medical lives have changed since then, and to make clear my own subsequent debt to that medical progress I will so persistently question in this book. My children underwent no such ordeals when they were growing up. Antibiotics took care of their infections. My own later, adult experiences with surgery no longer required that I be held down to have ether administered. The only good thing to be said of earlier times, which few are inclined to think of as the good old days, is that the cost of my treatments
Page 10
was minimal. My parents worried about me, but they did not have to worry about the expenses of my care.
Since then, everything has improved in the scientific practice of medicine, and I can testify personally to some of those benefits. What has not improved are the costs of that care. They remain out of control, steadily rising at an annual rate approximately twice that of general inflation. The $550 billion that we spend in this country on healthcare is not just a large number. It reflects the pressure of high costs that we are all now feelingwhether as elderly individuals, who have to pay more out of their pocket than in 1965, when Medicare was passed, or as employers, faced with insurance increases of anywhere from 20 to 70 percent over the past couple of years, or as young people, worried about the possibility of a catastrophic illness with its no less catastrophic costs. My children will, as a result, think twice before they even have children and, once they do, may well, despite some insurance, pay comparatively more out of pocket than my parents did nearly six decades ago.
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