Daniel Callahan - Setting Limits: Medical Goals in an Aging Society
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This is a provocative call to rethink Americas values in health care.
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Setting Limits : Medical Goals in an Aging Society
author
:
Callahan, Daniel.
publisher
:
Georgetown University Press
isbn10 | asin
:
0878405720
print isbn13
:
9780878405725
ebook isbn13
:
9780585225494
language
:
English
subject
Aged--Medical care--Moral and ethical aspects.
publication date
:
1995
lcc
:
RA564.8.C345 1995eb
ddc
:
362.1/9897
subject
:
Aged--Medical care--Moral and ethical aspects.
Page 1
Setting Limits
Page 2
Also by Daniel Callahan
The Troubled Dream of Life: In Search of a Peaceful Death
What Kind of Life: The Limits of Medical Progress
Abortion: Law, Choice and Morality
The Tyranny of Survival
Page 3
Setting Limits
Medical Goals in an Aging Society
Daniel Callahan
GEORGETOWN UNIVERSITY PRESS, WASHINGTON, D.C.
Page 4
GEORGETOWN UNIVERSITY PRESS WASHINGTON, D.C. 20007
1987 AND 1995 BY GEORGETOWN UNIVERSITY PRESS ALL RIGHTS RESERVED ORIGINALLY PUBLISHED BY SIMON & SCHUSTER, 1987 PRINTED IN THE UNITED STATES OF AMERICA
10 9 8 7 6 5 4 3 2 1995
LIBRARY OF CONGRESS CATALOGING-IN-PUBLICATION DATA
CALLAHAN, DANIEL, 1930 SETTING LIMITS : MEDICAL GOALS IN AN AGING SOCIETY, WITH "A RESPONSE TO MY CRITICS" / DANIEL CALLAHAN. P. CM. INCLUDES BIBLIOGRAPHICAL REFERENCES AND INDEX. I. AGEDMEDICAL CAREMORAL AND ETHICAL ASPECTS. I.CALLAHAN,DANIEL, 1930- RESPONSE TO MY CRITICS. II. TITLE. RA564.8.c345 1995 362.1'9897DC20 ISBN 0-87840-572-0 (PBK.) 94-34439
Page 5
For Ellen McAvoy and Rosalie Miller and in memory of Robert S. Morison
Page 7
Contents
Preface
9
1 Health Care for the Elderly: How Much Is Enough?
13
2 Reconstructing the Ends of Aging
25
3 Medicine and the Conquest of Aging
52
4 What Do the Young Owe the Old?
82
5 Allocating Resources to the Elderly
115
6 Care of the Elderly Dying
159
7 Old Age in New Times
201
Afterword, "A Response to My Critics"
225
Appendix: Demographic and Health-Care Projections for the Elderly
239
Notes
243
Index
263
Page 9
Preface
A question I was frequently asked while writing this book was whether, in my old age, I would be willing to live with my own recommendations. Would I be prepared to have life-extending treatment stopped? Would I decline an organ transplant that might give me in my old age a few more good years? I do not know how I might react. Some people hang on to life, others let it go, and I do not know which kind of person I will be. I can only now say that the writing of this book has forced me to think intensively about the course of my life and what aging will mean to me, what it is already coming to mean for me. I wrote this book when I was between the ages of 56 and 57, and I know that statistically speaking, I have a good chance of living to 80 or beyond. My mother lived to be 86, though my father died at 62. To which of them will I be closer in the age of my own dying?
I was told that a few people, shocked at what they had heard of my thesis, speculated that I might be going through a late mid-life crisis. They may have been right, but not for the right reasons. To paraphrase the old joke, there is nothing like spending months thinking about old age and death to focus the mind. If it was not the result of a mid-life crisis, it surely provoked one. I looked at my children with a new eye, trying to think about what happens to people over the span of a lifetime. I looked at the old with a new eye
Page 10
as well, trying to understand where they now stood in their own eyes, in their own lives. And I tried to look at myself in some fresh way, poised as I am on the edge of old age, whose tracings I can already discern. Would I be willing to live with my own recommendations? The question came back to me time and again as I thought about the problems.
This much I can say. There is little danger that the views I advance here will elicit such instant acclaim (or any acclaim, for that matter) that the present generation of the elderly will feel much of their effect. That could take two or three decades if there is any merit in what I say, and what I am looking for is not any quick change but the beginning of a long-term discussion, one that will perhaps lead people to change their thinking and, most important, their expectations, about old age and death. That kind of timetable would mean that my age group, not those who are now old, would probably be the first to feel its impact. It is my generation, and those who are still younger, for whom this book is most pertinent. I will be much better able to live with my own recommendations if, over the coming years, we all begin to change the way we think about aging and death. My own expectations will have changed, as will those of the people who care for me.
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