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Age Rationing of Medical Resources
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17728 |
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Section : |
MODERN THOUGHT
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6 / 1990 |
5,153 Words |
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Sharon Sytsma
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It is commonly recognized that the benefits of technology are often qualified by the burdens they impose. In the realm of health care there can be no doubt that technology has contributed greatly to both the length and the quality of life, but it has imposed on us monumental tasks of decision-making that make it clear that our technological knowledge has outstripped our practical wisdom. In health care as well as in other areas, we are forced into decisions for economic reasons. Technology is expensive. With resources limited even in relatively affluent nations, we are forced to decide just how our technological expertise is to be developed or used given budgetary constraints. In health care this means rationing medical technology and services. Often, those overwhelming decisions are ignored, and the rationing is accomplished in an ad hoc manner. As Plato argued, decisions and actions that are not governed by wisdom can never be virtuous. And it is all to obvious that, in fact, such unreflective and irresponsible decision-making readily leads to injustice. Rather than falling into and tolerating an unjust rationing system, policy-makers and medical professionals must devise a system of rationing that meets the demands of moral principles.
Daniel Callahan, in his recent book Setting Limits: Medical Goals in an Aging Society, gives extended and reflective argument in favor of age-rationing of medical services, in which the young would have priority over the old in obtaining life-extending medical treatment. His position is not one that can be comfortably accepted. Mark Seigler, for instance, has heatedly argued against age rationing. He claims that "discrimination in health care for the aged is not justified because it threatens to undermine the traditions of clinical medicine, which are based on medical need and patient preferences; and because it threatens to undermine the traditions of our society, which are based upon moral virtues of charity and compassion." In the face of such a predisposition against age rationing, Callahan will have to argue that age rationing either would not undermine these traditions or that the traditions are such that they require reexamination.
Traditionally, one of the goals of medicine has been the extension of life. Of course, this goal was entirely suitable until fairly recently. In the days when death was not even associated primarily with old age, because it resulted most often from diseases that attacked at any age, it was natural that medicine take the role of staving off death. Due to the discovery of sulfa drugs, penicillin, and other antibiotics in the 1930s and '40s, we now think of death as more closely associated with old age, and the deaths of infants, children, adolescents, and adults through middle age as early or "untimely" deaths. Correlatively, we tend to think of "old age" as fluctuating according to the advance of medicine. While at some time and place in history people in their thirties were thought to have reached old age, and more recently people in their sixties, now a person is not really thought of as "old" until they reach their seventies or even eighties.
Therefore, Callahan argues that the traditional life-extending goal must be revised. He states: "Medicine should be used not for the further extension of the life of the aged, but only for the full achievement of a natural and fitting life span and thereafter for the relief of suffering." And "function of the current state of medicine" has dangerous consequences.
What does it mean to revise the
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