A Good Old Age?: The Paradox of Setting Limits

Since it was published in 1987, there have been a range of agitated responses to Setting Limits , Daniel Callahan's controversial book suggesting that Medicare-funded life-extending therapies be denied to elderly people who have lived out a ``natural life span.'' Homer, formerly with the Hastings Center in Washington, D.C., and Holstein, of the Center for Ethics and Social Policy in Berkeley, offer papers from various ethical and medical perspectives that indicate the current state of the debate. Christine K. Cassel warns that Callahan's approach comes dangerously close to advocating ``genocide based on social characteristics''; William B. Schwartz and Henry J. Aaron argue that genuine reductions in medical spending require sacrifices by patients of all ages, not only the old; Charles J. Fahey says rationing medical resources is unnecessary because few elderly people want to prolong their lives in a ``mindless fashion.'' Unfortunately, while many contributors effectively target logical and practical problems in Callahan's thesis, none matches his readiness to propose difficult or unpopular solutions--as in Joseph Fletcher's bland assertion that the answers come from ``a new allocation of funds'' and financial stringency in ``other things.'' (Sept.)