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White House health-care adviser Ezekiel Emanuel blames the Hippocratic Oath for the 'overuse' of medical care.
Twenty years ago, medical ethicist Daniel Callahan published a book called “Setting Limits: Medical Goals in An Aging Society.” The costs of the Medicare program were rising rapidly, heavily driven by medical technology. Eventually, he argued, spending limits would have to be set. The best way to do so would be to use age as a cutoff point for the most expensive technologies, even those, like open-heart surgery, that might be lifesaving. About 80 was the suggested year to draw the line. Callahan is now 78. Have his views changed?
Old age itself, once a reason to deny care, is rarely a barrier any longer. The average age of those undergoing heart surgery, organ transplantation, kidney dialysis and advanced cancer treatment steadily rises. The headline of a story in The New York Times on November 11, “ Good Survival Rates Found in Heart Surgery for Aged,” tells that story. So does another, on July 18, titled “Rise Seen in Medical Efforts to Treat the Very Old.” Medical research has found no decisive cures for the diseases of aging, but it has found myriad ways of keeping sick and frail people alive longer and longer
Our society can not, and should not, promise open-ended, progress-driven medical care that is indifferent to costs. In that respect, age does matter, and that reality should not be evaded. It will take some as yet undeveloped combination of age and other considerations — including, for example, cost, possibility of benefit, and patient desires — to find an acceptable way of setting limits. Almost anyone can think of hypothetical win-win solutions to the problem. They are unlikely to work. We need instead to consider the likely unpleasant solutions to see if we can come up with those that might do the most good and the least harm. Then we can have a serious discussion.