Customer Reviews

Setting Limits: Medical Goals in an Aging Society with "A Response to My Critics"

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This is an important book. Many of Daniel Callahan's statements about health care for older people (75 and older, for example), if taken out of context, can be chilling (especially if you are 75 or older). But Callahan, a philosopher, views death as a necessary part of life. His opposition is not to health care for old people. Instead, his opposition is to the use of biomedicine for old people.

Biomedicine is expensive and interferes with the natural life cycle. Callahan maintains that biomedicine should not be used for old people who are seriously ill and who would otherwise die. Callahan questions the value of extending life without improving life.

Some readers might conclude that Callahan's approach is intended to cut the cost of health care. I think Callahan would disagree. Money might be saved if biomedicine were denied old people who are seriously ill. But, per Callahan, more money would be spent on improving their end-of-life care. Be careful of people who quote Callahan as a way to save money. They have minunderstood him.

Callahan approaches a difficult and controversial subject with both good thinking and feeling. He approaches the issue of dealing with the price we all pay by being unwilling to deal with our own mortality. His writing style is engaging and well- considered.

Daniel Callahan, ethicist and co-founder of the Hastings Center, has written a provocative book which discusses and evaluates the problem of resource allocation in Western society. Essentially, we spend a significant percentage of health care costs on the last few years of life, regardless of the quality of life being prolonged.
Dr Callahan warns that we will not be able to support these policies indefinitely, particularly as Western populations continue to age. The more tests and procedures we develop, and the greater our skill at extending life, the more expensive terminal health care becomes.
This is not a popular perspective. Many people believe that anything short of providing full available health care to all is morally reprehensible. However, it is undeniable that we are already unable to provide all people with even basic medical care with the current resources available. Indeed, we have only to look at the US to see a future of medicine - sky-rocketing costs, and massively disproportionate services depending on location and financial capacity.
As a nurse I have seen first-hand how focusing on prolonging life can be a worse, and certainly more expensive, outcome for the elderly. As an ethicist I find Callahan's arguments sound and convincing.

MSM (Main Stream Media) are lying through their teeth (unlikely anyone in that business who is poo-pooing the idea of death panels even remembers/knows about how this book relates to the current debate). Death Panels are a very real possibility. This book has been at the heart of such proposals for years. Many have been outraged by this book especially since its author's views on other issues have been adopted by the American Medical Association. A book that counters these views and sounded the alarm almost 2 decades ago is Set No Limits: A Rebuttal to Daniel Callahan's Proposal to Limit Health Care for the Elderly.

Something wicked this way comes.

Callahan's arguments for healthcare rationing based on age are neither valid, nor logical. More importantly they are not consistent with the United States Federal Civil Rights laws that are enforced by the Office for Civil Rights (OCR) of the U. S. Department of Health and Human Services (DHHS), nor are they moral in the international community by review of the United Nation's Universal Declaration of Human Rights. http://www.un.org/Overview/rights.html