In his article "Care of the Elderly Dying," Daniel Callahan discusses the need for physicians to factor in a patient's advanced age when determining a medical treatment plan. At present, doctors feel bound by a moral obligation to treat all patients alike, regardless of age. This unrelenting respect for life has resulted in skyrocketing health care costs and an enslavement to technological advancements. In Callahan's opinion, medicine should focus on the relief of pain, rather than the extension of life, for those who have lived out their natural life span. In general, a natural life span threshold would occur after a person reached his or her late 70s or early 80s.
Callahan admits that it takes courage to challenge the prevailing medical viewpoint which emphasizes compassion and charity to all patients. In his article, he asks several questions aimed at stimulating frank discussion about the way society thinks about medical treatment for the dying elderly. Callahan asks: What are the practical implications of a medical treatment philosophy that does not focus on life extension for the elderly? How should the elderly themselves think about the medical, ethical, and legal implications of life extension? What part does advanced technology play in life-or-death medical decisions?
In answering the first question, Callahan outlines practical criteria to be used in determining medical treatment for the dying elderly. He distinguishes between terminal decisions made for the incompetent elderly and for the competent elderly. In terms of incompetent elderly, a surrogate must make the decision about whether to terminate treatment. This decision should be based on three criteria: 1) inability to relieve pain and suffering; 2) disproportionate burden of treatment; and 3) inability to restore or maintain quality of life. Callahan sets forth similar criteria for determining morally appropriate care for competent elderly.
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