Monday, December 2, 2013

Let Death Have Its Day?

Ethicist Daniel Callahan, now in his eighties, reflects on the wisdom of extending the lives of the elderly in a column at the New York Times. Callahan believes that extending their lives would create more problems than it's worth and that it might be best to just let people of a certain age die rather than provide them with expensive surgeries and other care that give them a few more years of life. Here are some excerpts from his column:
Consider how dire the cost projections for Medicare already are. In 2010 more than 40 million Americans were over 65. In 2030 there will be slightly more than 72 million, and in 2050 more than 83 million. The Congressional Budget Office has projected a rise of Medicare expenditures to 5.8 percent of gross domestic product in 2038 from 3.5 percent today, a burden often declared unsustainable.

Modern medicine is very good at keeping elderly people with chronic diseases expensively alive. At 83, I’m a good example. I’m on oxygen at night for emphysema, and three years ago I needed a seven-hour emergency heart operation to save my life. Just 10 percent of the population — mainly the elderly — consumes about 80 percent of health care expenditures, primarily on expensive chronic illnesses and end-of-life costs. Historically, the longer lives that medical advances have given us have run exactly parallel to the increase in chronic illness and the explosion in costs. Can we possibly afford to live even longer — much less radically longer?

What’s more, an important and liberating part of modern life has been upward social and economic mobility. The old retire from work and their place is taken by the young. A society where the aged stay in place for many more years would surely throw that fruitful passing of the generations into chaos....One likelihood, even in just a few years, is that older people who stay longer in the work force, as many are now forced to do, will close out opportunities for younger workers coming in.

We may properly hope that scientific advances help ensure, with ever greater reliability, that young people manage to become old people. We are not, however, obliged to help the old become indefinitely older. Indeed, our duty may be just the reverse: to let death have its day.
I wonder how long it will take, once we begin denying certain life-prolonging procedures to the elderly, before we also start denying them to the mentally incompetent, and how long after that it will be before we begin to hear calls for actively terminating those whose lives are no longer "useful" to society.

Exit question: How does a society immersed in relativism, pragmatism, egoism, and nihilism, muster the ethical resources to resist such calls?