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By Daniel Callahan

This can be a provocative name to reconsider America's values in wellbeing and fitness care.

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Extra resources for Setting Limits: Medical Goals in an Aging Society

Sample text

I will make many references to the "old," the "aged," and the "elderly,'' and will use those terms interchangeably. What will I mean by them? For the most part, I will simply mean those over the age of 65. There is now great pressure to push back the time when old age is said to make its onset, to 70 or even 75. My own observation is that 65though arbitrary in many obvious respectsis not nearly so bad an age for policy and other purposes as it is often made out to be. That an increasingly large number of people, the majority, are in good health and vigorous at that age, and that many can and should continue to work, need not preclude what I think true, that the beginning of old age is by then putting in its appearance in almost everyone.

But it has become routine to casually entertain the idea of doing away with cancer, heart disease, and stroke (the great remaining killers of the elderly), and with arthritis and dementia (which can make old age such a misery). To the extent that our sense of life's possibilities must contend with the constraints of illness, the threat of a premature death, and the untoward health consequences of our actions, to that extent will a change in the way we think about health result in a deep change in the way we think about life.

Those over the age of 85the fastest-growing age group in the countryare 21 times as numerous as in 1900. In the early 1960s, less than 15 percent of the federal health budget went to those over the age of 65. By 1985, that percentage had grown to 28 percent. A little over $80 billion of private and government money was spent on health care for the old in 1981; that is expected to grow to $200 billion by the year 2000and in constant 1980 dollars. Public expenditures are expected to rise to $114 billion.

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