Health Care for an Aging Population

Edited by Chris Hackler

Paperback : 9780791420003, 232 pages, July 1994
Hardcover : 9780791419991, 232 pages, August 1994

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Table of contents


Introduction: Health Care Reform for an Aging Population
Chris Hackler

Part I. Aging, Justice, and Scarcity

1. Generational Equity in America: A Cultural Historian's Perspective
Thomas R. Cole

2. Between the Generations: Justice and Peace as Alternatives to Age-Based Rationing
Stephen G. Post

3. Justice within the Family
John R. Hardwig

4. Technological Deteriminism despite the Reality of Scarcity: A Neglected Element in the Theory of Spending for Medical and Health Care
James M. Buchanan

Part II. Rationing according to Age

5. Understanding Callahan
Janet A. Coy and Jonathan Schonsheck

6. Justice, Age Rationing, and the Problem of Identifiable Lives
Leonard M. Fleck

7. Age Cut-Offs for Health Care Entitlements: The Missing Moral Level
Howard Brody

8. Callahan's Medical Rationing Principle: Age or Quality of Life?
Sharon E. Sytsma

9. Designing Ethical Alternatives to Age-Based Rationing
Nancy S. Jecker and Robert A. Pearlman

Part III. Planning for the Future

10. A Values Framework for Health System Reform
Reinhard Priester

11. Limits and Equal Access to Basic Health Care: Suggestions for Comprehensive Reform
Robert J. Barnet

12. Just Caring: Lessons from Oregon and Canada
Leonard M. Fleck

13. Future of Long-Term Care
Robert L. Kane

14. Taking the Next Steps: Devising a Good Lifespan for the Elderly
Daniel Callahan




This volume examines one of the most important policy issues to be faced as policymakers address both current and future health care needs—the allocation of health care resources for an aging population. The first part looks at the role of the aged in society, what justice requires of the young toward the old and of the old toward the young, the source of rising health care costs, and the need to control medical spending.

The second part focuses on dramatic and controversial proposals by Daniel Callahan and others to control medical spending in the next century by rationing life-prolonging treatment according to age. Concluding chapters provide concrete proposals for a system that solves our immediate problems of cost and access while preparing for the extraordinary needs of an aging population.

This book explores proposed changes in the U. S. health-care system to meet unprecedented demand expected early in the next century when the "baby boom" generation reaches retirement age and eligibility for Medicare. A focal point is the possibility of withholding publicly-funded, life-prolonging medical care from the very old.

Chris Hackler is Director of the Division of Medical Humanities at the University of Arkansas for Medical Sciences.


"The book addresses an important aspect of health-care ethics and is especially timely as we head into constructing a new health-care system. A beautiful piece of work, competently done and put together. " — Dr. Erich H. Loewy, University of Illinois