Hunt R W
Southern Community Hospice Programme, South Australia.
J Med Ethics. 1993 Mar;19(1):19-23; discussion 24-7. doi: 10.1136/jme.19.1.19.
Daniel Callahan has argued that economic and social benefits would result from a policy of withholding medical treatments which prolong life in persons over a certain age. He claims 'the real goal of medicine' is to conquer death and prolong life with the use of technology, regardless of the age and quality of life of the patient, and this has been responsible for the escalation of health care expenditure. Callahan's proposal is based on economic rationalism but there is little evidence to suggest that substantial economic savings could be achieved. Moreover, his argument raises serious moral objections. A policy of withholding treatments from members of a social group involves elements of compulsion and discrimination, both of which would intrude on the doctor-patient relationship, undermine the autonomy of elderly patients, and invoke the slippery slope towards involuntary forms of euthanasia. Life-death decisions should be based on more than the one criterion of age, and take account of more relevant factors such as the patient's usual state of well-being, her/his expressed wishes, informed consent and the type of illness. Any move to the implementation and enforcement of the policy Callahan recommends would be rejected by health professionals and the public.
丹尼尔·卡拉汉认为，对超过一定年龄的人采取停止延长生命的医疗治疗政策将带来经济和社会效益。他声称，“医学的真正目标”是利用技术战胜死亡并延长生命，而不顾及患者的年龄和生活质量，这导致了医疗保健支出的不断攀升。卡拉汉的提议基于经济理性主义，但几乎没有证据表明能实现大幅的经济节省。此外，他的论点引发了严重的道德异议。对一个社会群体的成员采取停止治疗的政策涉及强制和歧视因素，这两者都会侵犯医患关系，损害老年患者的自主权，并引发滑向非自愿安乐死形式的危险倾向。生死决策不应仅基于年龄这一标准，而应考虑更多相关因素，如患者的通常健康状况、其表达的意愿、知情同意以及疾病类型。任何朝着实施和执行卡拉汉所建议政策的举措都将遭到医疗专业人员和公众的反对。
