Document Type


Publication Date



On her seventy-fifth birthday, Mrs. Smith and those most important to her gather together in her nursing home room. Her husband and children are there. Her close friends from both inside and outside the nursing home are in attendance. The nursing home staff arrives with a birthday cake. Finally, of course, the third party payor's fiscal intermediary, who has cared so much about her during the ten years she has been on dialysis, is there to wish her a happy birthday and to tell her that her dialysis eligibility expired on the last day of her seventy-fourth year, and that she will be dead in a week. Most of us find the above scenario inappropriate-perhaps even cruel and heartless. Even if Mrs. Smith led a full and satisfying life, we are distressed by the external imposition of the time and manner of her death; it seems more like an execution than a decision to let death take its "natural course." Unless our social values change substantially, we will continue to find this kind of arbitrary age cutoff of some kinds of medical care, which forms the basis of Dr. Callahan's proposal in Setting Limits, very troubling and ultimately unacceptable. In fact, what we find troubling is not the discontinuation of dialysis per se; we would have little trouble accepting Mrs. Smith's competent decision to forego that treatment. We might even applaud her altruism or bravery in making such a decision. What is unacceptable to us is the imposition of this determination by the fiscal intermediary whose decision is unrelated to Mrs. Smith's considered determination of whether she would want the treatment continued.

Publication Title

Saint Louis University Law Journal



First Page



Dr. Daniel Callahan, Health Care, Age Cutoff



To view the content in your browser, please download Adobe Reader or, alternately,
you may Download the file to your hard drive.

NOTE: The latest versions of Adobe Reader do not support viewing PDF files within Firefox on Mac OS and if you are using a modern (Intel) Mac, there is no official plugin for viewing PDF files within the browser window.