IS OLD AGE A DISEASE? The Elderly, The Medical System, and the Literature of Halakhah
Mark Washofsky
ne of the most difficult of all the moral dilemmas
pertaining to the field of“medical ethics” involves
the decisions that must be made about allocating health-care resources. This problem can present itself in two forms. In the first, which we might call the“micro” situation, physicians or surgeons functioning in conditions of war or of mass trauma may find that they cannot care simultaneously for all the wounded or injured and must therefore decide whom to treat first. In the second, or“macro” situation, entire communities or societies must determine just how they will apportion their available medical resources among all those who offer a valid claim on them. As in the micro case, the predicament here is one of limited resources. Whether for reasons of absolute shortage(for example, organs for transplant) or for reasons of expense(say, with new and sophisticated medical therapies and surgical procedures), it is unlikely even in affluent societies that sufficient means can or will be made available to provide every patient with every useful treatment in existence. In either case, those who control the resources(the physicians, the hospital, society as a whole) must decide which person, group, or institution will be given a priority or preference in receiving an allocation of medical resources and how large that allocation will be. Ethicists refer to this as the task of“patient selection.” Jews , in the spirit of unetanneh tokef, the powerful piyyut of our High Holiday liturgy, might well call it the choice of“who shall live and who shall die.” This question has a special application to our topic: given that physicians, hospitals, and the community at large must allocate scarce or expensive life-saving resources according to some set of criteria, are they permitted to use age as one of those criteria? Is it morally proper to grant to younger