MARK WASHOFSKY

population. This, of course, is to be expected and is not necessarily unjust, since the aged are much more likely than younger people to experience serious medical problems. But if the sheer expense of providing care to the elderly is found to prevent us from investing in the creation of a system of public health that saves more lives and that improves the quality of life for large numbers of our citizens, the reevaluation of our priorities is both a practical and a moral necessity.

At the same time, we would not be forced to draw such a conclusion. The principle of medical efficacy that we locate in the halakhic sources is derived from the mitzvah of piku’ah nefesh, which translates into a duty to practice medicine. This can be understood as a requirement to spend our medical resources in such a way as to cure more disease rather than less, to save more lives than would be saved were we to invest those resources otherwise. Yet the overriding demand that issues from this mitzvah is the obli­gation to heal, to cure disease; and this forces us to ask: is old age itself a disease? The point is not a facetious one. It is a rhetorical custom, which, like all such custom, reflects deeper habits of mind in our culture, to speak of the elderly as though they are a diseased group, as in“the elderly and the infirm,” a portion of the popula­tion that, like the sick, are viewed largely as consumers of medical services. It is certainly true that the elderly are statistically more likely to be“sick” than are younger persons, and it is also true that a sick elderly person is less likely to survive a severe disease than is a younger one afflicted with the same ailment. Yet it is by no means clear that we ought to view their advanced age in and of itself as a disease. On the contrary, although disease is an undesired and unintended interruption of the otherwise healthy state of human life, old age is an intended and fully natural stage of that life,

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