Physicians increasingly face ethical issues relative to the treatment of the geriatric patients whose lives are in their hands-complex issues such as the role of the surrogate decision maker and the validity of do-not-resuscitate orders. This article will address the ethical issue of age-based rationing of medical care. What is the ethical basis for age-based rationing of health care? What is the role of the orthopedic surgeon in implementing (or resisting) it? Does the increasing commercialism of the delivery of medical care relieve us of our ethical responsibility?
To the orthopedic surgeon, unresolved debate often appears to be the language of ethics. This article will attempt to piece together recent legal, philosophic, religious, and political observations to form a background on which you can base your own position (Greene, 1997).
In the United States, health care is a privilege, not a right. The Constitution neither requires its provision nor prohibits it. For that reason, it is not unconstitutional for a state to withhold access to health care. However, a state cannot administer a program of health care arbitrarily; the Fourteenth Amendment does not specify which laws are to be established, but it does require that all citizens be given equal protection under whatever laws are enacted.
In a legal sense, Medicare and Medicaid are welfare benefits at the federal level that government confers on all its citizens who are eligible to apply. The moralistic argument that health care should be seen as a right rather than a charity is based on the theory of distributive justice (Greene, 1997).
Buchanan has championed the philosophic concept of distributive justice as a basis for appropriate access to health care. Because no legal right to health care as yet exists, moralists press the issue of a moral right to health care. With sufficient popular support, a moral right can be.............
