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Ga il Woo ds IF DANIEL CALLAHAN is right, most Americans don’t agree with Shakespeare that death is “a neces sary end that will come when it will come.” In Setting Limits, his third book on the dilemmas of modern medicine, Callahan asks what it means to grow old and die in a society that attempts to deny death and bases both public policy and personal choice on the illusion of unending youth, everlasting good health, and the hope of perpetually extended life. Callahan’s meticulous consideration of the question raises bothersome issues, especially for those of us who have watched the modern drawn-out way of dying. When my father learned he had lung cancer in 1980, he was 70 years old with too many years of heavy smoking and drinking under his belt to be a good statistic. Understanding the slim chance he had of living for long with or without an operation, with our without chemotherapy he asked to forego all treatment and live as best he could until he died. Dissuaded from his decision by his doctors and my mother, he underwent an operation that removed a lobe of his right lung and brought on a stroke that left him with the shuffle of an old man, unable to work or enjoy his family. As his body and his spirits deteriorated, medicine for heart condition, stomach ulcers, high blood pressure, and depression kept him going. After refusing a second cancer operation, he was kept alive for another year with drugs and repeated trips to the hospital where oxygen, medicine, and food were pumped into his flagging body. By the time he died, an ordeal that might have lasted one year had lasted five. By then my mother’s health was broken as well. Plagued by both emphysema and heart disease, she endured a terminal illness prolonged even more agonizingly than my father’s had been. In the hospital where my mother was taken in her last months, I saw intensive Judith Paterson’s most recent book Be Somebody, is a biography of women’s rights activist Marguerite Rawalt. Paterson teaches journalism at the University of Maryland. care rooms filled with bodies kept going for no reason. Cancer patients without hope of recovery got chemotherapy, blood transfusions, radiation. The very old lay barricaded in their beds, liquids dripping all day into.limbs deathly still and crisp as parchment. Agonizing, medically prolonged ter SETTING LIMITS: Medical Goals In An Aging Society By Daniel Callahan New York: Simon and Schuster, 1987 256 pages, $18.95 minal illness is rapidly becoming the norm in America. As a friend who has practiced internal medicine for 25 years told me, “Hardly anyone dies with dignity anymore. Very few people have grasped the immensity of the problem. Nobody was prepared for this.” Daniel Callahan predicts colossal economic and sociological catastrophe if Americans continue to live longer and longer and medical technology persists in keeping them alive beyond the point where life has meaning. His cautiously stated but troubling conclusions will disturb readers at all points on the political spectrum: from right-to-lifers wanting to preserve life at all costs to egalitarians worried about age discrimination. Although Callahan opposes both euthanasia and assisted suicide, he calls for radical accoss-the-board changes in public policy, as well as values and attitudes. His approach includes recommendations such as these: cutting back on research and treatment that benefits mainly the old and seeks to extend life indefinitely; changing Medicare to favor longterm health care for the elderly rather than hospitalization and critical care; encouraging all age groups to work toward an acceptance of the concept of a “natural life span” that ends in old age and death; the criterion for cutting off government subsidy for life-extending treatment; exchanging life extension for the elderly for health care goals that would improve the quality of life for everyone by instating a “full-blown national health-insurance program, guaranteeing a minimally adequate level of health care for all”; reassessing public policy to reduce the danger that the old and terminally ill will deplete resources that should go to medically deprived children, women and minorities. Callahan addresses the most universal of subjects. Yet his book is so packed with statistics and references and the discussion is so carefully hedged with extenuating arguments that many readers will find it hard to get through. Nevertheless, everyone who can read this book, should read it. Those who can’t will probably be influenced by it anyway since it promises to be a benchmark work in a drama soon to be played out in public debate and private lives. The Modern Way of Dying By Judith Paterson THE TEXAS OBSERVER 21