Although there exists no rigid guideline delineating society's obligation to provide health care, at a minimum Americans are entitled to an adequate level of care without excessive burdens being placed upon them. Fulfilling this ostensibly simple mandate, however, presents an enormous challenge. The need to allocate limited financial and human resources increasingly clashes with the moral desire to provide health care resources to elder Americans beyond their years of economic productivity. As a result, health care professionals face the difficult task of weighing against society's other priorities the efficiency of distributing limited health care resources to the elderly. This demand places upon health care professionals, particularly physicians, a unique burden. Today's physician must become the "gatekeeper," a designated guardian of society's resources. It is reasoned that the physician can be forced to conserve society's limited health care resources by controlling the administration of medical treatments. Inevitably, the demands placed on health care administrators results in a balancing test that challenges the breadth of elderly health care services by forcing difficult and sometimes controversial health care decisions to be reached in order to avoid an economic catastrophe. Health care considerations for older Americans so often involve disabled, ill, poor or lonely persons. Moreover, members of society tend to place different values on each of these groups and, as such, no collective societal obligation to such groups emerges. A continuous process that allows for the examination and re-examination of health care costs and benefits, coupled with an evolving assessment of value judgments and ethical concerns, would move towards establishing an equitable elder health care allocation program or, at least, a template for humane decision making. And, if combined with a firm grasp of the formal discipline of ethics, allowing for the critical and rational objective examination of competing values, an acceptable long-term societal solution towards elderly health care allocation will result.
George P. Smith, II, Our Hearts Were Once Young and Gay: Health Care Rationing and the Elderly, 8 U. FLA. J. L. & PUB. POL’Y 1 (1996).