Age Criteria in Medicine

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Abstract
• Age criteria are increasingly being advocated as means of determining who should receive treatment. Four types of medical justification have been proposed. Three of these, namely, length of medical benefit, quality of medical benefit, and likelihood of medical benefit, entail comparisons of patients. The fourth, medical benefit, involves identifying for each patient whether or not a significant benefit is likely to result from treatment. I contend that the three types of comparative justification are questionable. For example, they rest on statistical generalities that are misleading in particular situations, and they value characteristics of persons (such as life-years) more than they respect persons themselves. I also contend that the fourth type of medical justification, rooted as it is in response to human need, is ethically sound, but that it warrants a medical-benefit criterion rather than an age criterion. (Arch Intern Med. 1989;149:2343-2346)