ABSTRACT
Technologies ranging from the development of sanitary, disease-free environments and an increased role of drug and immunization therapies for control of communicable diseases to advanced surgical techniques, artificial life support and vital organ replacement have dramatically increased survival beyond the high risk periods of infancy and childhood and added years for persons over 65. The national challenge in health care decision making is to protect the rights and autonomy of older people while providing the best medical technology possible to preserve life. Life expectancy at birth in the United States has risen sharply, from 47 years in 1900 to 75 in 1987. The confluence of the factors of greater life expectancy, causes of death precipitating longer periods of disability and dying, removal of death and dying from the moral order of families to technological institutions and changes in family structure have produced an unprecedented need to rebut the unbridled use of life-sustaining technologies.
