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Nancy S. Jecker, PhD

JAMA. 1991;266(21):3012-3015.

Abstract
The expense of caring for growing numbers of older individuals can create strong incentives to ration health care based on age. While not directed explicitly at women, this form of rationing would affect women disproportionately because more women than men occupy the ranks of older Americans. A proper understanding of age-based rationing requires attention to gender issues. Once gender issues are taken into account, age-based rationing appears to perpetuate broader gender inequities in the society. This position is supported by three arguments. First, although age-based rationing leads to inequalities between age groups, the inequalities it produces between the sexes are more ethically troubling. Second, these departures from equality cannot be justified even when they benefit society at large by enabling investments in other health care priorities. Finally, since older women represent a disadvantaged and vulnerable group, age-based rationing is difficult to justify even if our obligation to protect the vulnerable is minimal.

(JAMA. 1991;266:3012-3015)

Author Affiliations
From the University of Washington, School of Medicine, Department of Medical History and Ethics, Seattle. This article was written when Dr Jecker was a Visiting Scholar at Stanford (Calif) University Institute for Research on Women and Gender and the Stanford University Center for Biomedical Ethics, Palo Alto, Calif.

Footnotes
Reprint requests to the University of Washington, School of Medicine, Department of Medical History and Ethics, Mail Stop SB-20, Seattle, WA 98195 (Dr Jecker).

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