The bottom line here: ""We cannot continue on the present course of open-ended health care for the elderly""--resources are too scarce, the costs too great, the benefits too questionable. What limits might be set on aggressive medical care for the elderly, and what should take its place? The answers and suggestions posed here are likely to provoke discussion and debate. Callahan (Abortion: Law, Choice and Morality) offers in his first work in some years a controversial suggestion: ""using age as a specific criterion for the allocation and limitation of health care."" He proposes that by one's late 70's or early 80's, the natural end has come: ""one's life possibilities have on the whole been accomplished; one's moral obligations to those for whom one has had responsibility have been discharged; and one's death will not seem to others an offense to sense or sensibility, or tempt others to despair and rage at the finitude of human existence."" Callahan adds a stipulation that such a death not be accompanied by unbearable pain, and has thus laid out a biographical, rather than a biological, definition of a natural end-point. And it is after this end-point, he feels, that medical care should be oriented towards the relief of suffering, rather than resisting death. To support such a new approach, our understanding of aging and of medicine, and their interaction, will all have to change. Callahan believes that the primary goal of the aging ought to be to serve the young and the future by being ""moral conservators of that which has been"" and proponents for the future. At the same time, medical care should seek to improve the quality of life, rather than extend its longevity; and we should abandon medical programs that primarily benefit the elderly, pouring resources into this one small--soon to be gone--segment of the population. The natural lifespan will have to be understood as having an acceptable end boundary, rather than an enemy to be held off at all costs. Callahan is, as before, logical and persuasive; it is clear that he wants to incite discussion, rather than prove a particular set of specifics. Provocative, well-based arguments from a respected voice.