Age-based rationing and women.

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.