Daniel Callahan proposes a new way of thinking about health care, what he calls the need for a "sustainable medicine." By that he means a medicine that is equitable and affordable to all well into the future, relieving us of the constant economic crises of contemporary health care systems. He draws the terms "sustainable" from the environmental movement which has stressed preserving the earth and its resources for the indefinite future. Modern medicine, by contrast has been progress- and technology driven, admitting of no boundaries of limits to human aspirations. But that kind of ideal is turning out to be financially unaffordable and will become even moreso in the future as societies age and medical needs grow. His alternative is to place the emphasis on public health and disease prevention, on developing affordable technologies, and on understanding that an unlimited campaign to eliminate aging and death is now creating enormous economic problems and doing harm to other important sectors of society, such as education.

In order to understand the implications of Callahan's critique of the "impossible medicine," one needs to grasp that, in the industrialised countries at least, life expectancy has risen to double the one we had a century ago. Pharmaceutical industries are investing heavily on health research and technological applications. As a result, a demographic, financial and even psychological pressure has developed, one that perceives the right to health in terms of a right to medically assisted happiness, without seriously considering the limits of what is morally, economically and demographically sustainable.
Especially in the light of recent and diffuse pressures towards crossing a further threshold in health research and applications (i.e. developing gene therapy and tailor-made drugs derived on genetic databases or bio-banks), Callahan's stance raises some radical doubts. Are we facing a form of irresponsible innovation, one that is unable to state its own limits and scopes? The principle from bioethics, that not all that can be done should be done, is here extended to the health system. Not posing the question means de facto choosing to pursue an unlimited ideal of science and innovation, that is by now perceivably unsustainable, in terms of economic and social costs.

Daniel Callahan (1930) has developed some of these arguments in several books, including False Hopes (trad. it. La Medicina Impossibile, Baldini e Castoldi, 2000), and in his award-winning trilogy Setting Limits: Medical Goals in an Aging Society (1987), What Kind of Life: The Limits of Medical Progress (1990), and The troubled dream of life (1993). He has coordinated the international research project The goals of medicine (Gli scopi della medicina: nuove priorità, published in Italian by Notizie di Politeia, 1997). He is the founder and director of the Hastings Center in the State of New York State, a bioethics centre that contributes to formulating concrete policies for health governance.