ABSTRACT Curtailing health care for the very old promises to free resources that can be devoted to others. Such self‐conscious limit‐setting, leading to premature death, requires both a moral justification and a change in the paradigm of physician obligation. This paper argues that the moral justification for curtailing care is absent, and that the paradigm of the physician as a servant of life, and the patient's agent, is worth preserving. Finally, it is suggested that, if the ailing old need to (...) be deprived of life‐extending care, then the state should undertake the task of killing them. Physicians should not undertake this role, for it is the state that may gain an advantage it seeks by saving money, not the physicians. (shrink)