Justice between the young and the old

Philosophy and Public Affairs

Volumn 30, Issue 2, 2001, Pages 152-177

  McKerlie, Dennis ^a  

^a NONE

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EID: 1042264718     PISSN: 00483915     EISSN: 10884963     Source Type: Journal    
DOI: 10.1111/j.1088-4963.2001.00152.x     Document Type: Article

References (40)

1. I use the term "generation" to refer to a group of people born at roughly the same time. We belong to the same generation throughout our lives. By contrast "age-group" picks out people in the same temporal stage of life. Individuals belong to each age-group in turn as they pass through the stages of youth, middle age, and old age. A particular generation first constitutes the age-group of the young, then that of the mature, and finally that of the elderly.
2. Thomas Nagel, Equality and Partiality (New York: Oxford University Press, 1991), p. 69.
3. For example, W. D. Ross believed that happiness should be proportional to virtue. And he thought that the assessment should be made in terms of lifetimes. "What we perceive to be good is a condition of things in which the total pleasure enjoyed by each person in his life as a whole is proportional to his virtue similarly taken as a whole" (W. D. Ross, The Right and the Good [Oxford: Clarendon Press, 1930], p. 58).
4. Thomas Nagel "Equality" in Mortal Questions (Cambridge: Cambridge University Press, 1979), pp. 106-27, see p. 120 and pp. 124-25 n. 16. Compensation means that a larger benefit at one time outweighs a smaller harm at some other time, so that it is reasonable for a person to choose to have both the harm and the benefit rather than neither. Nagel assumes that compensation also means that if the harm creates inequality at a particular time with some other person, this inequality would be morally erased if the benefit created a matching inequality with that person at some other time. We might agree that there is compensation in the first sense while denying that there is compensation in the second sense. However, this will not be my answer to the argument about compensation.
5. The source of the quote is Martha Derthick, Policymaking For Social Security (Washington D.C.: The Blockings Institution, 1979), p. 253.
6. Norman Daniels, Am I My Parents' Keeper? (Oxford: Oxford University Press, 1988), p. 45.
7. Many other writers agree in using prudence as the criterion of justice between the young and the old. Ronald Dworkin applies it to the distribution of health care (Ronald Dworkin, "Justice and the High Cost of Health" in Sovereign Virtue [Cambridge, Mass.: Harvard University Press, 2000], pp. 307-19).
8. Similar views about health care are found in Daniels's earlier book Just Health Care (Cambridge: Cambridge University Press, 1985)
9. and Dan Brock's Life and Death: Philosophical Essays in Biomedical Ethics (Cambridge: Cambridge University Press, 1993), chapter 12.
10. The view fits some recent historical work about the origin of the welfare state. We associate the welfare state with programs that transfer resources from the well-off to the the badly off. But historians point out that many of its characteristic programs - social security, unemployment insurance, disability compensation, and the public provision of health care - were designed to benefit everyone. The benefit is created by these institutions encouraging, or rather compelling, individuals to manage their resources prudently over their lifetimes. See Brian Barry, "The Welfare State versus the Relief of Poverty," Ethics 100 (1990): 503-29.
11. Daniels, Am I My Parents' Keeper? p. 45.
12. The three features of concern for a lifetime, temporal neutrality, and maximizing are part of most philosophical accounts of prudence. Nevertheless, their status as rational requirements has been challenged. Derek Parfit questions the requirement of temporal neutrality in Reasons and Persons (Oxford: Clarendon Press, 1984), part two. My concern will initially be with the implications of the features if prudence is used as the criterion of fair distribution between the temporal parts of different lives, not with their application to a single life. However, in the end I will question the claim that prudence should maximize the total amount of well-being in a life.
13. Richard Posner (Aging and Old Age [Chicago: The University of Chicago Press, 1995], pp. 266-67)
14. and Tyler Cowen ("Comment on Daniels and McKerlie," in Lee M. Cohen, ed., Justice Across Generations [Public Policy Institute of the AARP, 1993], pp. 227-35) also criticize the appeal to prudence. However, they assume that the prudential choice is made by a young person aware of her current age and goals, with the result that the choice will be biassed in favor of the young. This is unfair to Daniels, who requires that the chooser should not know these facts. The objection does seem to apply to Dworkin's view.
15. Daniels sees the choice as distributing a fixed amount of resources across a lifetime. The criticism would be easier to answer if the prudential agent were instead deciding whether to cooperate with other people to create a system of insurance against extreme old age (as we will see, this is Dworkin's version of the prudential choice). In replying to a similar criticism Daniels mentions the idea of purchasing an annuity that would provide financial support even in extreme old age ("The Prudential Lifespan Account: Objections and Replies," in Justice and Justification [Cambridge: Cambridge University Press, 1996], p. 247). Perhaps this indicates that he would adopt the suggestion, but Daniels does not work out the consequences of this approach or explain how to integrate the annuity idea with the rest of his theory.
16. Posner, Aging and Old Age, pp. 84-95, contends that the belief that resources would benefit the elderly less is a mistake explained by the tendency of the young to disvalue the characteristic goals of old age. However, it is not simply a matter of the young using their own values to judge the quality of the lives of the elderly. Such objective factors as illness, infirmity, loneliness, and depression make it more difficult for the elderly to live happily. In many cases the elderly themselves would agree that the projects they pursue after retirement, while important, are not as important to their lives as temporal wholes as the goals of their middle years. Nevertheless, changes in goals and values during our lives create a problem for prudence. My case against the appeal to prudence will not depend on this difficulty. It applies even if a young person and that person when she is old would agree about the quality of her life during old age.
17. Philip Larkin, Collected Poems (London: The Marvell Press and Faber and Faber, 1988), pp. 196-97
18. Those interested in Larkin's assessment of his poem should read Andrew Morton, Philip Larkin: A Writer's Life (London: Faber and Faber, 1993), pp. 425-26.
19. Posner's comment (Aging and Old Age, pp. 256-57) is actually about Dan Brock who reaches a similar conclusion, but Posner connects it to Dworkin (pp. 267-68). I strongly disagree with Posner's view (p. 257) that the moral intuitions he is appealing to are merely the result of genetic programming and consequently are non-rational.
20. My view of the results of the appeal to prudence will be controversial. The writers who use prudence to distribute resources between age-groups often make little more than a suggestive case for thinking that it will generate the specific conclusions that they go on to draw. Sometimes they disagree about the general tendency of those conclusions. Daniels believes that his theory will be generous to the elderly. He says that applied to social security it will recommend rough equality in income between the old and the young (Am I My Parents' Keeper? p. 121). One aim of his book is to answer the criticism that the elderly receive too much from such institutions as social security and Medicare. By contrast, Dworkin believes that in the case of health care, prudential thinking will strictly limit the claims of the elderly. I have tried to explain why I think the view's implications will be radical rather than moderate.
21. Nagel, Equality and Partiality, p. 68.
22. Egalitarian priority, and how it differs from equality, are discussed by Derek Parfit, "Equality or Priority?" (Lindley Lecture, Lawrence, Kans.: University of Kansas Press, 1995)
23. and Larry Temkin, Inequality (Oxford: Oxford University Press, 1993).
24. If we apply a value concerned with distributive justice to temporal stages in lives, why should it be priority rather than equality? I will not consider this issue, but I think there are strong reasons for choosing priority when the application is to life-stages. For discussion see Dennis McKerlie, "Dimensions of Equality," Utilitas 13 (2001): 263-88.
25. I have not tried to say in what well-being consists, because I think it is plausible to apply priority to people at particular times on most accounts of well-being. There is some discussion of the relationship between different theories of well-being and the time-specific priority view in McKerlie, "Dimensions of Equality."
26. The argument from responsibility also arises for the lifetime priority view and it receives the same answer. The answer would not be available to the time-specific view if applying priority to people at particular times required rejecting the notion that one and the same person persists through all of the temporal stages of a life. In Section IV, I will suggest that time-specific priority does not depend on challenging the ordinary view of personal identity.
27. This is not to deny that how people fare during old age might have special importance because old age is the last temporal stage in their lives. However, I do not think this is the source of the moral reasons I am trying to explain.
28. In characterizing the issue this way I am supposing that Dworkin's conclusion does not depend on his view (Life's Dominion [New York: Alfred A. Knopf, 1993], chap. 8) that sufferers from Alzheimer's disease have experiential interests but no current critical interests and are incapable of exercising autonomy.
29. Dworkin's view of the capacities of Alzheimer's patients has been persuasively challenged by Agnieszka Jaworska in "Respecting the Margins of Agency: Alzheimer's Patients and the Capacity to Value," Philosophy & Public Affairs 28, no. 2 (Spring 1999): 105-38,
30. and Seana Shiffrin in "Autonomy, Beneficence and the Permanently Demented," in Dworkin and His Critics, ed. Justine Burley (London: Blackwell, forthcoming).
31. I have not explained precisely how the time-specific priority view could reach this conclusion. There are three possibilities. The first is used by Frances Kamm, who applies a kind of priority - she calls it "urgency" - to the allocation of medical resources (Morality, Mortality, volume I [New York: Oxford University Press, 1993], chaps. 11-14). Kamm makes the temporal proximity of the potential harm an important factor (this is true of what she calls "urgency for time," not "urgency for quality of life" - the latter is very close to time-specific priority). Preventing a temporally imminent harm has priority over preventing a temporally remote harm. Apart from making time matter for its own sake (Kamm says that this kind of urgency expresses the moral "pressures of the here and now," p. 269), the explanation might not apply to my choice since death for the Alzheimer's patient need not be more imminent than illness for the younger person. A second explanation is that death counts as a harm in its own right, apart from the future well-being it deprives us of. This might make death a worse harm than the illness, so priority would be given to avoiding it. Kamm speaks of the factor of extinction in assessing the harmfulness of death, the thought that death is bad because it means that we are all over (pp. 59-60). (Larkin emphatically agrees: "At death, you break up: the bits that were you / Start speeding away from each other for ever / With no one to see. It's only oblivion, true: / We had it before, but then it was going to end. . . . Next time you can't pretend / there'll be anything else"). Using the medical resources in old age can only postpone, not prevent, death and extinction, so to complete this explanation we need to show that delaying extinction can count as a gain that outweighs a loss in terms of well-being. The last possibility returns to time-specific priority. If the Alzheimer's patient lives on, his life will contain some but not much well-being. We might think that the well-being he does possess has special value because the quality of his life is so poor, just as we think that an increase of well-being for someone at that low level would have special value. So it might outweigh the greater amount of well-being that the younger person would lose from the illness. This explanation implies that a life in which the medical resources are used to postpone death in old age is a better complete life than a life in which the resources are used to prevent illness during middle age, although the first life contains less well-being and ends with more years of low quality. Some will find this consequence implausible.
32. Posner, Aging and Old Age, pp. 263-64, 281-82, and 293.
33. Derek Parfit describes how a more sophisticated reductionist view of personal identity might lead us to apply egalitarian values to temporal parts of lives (Reasons and Persons, chap. 15).
34. Neither objection would arise if we endorsed the traditional conception of prudence - that is, if we agreed that prudence is focused on a complete life, is temporally neutral, and presents a maximizing view - and claimed that priority judgments only apply between the temporal parts of different lives. There would be a substantive difference between prudential judgments about one life and time-specific priority judgments about different lives, and priority would be restricted to interpersonal cases. The application of priority could be linked to the moral importance of the separateness of persons, and we would have a straightforward reason for rejecting prudential thinking - which is appropriate inside a life - as the test of justice between different people of different ages. Nevertheless, this is not the view I have defended. I think that we do make priority judgments about the different stages of a single life, and it seems to me that the best explanation of time-specific priority gives it application to both interpersonal and intrapersonal choices. A compromise position would hold that although we apply priority both across lives and inside lives, the degree of the priority is stronger when the application is to different lives. In other words, we should give some priority to temporal stage S1 (assuming that it has the lower quality of life) rather than temporal stage S2 if they belong to the same life, but a greater degree of priority if they belong to different lives. Jamie Mayerfeld describes a view like this (for the particular case of suffering) in Suffering and Moral Responsibility (Oxford: Oxford University Press, 1999), chap. 6.
35. Kamm discusses these choices in detail (Morality, Mortality, vol. I, part III). In her terminology, the twenty year old's claim is a matter of need (corresponding to priority based on lifetimes), while the eighty-year-old's claim is a matter of urgency for time (closer to time-specific priority, but treating the temporal imminence of death as a ground of priority).
36. Applying priority to both particular times and lifetimes helps to answer the concern about the time-specific priority view and the foundations of egalitarianism. I have suggested that our priority judgments about two life-stages will be the same whether they are stages in the same life or stages in different lives. This might seem unreasonable because it refuses to treat temporally complete human lives as morally significant units. However, if we also apply priority to lifetimes that application of the value .does treat complete lives as morally significant units. It is not obvious that in addition we must treat lifetimes as morally significant units in applying priority to people at particular times.
37. Like Daniels, I think it is helpful to distinguish between justice with respect to generations and justice with respect to age-groups. In my view, principles of justice for generations will be concerned with complete lives while principles of justice for age-groups will be explained by time-specific priority.
38. Reinhard Hohaus, "Equity, Adequacy, and Related Factors in Old Age Security," (1938), p. 62,
39. quoted in Social Security: Programs, Problems, and Policies, ed. William Haber and Wilbur J. Cohen (Homewood, Ill.: Richard D. Irwin, Inc., 1960).
40. Chapter 10 of Derthick, Policymaking for Social Security, discusses how these values were interpreted by American Social Security during the 1950s and 1960s.