INTERGENERATIONAL JUSTICE

The term intergenerational justice refers to the ethical problem of distributing scarce resources between different age groups in a society. For example, intergenerational justice is at stake when societies debate how much of their scarce resources should be devoted to areas such as education that primarily benefit the young, versus programs such as social security or Medicare that benefit older members of the population. Similarly, the problem of justice between generations arises when societies consider limiting health care resources to the elderly in order to increase health care resources available to the young.

Historical background

While the problem of allocating scarce societal resources among age groups has always existed, during the past two centuries this problem has gained prominence in many developed nations. Greater attention to intergenerational justice is in part due to the fact that the societies of many developed nations are aging. Unlike the aging of individuals, which occurs in a progressive, chronological fashion, societies are said to age whenever their number of older members increases relative to their number of younger members. Most industrial nations, including the United States, have been aging since at least 1800. In 1800, the demographic makeup of developing countries resembled that of today's Third World countries: roughly half the population was under the age of sixteen, with few people living beyond the age of sixty. Since that time, these countries have become developed nations, and have witnessed increases in life expectancy and decreases in fertility rates. Thus, since 1950, the ranks of Americans age sixty-five and older has more than doubled, while the number of persons over the age of eighty-five has more than quadrupled. These trends are forecast to continue until around the middle of the twenty-first century. At the other end of the age span, developed countries have seen a decline in the proportion of young people. After 1964 the total fertility rate began to plummet, reaching a low of 1.7 in 1976, a figure below the replacement rate of the population. These twin phenomena have dramatically increased the proportion of older persons in developed nations. At the same time, the age profile of many Third World countries remains heavily weighted toward younger age groups.

A relatively larger number of older citizens increases the demand for a variety of services used primarily, or disproportionately, by older individuals. For example, consumption of health care services rises sharply with age. In the United States, persons sixty-five and over represent 12 percent of the population, yet they account for 33 percent of the country's total personal health care expenditures, exclusive of resource costs. Between 1980 and 2040, the demand for health care among the oldest Americans (those seventy-five and over) is forecast to increase at a dramatic rate. There will be a 265 percent increase in physician visits, a 291 percent increase in days of hospital care, and a 318 percent increase in nursing-home residents among this age group.

Contemporary debates over intergenerational justice frequently focus on the problem of whether society should limit the share of scarce resources it devotes to the elderly. For example, in the United States, where the old increasingly outnumber the young, debates about limiting health care expenditures for older individuals have emerged in political and philosophical discussions during the latter part of the twentieth century.

Philosophical and ethical background

It is revealing to consider what form discussions about intergenerational justice might take if the young outnumbered the old. Would such concerns be expressed in terms of setting limits to publicly financed health care for the young? If not, perhaps there is more at stake here than the proportion of old persons compared to young persons within society. If a society would be relatively less willing to curtail resources to younger people, this might suggest that its sense of justice somehow includes the idea that the young are inherently more morally deserving of scarce resources than older persons are. It is unclear that any ethical basis can be found to support such a position.

The philosopher Daniel Callahan argues that it is not unjust to deny persons access to publicly financed life-extending medical care once they reach a natural life span. Callahan's reasoning is that once individuals reach old age, death may be an occasion for sadness, but should also be thought of as a relatively acceptable event. To clarify this idea, Callahan asks people to imagine the death of both an older person and a younger person they know, and to consider how they will feel about their deaths twenty or thirty years after the fact. According to Callahan, while the death of any individual is a loss, we perceive the deaths of young and old persons differently. When viewed in distant retrospect, people continue to feel despair and moral outrage about the death of young persons because such persons were deprived a full and meaningful life. By contrast, over time the deaths of old persons are regarded as philosophically and ethically tolerable because death in old age does not rob persons of living their full or "natural" lifespan.

If these judgments are correct, perhaps society's obligation to prevent the death of younger persons is not the same as the obligation to prevent the death of older persons; perhaps more of its scarce resources should be devoted to preventing premature deaths, and comparatively less devoted to preventing death in old age. Callahan proposes that society can ethically ration publicly financed life-extending health care to people who have reached a "natural lifespan." Most people will reach a natural span of life by age sixty-five, or certainly by their late seventies or early eighties. After this age, individuals remain free to use personal resources to pay for life-extending care in old age, yet society is not obligated, according to Callahan, to devote scarce resources to this end.

Contractarian approaches to intergenerational justice

Social-contract theories of justice offer us a quite different way of looking at intergenerational justice. According to this school of thought people incur morally binding obligations of justice only by virtue of their consent or agreement. Whereas for Callahan the concept of a natural lifespan defines what expectations for health care are reasonable at different stages of life, for the contractarian normative judgments are solely a matter of rational choice by unfettered individuals. Rather than viewing ethical obligations as unalterable dictates imposed by God, nature, or by one's station in life, the contractarian regards the source of ethical obligation to be free and rational agents. The social contract view is sometimes put forward as a comprehensive ethical theory, and sometimes presented as an account of justice and social obligation.

Working in this tradition, philosopher Norman Daniels frames the problem of intergenerational justice as a problem of choosing what resources we should devote to old age. Yet rather than calling for a consensus among members of the society, as social contract views typically do, Daniels casts intergenerational justice as a first-person problem of prudential choice. Intergenerational justice is thus viewed as a problem of distributing scarce resources between the older and younger stages of each person's own life. In other words, we should stop thinking about intergenerational justice as arising between distinct groups of people. The young and old are one and the same—in the sense that each person passes through youth, adulthood, and old age.

Before choosing how to allocate resources across our life span, Daniels introduces a procedural constraint aimed at ensuring fair and impartial conditions for choosing. To prevent people from biasing the distribution of resources to the stage of life they currently occupy, they must be blind to their own actual age, and then imagine that they will live out their whole lives with the result of their choice. In other words, people should expect to experience firsthand the advantages and disadvantages of their distributive choices for youth, adulthood, and old age.

With this background, Daniels goes on to argue that people would opt for a scheme that improved their chances of reaching a normal life expectancy, rather than one that gave them a greater chance of living beyond a normal life expectancy. In the area of health care, for example, it is just for a society to impose age-based restrictions on health care in order to free up resources devoted to improving people's chances of reaching normal life expectancy. Daniels emphasizes that rationing medical care by age is consistent with treating persons equally. This is because, unlike sexism or racism, differential treatment by age equalizes over time. If we treat the old one way and the young another, over time each person is treated both ways.

Utilitarian approaches

Whereas contractarian approaches take as their starting point the idea of rational choice by individuals, utilitarian theories begin with the premise that all human conduct should promote, to the greatest extent possible, the welfare of all. Whereas Daniels places emphasis on the long-term prudential interest of the individual, utilitarianism is concerned impartially with the interests of all. Thus, utilitarianism sometimes requires substantial sacrifice on the part of individuals as a means to producing the greatest good for everyone. Rather than inviting people to calculate their own prudential interests, utilitarians instruct people to consider the interests of all conscious beings who may be affected by what they do.

How are problems of intergenerational justice settled within a utilitarian framework? Often this approach requires age-based rationing of scarce resources in order to maximize the achievement of some important goal. For instance, it might be argued that to maximize public welfare, scarce health care resources should be aimed at prolonging the life of young persons who are relatively more productive and efficient in their contributions to society. Older individuals contribute to society in fewer areas and function less efficiently where they do. They cease professional work and take leave of active participation in other social roles, such as parenting. Alternatively, working within the utilitarian tradition, it might be argued that older persons should be excluded from scarce medical resources in order to maximize cost savings. As noted already, elderly individuals, on average, consume a disproportionate share of health care. Finally, utilitarian thinking might support agebased rationing in order to yield the greatest possible return on society's health care dollars. The young have, on average, many more years ahead to live than older people do. Therefore, life-extending health care distributed to younger people will tend to yield a greater return on investment in terms of life-years saved.

Libertarian approaches

Whereas utilitarian approaches tend to grant societies authority to require substantial sacrifices from individuals to promote the public welfare, libertarians reject state authority altogether, or at least want to see it substantially reduced. Libertarians underscore individual liberty and individual rights to private property. While bearing affinities to social-contract theories, which also place emphasis on free choice by rational individuals, libertarians tend to emphasize the free market approach to distributing scarce resources. According to one prominent libertarian view, what makes a distribution of scarce resources just or unjust is not its outcome, but how it was arrived at. So long as individuals are free to acquire and exchange goods on a free market, whatever distribution of goods results is just.

What are the implications of libertarian thinking for intergenerational justice debates? First, one cannot say in advance how much of society's scarce health care resources the old and the young deserve. Rather than viewing health care as a right, the libertarian views private property as a right. Thus, people are free to exchange private property for health care, or for other goods, in a free market. According to this conception, inequalities in health care are fair if they were historically acquired through fair acquisitions and exchanges, rather than through blatantly unfair means such as stealing, enslaving, defrauding, or otherwise coercing people. Society is not justified in establishing health care policies that require, through taxing or other means, individuals to sacrifice justly acquired goods. When elderly or other groups in a society lack access to basic health care, the libertarian calls upon a principle of charity, rather than social justice, to improve their plight.

Summary

The distribution of scarce resources between the young and the old will continue to attract widespread attention in scholarly and public-policy discussions. Different philosophical approaches to justice yield very different answers to the question of how these concerns should be settled. The philosophical assumptions inherent in proposals for rationing based on age, for example, derive little support from libertarian schools of thought, yet fit well within the framework of utilitarian and contractarian viewpoints. Gaining clarity about the problem of intergenerational justice in health care and other areas will require paying closer attention to the philosophical and ethical assumptions that underlie different policy proposals.

Nancy Jecker

See also Generational Equity; Population Aging.

BIBLIOGRAPHY

Callahan, D. Setting Limits: Medical Goals in an Aging Society. New York: Simon and Schuster, 1987.

Daniels, N. Am I My Parents' Keeper?: An Essay on Justice Between the Young and the Old. New York: Oxford University Press, 1988.

Gauthier, D. Morals by Agreement. New York: Oxford University Press, 1986.

Jecker, N. S. "Aging and the Aged: Societal Aging." In Encyclopedia of Bioethics, vol. 1. Edited by W. T. Reich. New York: MacMillan Publishing Company, 1995. Pages 91–94.

Rawls, J. A Theory of Justice. Cambridge, Mass.: Harvard University Press, 1971.

INTERGENERATIONAL RELATIONS

See Parent-child relationship