9.8.2013

AGE OLD JUSTICE

Paper for Political Theory Workshop, Columbia University

September 11 2013

Mark Philp

Oriel College/ University of Oxford/University of Warwick

This is a first draft. Please do not cite without permission.

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Mary’s mother was left a widow in her early eighties. Some people adjust; a lot do not. Mary’s mother did not. She sold the house, moved to a small apartment not far from Mary, (but a good distance from her other children), and she withdrew into her own world. Depressed, increasingly physically unwell, and with some signs of memory loss and forgetfulness, Mary’s mother became isolated, and increasingly reliant on Mary. Mary and or her husband would go round every couple of days. They would make sure there was food in the fridge, they would clear out the stuff going rotten; and Mary would take her mother out for occasional day trips. Mary’s mother was not especially grateful. She didn’t admit to depression – ‘I just don’t want to live anymore.’ She also tended to assume that Mary would do whatever needed doing. After a couple of years, things began to deteriorate. She started to fall. Mary arranged for her to have an alarm to wear round her neck so that she could summon help if she fell. She would press the button, that would contact the emergency services, and they would contact Mary, who would go round and help her up and make sure nothing was broken. But the calls became more frequent, and Mary and her husband found it increasingly difficult to get her off the floor, and increasingly difficult to be at the other end of the phone and to be asked to drop what they were doing to rescue her (since they both worked). They tried employing carers to go in to provide support; but Mary’s mother did not want strangers in the apartment and roused herself to dismiss them or was so uncooperative that they resigned. While she claimed she did not need support, her diet deteriorated, and she developed problems with incontinence at night – that led to more falls in the middle of the night, when she had to be helped up by Mary, changed and eventually got back to bed.

Mary also became depressed. The constant demands; the endless uncertainty as to whether she’d be called out; the collapse of her normal relationship with her mother and its replacement with one in which her mother would not take responsibility, and in which she needed to attend to the physical care needs of her mother; and the sheer weight of the demands on her time, were all taking their toll.

Then, one night, Mary’s mother struggled out of bed in the middle of the night to use the bathroom, slipped on the floor, and cracked her head as she fell. She had left her alarm by her bed and could not call for help. She died some 24 hours later, having been found still on the floor by Mary when she called later the following day.

Mary was disconsolate, both grieving and consumed with guilt, partly at the relief she could not help feeling.

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Mary’s story is not unusual, and it is likely to become more common as more people live longer. We know that levels of emotional strain for caregivers can be very high. Apparently, men and women find different things stressful. Men find it stressful to have to handle difficult parental behaviour; women react to the interference with their work and to the decline in the quality of their relationship with their parent. Although male careers for parents are not uncommon, making up about 25% of parental carers in the US, for example, it is clear that in many families women carry the major burdens. (Mui 1995).

The pain and costs, and loss of value to Mary’s life are regrettable. As a widespread phenomenon it is something about which we ought to try to think clearly, but we need to start by asking what sort of issue it is. Let me just suggest some different ways of construing it:

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1. We could say that Mary has just had a lot of bad luck. Things work out for some people, but not for others. Some people meet Mr/Ms Right – and some Mr/Ms Wrong and their lives go accordingly well or badly. But, as Kurt Vonnegut would have said: ‘So it goes.’ It can’t be anyone else’s responsibility to sort this out.

2. Alternatively, we might pick up the reference to Mary’s siblings, and say that the distribution of burdens seems to have fallen unfairly on Mary. Even if the state has no responsibility, and even if there’s not an issue about social justice that requires intervention, it is nonetheless the case that, within the family, Mary has borne an unfair burden that she is right to resent; and that her siblings have some responsibility to compensate her.

3. In theories of justice, luck egalitarians believe that, while what people should bear the costs of what they choose to do (option luck), brute bad luck ought to be compensated for. The choice of Mr/Ms Wrong might be bad option luck – but having a parent who is falling apart is just brute bad luck, people’s lives go less well as a result, and that is something a luck egalitarian might argue should be responded to and compensated by society at large.

4. We might also think that this is about justice, but less as an ideal of an equal distribution of burdens and more as a threshold to cross – a sort of prioritarianism. In an advanced industrialised society, the state should seek to avoid certain bad outcomes. People should not die of malnutrition, they should not be harming themselves while the balance of their mind is disturbed, they should not be without basic protections and services to ensure their basic security and well-being. And one such ‘threshold’ that such a society might aim to cross is ensuring that the elderly can continue to function independently or as long as possible and that there are services to support them and ensure that they are not left vulnerable, insecure, or burdensomely dependent on their families.

Each of these four responses has some value. Clearly they are in tension; but they might be in tension in part because of the complexity of the case, and that might be a function of the competing considerations that are in play.

One thing in play is the depth of the emotional engagement and psychological burden involved in such caring roles. It is hard to deal with ageing parents. In many families the distribution responsibilities, which may be a function of family members’ differential emotional vulnerability and susceptibility and a degree of brute bad luck, is often (perhaps usually) deeply inequitable and justifies resentment. It. The bad luck has powerful emotional consequences: having to be the person with whom the buck necessarily stops, fundamentally changes the nature of the relationship that one has with the parent, and as a result, with one’s siblings. One problem is that this makes rectification for burdens extremely difficult – perhaps impossible. Mary’s situation is not just about financial loss, or even the loss of time – both of which might be compensated for by money or inheritance. It also involves emotional loss – associated with having to experience one’s parent in ways that those who are not primary carers do not – and consequently about losing elements of that parent-child relationship - and thereby elements of oneself and also often elements of one’s relationships with one’s siblings. And the ‘goods’ that inheritance brings, or that siblings can offer, cannot wholly replace these losses. I want to suggest that such senses of justice and resentment are deeply ‘situated’ – rooted in the particulars of this unique context - rather than direct deductions from more general principles. But, as such, they blur boundaries between the reasonable and our deeper emotional lives and psychologies, and that mean that there can be a limit to how far abstract principles – principles that make idealising assumptions about the ability of agents to split the emotional and the reasonable – can be brought to bear on such issues.

Consider Mary’s family. One suggestion in the story I have told is that Mary has to carry this burden alone, despite the fact that there are other siblings – assume a brother and a sister. This might be a component of the costs. When the other siblings visit occasionally, to the evident pleasure of Mary’s mother, and tell Mary what she ought to be doing to ensure a better quality to their mother’s life,

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Mary feels justifiably resentful: it underlines her sense that they enjoy a relationship with their mother that the quotidian round of physical care has compromised for Mary; and it points to the fact that Mary’s burdens have rendered her emotionally isolated from her siblings – because they cannot see the world from her point of view.

We need not assume any great fault on these siblings’ parts: perhaps one lives in the mid-West, the other in California, and Mary is on the East coast. Mary’s mother wanted to live near one of her children (and couldn’t live near more than one); and she chose Mary. Does it matter why? It might have been because she lived in a town that her mother found familiar, neither of the other children did; or she may have been chosen because her mother had most confidence in her; or because she had always had a good relationship with her; or because she was seen as having less important things to do than her siblings. Some of these might be good reasons; at least one is certainly bad. But, in many respects, her mother’s choice is no more than a compounding factor to the complexities. The more questionable the motives, the more complex the emotional impact on Mary is likely to be. But even simple motives, like proximity to where she was previously living, end up having essentially similar effects. Moreover, whatever the reason she chose Mary, Mary has ended up accepted that choice, and in some sense (since it is hardly a contractual situation) ‘took on’ the responsibilities in relation to her mother. I am not saying that this makes her responsible for everything; but in many respects the (usually unspoken) formulation is - in a rueful inversion of claims of sovereignty - the carer’s situation is that the buck will now stop here. That is a burden that has to be borne by someone when people are no longer capable of bearing it for themselves, and the person who becomes the primary carer has precisely that burden (although it is something that often only dawns on people slowly). I have suggested that there are special features to that burden that often exacerbate its impact on the individual. But, even without that, by bearing that burden, and thereby absolving others in the family from bearing it, the issue of what others owe to Mary is necessarily raised.

Within Mary’s family, there is clearly an issue about the equal distribution of burdens. That is both simple and complex. It is simple because it seems plausible to say that there is at least a prima facie case for saying that the burdens ought to be roughly shared to the extent that this is possible. And we might also say that there are levels of burden that can be agent-damaging and that call for a wider spread of the responsibilities for shouldering the burden within the community – in the UK Mary’s mother would get certain levels of service provided by the local authority once a certain level of need is demonstrated. This provision seems to be based on the recognition of need, and the motivating assumptions seems to be avoidance of harm, responding to vulnerability, and trying to ensure a minimum quality of life, both for the individual concerned and for those attempting to support their continued existence in the community (the fourth approach outlined above). That is, these concerns seem to be about risk – either because of the agent’s vulnerability, or because of the level of burden borne. The provision is a safety net, and like other safety nets might be thought of as levels of provision that we regard as a minimum acceptable level for a civilised society. At the same time, given the ageing of most western populations, this may not be something that the state can solve for every elderly person – so there could be no realistic ambition to make ageing wholly burden free for the children of the ageing.

If equal distribution of burdens is one dimension of the situation, it is certainly not the only one. That is clear from the fact that much of the emotional experience and cost would be identical in either of the following two cases: a. where Mary is an only child; or b. Where her sister has a disabled child that she cares for, and her brother’s partner has MS, so that neither is in a position to bear the burden of their mother. In both cases, only Mary can bear the burden. In such situations – being an only child, or being the only person able to do what is necessary - is there no issue about justice in relation to the burden that Mary must bear?

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The equal distribution of burdens is complex. The nature of the relationships involved are such that emotional and psychological factors complicate the experience of burden-bearing relationships in families. Professional carers – this is not a criticism so much as a specification of the category – provide physical care, social connection and psychological comfort, but they are not themselves implicated emotionally to the same degree. The burden for children of caring for parents has some distinctive (although perhaps not unique) features. These include: as I have suggested, the loss, because of the inversion, of the parent-child relationship. The family carer has to experience their parent, often with degrees of physical intimacy, in ways that invert their earlier relationship; they have to take control of areas of their parent’s life that they may never previously have been privy to; and past issues of authority and power, and attachment and resentments are inevitably revived as the relationship changes. We do not need to go far to see that there will be issues here that are challenging and that will play a part in determining both the character of the burden that the agent bears, and the weight of that burden for that particular individual. Similar things might be true in a relation to one’s sick or terminally-ill partner – but that relationship is one that we have ‘freely’ chosen and committed to: ‘in sickness and in health, for better or for worse.’ In comparison, being someone’s child is not a matter of choice.

The nature of the burdens of caring, and the emotional relationships that exist between parents and their children are such that State is not in a position fully to compensate those who bear them. Or, at least, this is true whenever the child retains an emotional connection, psychological attachment and sense of responsibility in relation to their parent, irrespective of how well the physical and social needs of their parent is being met. Some families, through brute luck (their parents remain fit and healthy and active until the day they die), are spared some of these particularly intense and wearing burdens. But for others the burdens can be intense both in and of themselves, and because they are complicated by factors such as the prevailing pattern of relationships within the family.

II

Is it helpful to use the language of justice to describe these situations and to assess people’s responsibilities and the responsibilities of the community? Modern conceptions of justice – whether Rawls or Nozick (or in between) start from what I would describe as a fungibility model of justice: that is, that the elements of an account of justice are all tradable or resolvable within the same conceptual space and often along a single dimension (although that may itself have plural strands – like an account of primary goods). In the simpler versions, if A treats B unjustly, then the state is justified in punishing and/or exacting retribution from A, and/or compensating B. If, through no fault of his or her own B is on some dimension worse off than A, then B can be compensated in some way, unless being worse off is justified by individual choice, or the difference principle, etc.. Moreover, we are encouraged to conceive of justice as distribution in accordance with particular metrics – resources, welfare, capabilities, access to advantage etc. For most modern theories of justice a key presumption, reflected in (perhaps modelled on) the scales of justice, is that an injustice can be corrected, or rebalanced. In contrast, one thought that drives this paper is that the multi-dimensional nature of some areas of life are such that it is very difficult to see what could adequately re-establish equality between those involved. And, to anticipate my conclusion, my sense is that this might tell us something about the limits of modern justice.

If we return to the four types of response I indicated above, we might say that each account seems to have some weight:

1. Mary has had bad luck in ending up caring for her mother, and her life has gone worse than it otherwise would as a result. But that (Mary’s situation) is not something we should do anything about – in part because it is not something we can resolve or compensate for.

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2. There is an issue about what Mary’s family should be doing for her – and that might have an influence on subsequent issues of inheritance. Even if they can’t rectify the situation – or fully compensate, there is some sense that, at least within the family, something like ‘recognition’ is called for to acknowledge the burdens she has born. Where Mary is the only family member of any kind, then the case might fall into the first category.

3. That said, there an element of brute bad luck in this situation, which demands some response. It would be unjust to treat the situation as one of Mary’s choice. Even if Mary gives up her job to take care of her mother, we’d need to be clear whether feasible alternatives existed before we conclude that this was just a choice being exercised, rather than a responsibility being assumed under conditions where the agent is bound to assume the responsibility! So, considerations of tax breaks, provision of carer benefits, the creation of services to support the elderly and to provide respite for those who assume such burdens might all be ways in which the state can respond in relation to financial an opportunity costs of care and to recognise the fact that the carer is bearing a burden that is un-chosen, costly and one that the state would otherwise have some responsibility to meet.

4. This ties up with the broader question of what level and kinds of provision the state should make for those who are rendered vulnerable in virtue of age and sickness. In Europe, we tend to start with the State; in the United States, people tend to start with insurance and the individual’s responsibility to plan for their future. I cannot get far into this – just to say that, however it is done, the State needs to ensure that it is done, and reliably, and in ways that protect people’s interests. And if that is right, it seems plausible to claim that there are issues of justice in relation to Mary’s case, even if it is only the case of the state acting to ensure that the structure exists to enable Mary to undertake the role in ways that are consistent with the other forms of provision that the state makes for those who are most vulnerable within society.

On this account, it seems that there are many different considerations that relate to Mary’s case, and that these partly add up to the conclusion that on most standard accounts of justice there will inevitably be some uncompensated burdens. In many theories of justice it is problematic to say that there remains some injustice, but that may be because we tend to adopt a conception of justice that sees like a State, insists on a public private divide, sees justice as a matter exclusively of the public domain, and that cannot deal with elements of the private world of emotional cost.. Hence the rather fractured response to Mary’s case. In the conclusion to this paper I will suggest that this fractured response is itself a function of the fractured ethical world we inhabit.

III

One reading of Mary’s position, which might attract some, is to say that I have characterized the situation in freighted terms. That is, that we might better see Mary’s relationship with her mother in a narrative arc, from Mary’s birth to her mother’s death, and that what it is to be human is to have relationships that are deep, enduring, and complex, that change over time, with the balance of ‘giving’ evolving over time. To focus on Mary’s distress and loss, is to fail to see this as an essential part of the relationship and its quality.

This kind of concern surely has some weight. We might retain intra-familial concerns about the equity of the distribution of burdens and benefits, but this sort of wider narrative weakens the claim that as an only child Mary’s necessarily suffers brute bad luck. Clearly, there is cultural variation here. There are expectations of caring for the elderly in certain cultures, and these help frame people’s experiences of and responses to these situations. Moreover, in such cultures, it is often easier to make the physical adjustments necessary to include a parent and integrate them into a more communal existence. But while there might be areas in the West in which this holds true, it is

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clear that, in general, this is not the case. The way our conception of the individual has evolved, the aspirations that people have for their lives, the levels of geographical and social mobility, the expectations people have of work and leisure, the kinds of relationships that they have with each other and with their parents, and the ways in which space is privatised and occupied, all complicate the familial management of ageing. And considerable evidence points to the costs that people bear, in terms of depression, anxiety, and a range of psycho-physical conditions, linked to the responsibilities of caring for elderly parents. In this sense, this is a modern, cosmopolitan, individualist problem, but it is not one we can solve simply by asserting the embeddedness of people in relationships, the depth of their obligations to each other, the sense of duty, and so on. We cannot solve it in this way because, while some of these things clearly exist, they are part of the problem, as much as part of any solution. We are both modern individualists and endowed with psychologies and a humanity that ties us closely to others in ways we cannot wholly rationalize. And it is in our deepest relationships that we experience some of these conflicting principles so powerfully (in part because these modern expectations are one’s which those closest to us want us to have).

While elements of this problem may have existed for some time, my suspicion is that they were often borne more easily – partly because they were shorter problems. The dramatic rise of longevity has meant that caring for someone may involve twenty or thirty years of one’s life, in a way that few experienced forty or fifty years ago. Moreover, the increase in longevity in the West has been coupled with much greater social and geographical mobility, increasing rates of family break-up, and growing numbers of single parent families, and families in which all the adults are in full time work. Each feature exacerbates the problem.

On this account, while we might welcome those who can bear such burdens without them weighing heavily, we cannot expect that most people will be able to resolve the conflicting demands they face without a sense of loss and guilt. We should not think that people’s distress and sense of burden indicate moral failings on their part; rather, we should recognise it as something that is symptomatic of the world we have made – with a corresponding sense that an issue of injustice exists. But this argument also suggests that the issue of justice is an integral part of that construction – and one riven by many of the same tensions. We acknowledge the individual burdens, but we baulk at seeing this as a collective responsibility, and find it difficult to say how justice could be done.

Feminists rightly point out that this is predominantly a burden for women. But they face an essentially similar difficulty. In demanding equality and the right of all individuals to choose and shape their own lives, they create expectations and demands – constructions of the life we believe we are entitled to – that cannot really take on board the depth of the emotional connections and senses of responsibility between children and their failing parents, that we then find disrupting our ordered world, leaving us unable to be what we think we ought to be – both the good child and the successful, independent agent. Where feminism contributes to our recognition of the depth of the problem is in resisting a view that we can simply declare that these are matters of private concern and arrangement, since it is clear that this is a burden that is systematically unevenly shared, with women being the primary bearers of the burdens, often through the structural disadvantage reproduced through the family.

IV

The responsibilities of families is a complex matter, into which I cannot go far. But there are a few points worth making.

We do not think that when someone is robbed, it is solely their family’s responsibility to come to their aid. Yet, if there is family, and they are available, the police and other services might discharge

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their obligations by satisfying themselves that the person is being looked after by them. It may differ in different cases and across different cultures but in general the State and its subordinate authorities have a duty of care, which in a number of cases they may be able to discharge by satisfying themselves that some family member or friend is prepared to do what needs doing. One way of seeing family responsibilities is in this light - at a certain point, the state and its subordinate agencies have some responsibility to assume a duty of care, or have to satisfy themselves that someone is assuming that responsibility. That someone is often a family member. But the authorities have considerably less responsibility for showing concern in relation to those who have assumed that responsibility for their relative – having made some broad judgment about competence, in most cases that is that. And they have no remit for arbitrating between family members to ensure a fair distribution of burdens. In this respect, the public private split seems largely assumed. If the family takes responsibility, then those whom it assures of this have no basis for questioning whether the responsibility is being distributed fairly or, in other ways appropriately. i

Yet the distribution of burdens does look like a question of justice. If Mary’s siblings are nearby and simply do not contribute to her care, this looks like being unfair to Mary. Of course, there may be many different kinds of back story to such situations – if Mary is the long-standing maternal favourite who does nothing but disparage her siblings to her mother, we might not be surprised by her siblings’ reaction. But, in many respects the more common case is one where the dynamics of the situation create unfairness without intent, and in ways that are difficult for those involved to see – except Mary! From her siblings’ points of view, if they are not conveniently close, it makes more sense for Mary to call more regularly. In terms of the distribution of time and effort, let us assume that her brother Frank lives further away, so that the trip to see his mother takes three times as long as it does for Mary. If Mary is going to her mother three times a week, then Frank should go once (and stay longer) – since it will take as much time or him to do that as it takes Mary to do her three trips. But this is a classic case – widely experienced in the case of childcare – where the cost to the agent in terms of time is not the only measure. The person who is there most regularly necessarily ends up taking responsibility for a substantial proportion of the quotidian round. Even if Mary actually spends no more time with her mother than Frank does, in virtue of being the most frequent contact, the range of things that fall to her as a responsibility will dramatically outweigh those that fall to Frank. This does not presume any ill-will on Frank’s part. Indeed, the more sensitive he is to not interfering with the arrangements that Mary makes in the week, the more he re-enforces her responsibility for those arrangements; but the more he ignores them, the more he adds to Mary’s labour.

This is a quasi-Hobbesian point about sovereignty!. The situation is one in which the agency of A must become the responsibility of some B. Splitting responsibility between plural Bs threatens incoherence of agency with respect to A, where the costs of that incoherence are deemed by all involved to be too high. Mary and Frank cannot share ultimate responsibility. Even if they are in constant communication (if there are just the two of them) they would need some way of deciding cases where they disagree. But, unless that rotates (Mary decides on odd days, Frank on even), what will emerge is a sovereign – or a primary holder of responsibility. Even dividing task areas requires some locus of decision to determine whether an ambiguous task is in category M or category F.

Of course, Frank can experience the same loss of the parent-child relationship if he is at least moderately involved, and that may be the basis for giving Mary a sense that her burden is both understood and shared. But it is not difficult to see that any sort of ‘grit’ in the relationship between Mary and Frank, is likely to emerge in the constant friction associated with someone needing to take charge of the situation, and with the inevitably different judgments that will be made about how to handle things. Things are more complex in the three siblings case; and we have said nothing about

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the capacity of one’s parent unintentionally to fan flames – telling Frank to leave it to Mary; praising Frank’s selflessness and devotion but not Mary’s (since that generation of mother works on the assumption that daughters do this sort of stuff, while sons have other responsibilities!); and so on.

I don’t have any good solutions to any of this – but I think two points can be made. The first is that these situations are complex, and common. Families suffer their most intense stresses often over issues concerning the care of their elderly parents (and the subsequent distribution of family goods after their parents’ deaths). And my suspicion is that many of the disputes in the latter group are really displaced emotional legacies of childhood compounded by the final years of the parents’ lives. They are complex because human relationships are complex; and because, where there are many dimensions in a life – one’s own family and partnerships, our work, our social responsibilities and friendships, and our own aspirations and the life choices we have made – and these many dimensions only rarely and imperfectly parallel those life choices made by our siblings (for obvious reasons), ensuring that we will not see the world in the same way as they do - since doing so relies on being able to imagine according the same weight to certain options that one’s sibling accords.

The second point concerns how bad people are at handling this – and I say that with no sense of superiority or criticism. Providing parental care and the subsequent clearing of the parental home and the distribution of family effects inevitably brings a mass of suppressed family baggage to the surface. There may be families without that – but with Philip Larkin I’m inclined to think that there is an inevitability about this.1 Unlike Larkin I’m inclined to think that it is just a corollary of deep relationships that they generate pain and loss. But that these feelings are inevitable, does not mean that they necessarily take destructive forms. Indeed, part of what makes them destructive is that they take people by surprise and overwhelm them; and part may also be that families tend to create hierarchies, distinctions and inequalities – eldest/youngest, gifted/hard working, Mummy’s/Daddy’s boy/girl - and these create orderings between siblings are disrupted when the presiding authority abdicates or dies. Again, nothing is straightforward – the marital relationships people form often reflect their familial location, thereby reinforcing patterns. So if you resented your big brother for assuming he was the genius of the family, and he’s found himself a marriage that treats him in exactly that way, it is unlikely you’ll find it easy to find a mode of communication with which you will both be content. Similarly, even peacemakers will not always be blessed!

Even if people are often very bad at all this, it is not clear that they could not be better. Moreover, while some psychological insight might help, this also seems to be a situation in which political theory might be distinctively appropriate – in that our subject is one which theorizes bringing together people with various amounts of emotional baggage and resentments, but where the aim is to construct something between a modus vivendi and an overlapping consensus over terms of engagement (that can allow the process of care management and the distribution of effects to be done without breaking down into war), and without re-playing patterns of dominance, subordination and exploitation. In this sense, we would be treating the family as a unit of justice in which there is equal citizenship – although we might also need to call on literatures of recognition to accommodate those who are been most damaged by its structures of power.

(Similarly, the literatures on justice might be directly helpful in providing people with tools for thinking about how to resolve disputes over inheritance – especially where there is both money and objects to which people may be differentially but competitively attached. These things often

1 Philip Larkin, This Be The Verse

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become deeply freighted with senses of attachment and entitlement that may derive from childhood, but may subsequently be compounded or cross cut by feelings and attachments that have arisen in the course of undertaking the care of the parent, any of which may be understandable, but without being in themselves ‘reasonable’ or open to rational justification. Given these features we are concerned with a political process – something which is good enough for those involved, and that allows them to remain on good terms with each other. Something, that is, that sustains civility in an arena in which conflicts are deep, multi-dimensional and often partly zero sum).

Note that, in contrast to ideal theories of justice, the aim of a justice-type process in the family context is not the eradication or full compensations of burdens or the rectification of all past inequalities and their concomitant costs – it is more a negotiated compromise than emancipatory or transformative, and it is partly a matter of recognition. It aims to solve some distributional issues in a context where there is more going on, but where the aim is to resolve those limited issues without exacerbating these other components and, in part, by according the participants a degree of standing and respect that acknowledges their distinctive positions and experiences. This is justice for a fractured world – and for fractured individuals. It makes no pretence to being fully reasonable, or ideal. There is a great deal it cannot undo or resolve, but for the purposes of the family unit it can provide a means by which people can work with each other in a limited range of common tasks. And that essentially political task is something to which contemporary political theory may have much to offer – since politics at its heart is about attempting to establish workable compromises between people who are in many respects at odds with each other.

V

The ‘brute bad luck’ claim also has some claim on our attention. Some people are cosmically dumped on – sometimes directly, and sometimes by finding themselves responsible for others who have been. Having a child with a terminal condition, for example, is not something that people choose; but it is also not something that the vast majority of those affected walk away from. But while, following Elizabeth Anderson’s attack on luck egalitarianism, we might try to show some care in the way we construe this situation, it would be callous in the extreme to say that there is nothing there to address in distributional terms.

The situation with a parent is more complicated. The foetus could not be expected to make the appropriate arrangements; parents might be expected to try to address some of the issues in advance. Watching one’s child progressively fade is different from watching one’s parent do so. In one case the telos is being cruelly interrupted; in the other, it is fulfilled. That fulfilment, however, can go better or worse, and to care about how it goes is partly what it is to care about this person and their life, even when they are no longer capable of attending to it themselves. And that means that some of the burden is self-imposed – in that it combines the parent’s physical end with their offspring’s desire for a normative arc that does justice to the life as a whole – difficult as that is to achieve.

But even if parents should plan for their ageing, and even if children bring something to the burden that they assume, there still seems to be an element of brute bad luck. Although ageing is something that more and more people will face, for longer and longer period of their lives it is a matter of luck how that goes, and a matter of luck how it impacts on family members.

Should social justice address this as a matter of bad luck? I cannot give a full answer to this question, simply because it is too large. But here is a sketch of how one such answer might go.

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The literature on luck egalitarianism comes out of a literature on distributive justice in which the emphasis is on the extent to which deviations from equality are acceptable. It is primarily addressed at differentials in life chances and distributive shares. But people’s lives can go well or ill on many dimensions, and no account of distributional justice could claim to be of relevance to every dimension – consider for example, being unlucky in love. There is no bright line, however, between ‘justice-relevant’ and non-justice-relevant outcomes. Love certainly seems in the latter category. But the costs of caring for a dying child or parent, while partly emotional may also be financial, and may affect career, occupation, and thereby more economically and socially framed aspects of life chances. If we care about ensuring that the life chances of individuals are not affected by irrelevant factors such as class or ethnicity - where the aim is to ensue to all individuals a chance to use and develop their talents equally with others – then it would seem that being bounded by responsibilities that are not fully freely chosen is a similar constraint about which justice should be concerned. We might feel greater urgency if we are dealing with a 16 year old who is suddenly in a position of responsibility because of the sudden onset of a terminal illness in his only parent than if we face a retired person caring for their parent. Nonetheless, they are not separate categories but represent different ends of a continuum –or of several: impact on current life; impact on anticipated arc; impact on physical resources; impact on emotional resources; safety and security of the person cared for; and so on. These don’t all go the same way: for example, older people may find the physical burden much more difficult to manage.

As a result, one of things that a luck egalitarian has to do is to work out what dimensions of the effects of brute luck are bad, and what kinds of badness should be given priority in the allocation of resources – taking into account that, because not every dimension of bad luck can fully be compensated for, some judgement is necessary to identify what has normative priority and what might provide an argument for trumping the normative priority in virtue of the efficient use of resources. A very bad experience of caring for a parent might be extremely costly to rectify (and could do so only imperfectly), that it would be better allocating resources to make more difference to a number of less extreme experiences. Although, with Nagel and Parfit, there may be a priority case, it is not clear that the priority case can always trump other less pressing cases where we are dealing with limited resources, and perhaps especially once we acknowledge that the experience and outcome of bad luck is not something that can be wholly or substantially compensated for.

Moreover, with Anderson we have to avoid characterising people’s experiences in ways that stigmatise their conditions, even if we do so with the liberal aspiration of helping them more. Nonetheless, the more one tells a story about the difficulty of compensating people for the costs of becoming carers, the more it seems like the aspirations of luck egalitarianism have to be set aside. There is brute bad luck, and there is not a lot that the state can do to compensate for a number of dimensions of that bad luck. It can make things easier by facilitating certain sorts of provision – and providing certain forms of support. But these do not look like they are being offered on the basis that they compensate people for their bad luck – so much as representing provision that the society collectively regards as an acknowledgement of some of the practical costs and difficulties associated with caring for the aged

VI

In Europe we find some aspects of the USA difficult to understand, perhaps especially its attitude to the kinds of lives it is prepared to tolerate for many of its citizens – whether in terms of medical provision, or in terms of basic care. But I say this, less as criticism and more in recognition of the starkly contrasting cultural traditions in relation to provision in extremis – whether ageing, sickness, unemployment, or multiply determined poverty.

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One way of reacting to this is to say that justice has no place in many of these areas; that people should make provision for their own lives; and that intervention on the part of the State creates a dependency culture which is economically collectively harmful, and produces poverty traps and a stigmatised and excluded underclass. In reality, of course, both types of system generate some of these problems. But it does seem to me to be a central issue for modern political theory to address the more basic question of what it is reasonable to expect of citizens in a highly complex technologically advanced society – and what it is reasonable to provide in terms of a threshold. As I have emphasised in the previous section, this is not with the expectation that it will compensate people for this brute bad luck – at least in the case of ending up being responsible for someone’s care. It is to minimize, or seek to create a buffer, so that the practical, financial and physical costs of care do not exacerbate the emotional strains and costs. In a world where we expect people to be their own masters – and to take responsibility for their own lives (in different dimensions to different degrees) – we have to recognise that circumstances can unmaster us through no fault of our own – and can impose burdens that have to be borne but to which we have conflicting responses: on the one hand treating them as intrusive on the lives we have been expecting to lead; on the other, seeing them as a concomitant of the emotional relationships that we have as members of a family. What we should not do, it seems to me, is to think that only one of these routes is the right one. It is because we are both egoists (and society wants us to be that – aspirational, competitive, wealth generating) and emotionally connected to those who have cared for us, that we must acknowledge both those features, and make some decisions about how to help meet the consequent burdens.

VII

If the other material is difficult, the question of the responsibilities of those who are themselves ageing seems more than doubly so. What parents are able to do to prepare is a function of how far the social and economic order facilitates certain kinds of decisions and allows future planning. If you spend your money putting your kids through the best education you can buy, but then find yourself the victim of a bank collapse and motor neuron disease – or sudden onset dementia – have you failed to act responsibly? How much of your current income should you devote to providing for the worst possibilities of your future? Economists can doubtless say some very clever stuff about optimal insurance rates, but any gaming of this form means that some people will be caught out – and who then is responsible for them?

None of us know what our trajectory is: you can be on great form one day, and paralysed with a stroke the next. Should you have planned for this? To what extent? If you are 60 and live in a three storey house without an elevator, when do you move? Older people prefer not to have to change, so they tend to introduce or accept innovations in their homes only under pressure – by which time they find it harder to adapt to them and optimize their use. But it can go the other way – you can prepare for aging by getting easy-use taps and door-nobs, etc, (that tend to reduce the market value of the house) and then fall prey to a brain tumour – when the capital value of the house becomes critical.

We have this sense of an arc of life – but it is not one that we can guarantee since it can be deeply affected by matters of brute bad luck. And that means that you cannot wholly prepare – and you cannot guarantee that you won’t become your children’s burden. But it does raise the question of what it is reasonable for you to do in preparation and how it is reasonable to respond when something catastrophic happens.

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In a recent paper Joseph Raz pointed to four other-regarding reasons that people might have for ending their lives:

1. sparing the effort and distress that looking after ailing people causes one’s loved ones2. preventing one’s savings from being used up and having nothing to bequeath 3. saving the public the expense of care4. preventing the memories of one’s family being dominated by the failings of one’s final years

As he says, it is difficult to see that these are not appropriate reasons, and the third, at least, influences public bodies financing treatment – where some treatments are judged too costly for people in decline. If it is right for the public authority to have these reasons, Raz suggests it is also right to apply similar standards to oneself in reflecting on the burden that one is imposing on others.

While I think Raz is right, I also think we should not underestimate the difficulty of such decisions in the case of ageing. One deep problem with ageing is that issues are incremental, We face something like a Sorites paradox – you are young today, and will still be young tomorrow, and the next day… then one day you are not! But how do you know which day it is that is the decider on being too old to go on? Many old people are frightened by what they don’t know – their life may be poor, but since one day is much like another they tend to feel more confident in a tomorrow like today rather than in any alternative – especially when (with death) you haven’t really got a clue what it is, if anything. Also, tenacity in the old can be very exclusive – they may not want their children’s or society’s care; they may have their own sense of their arc and may resent our intrusion. In Haneke’s film Amour (2012) one of the striking features is the way the couple’s daughter is excluded and the difficulty she has in comprehending and accepting that. All these aspects make the kind of humane and empowering decision-making that Raz talks about in cases of extreme and unremitting pain or of total dependence more difficult to apply in cases of diminished mental capacities, dementia, and depression associated with ageing. And while Raz’s scenario may make sense where relations are good, etc., we should not underestimate the difficulties in familial deliberation when there is a back history of increasing dependency, cantankerousness, and the beginning erasure of the carer’s sense of who the person really used to be. This is not to say people should not be given a right to euthanasia but that, while the case for a moral right is strong, it presumes a level of self-mastery and rationality that the very character of ageing may render doubtful (for many, if not for all). And in these situations, invoking a duty could not be the way forward.

VIII

There are many situations in which people suffer burdens whose weight is unjustly distributed, often compounded by structural features of our societies (in which women are still regarded as the default primary carers). Not all those burdens can be lifted, more equally shared or compensated for, in large part because they are intertwined with emotional connections and senses of duty and responsibility that are relatively deeply embedded in human psychology . But they can be recognised, their impact can be diminished, and people in those situations can often be empowered to some degree by greater awareness of how these situations may come to affect them over the longer term. But they may need help to get to this!

If society cares about people having roughly equal life chances, then it needs to reflect on the costs that some bear as a result of the care they provide for others – where the fact that those others are their relatives does not diminish the brute bad luck they experience in the impact their burden has on their capacity to fulfil their own ambitions and pursue their own opportunities – and to recognise that this is not merely a matter of private concern but raises issues of social justice, even if there cannot be compensation for all burdens.

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We also need to think collectively about the public culture we have and how we educate people’s expectations, help them to prepare for their future, and avoid their risk-taking imposing unfair burdens on their children, grandchildren or society more widely. This raises questions of how we educate people in relation to the responsibilities we think they have to prepare for their own ageing and death and to avoid imposing burdens on those around them.

The broader point we might make about justice is something as follows: We have a distributive conception – one that focuses on distributive shares, and is act based, rather than agent based, and is built on assumptions of fungibility and rectification . And yet the qualities we are concerned with in relation to ageing – to providing care, sharing burdens, recognising others’ contributions and costs even when we cannot share them, being sensitive to the distinctive needs and hardships of ageing, and so on – these are not solely distributive concerns. They are also questions of character, and of what it is to have a life with integrity over time – both as an ageing person and as a carer – and of the virtues of compassion, directed concern, and filial responsibility. 2 That is, they are age-old concerns about a life of the virtues, in a society where that life sits uneasily with modern instrumentalism and individualism. The result is that neither ancient nor modern justice can be fully achieved.

This means that we need better, more honest reflection about the character of our societies and what we collectively regard as acceptable and unacceptable. What I have tried to show is that considerations often pull in different ways, not least because we are dealing with embedded and constitutive attachments alongside more individualist expectations and aspirations. In this sense, our societies do not facilitate the integration of ageing and caring for the aged into a life of the virtues, and longevity makes the burdens of virtue long term, onerous and often harmful. But seeing this means that some fundamental rethinking needs to be done in relation to what kind of ageing society we think can meet our concerns for justice, while recognising that it will be a classically political solution – imperfect, negotiated, and reproducing (if also redrawing) a line between the public and the private.

2 Eg Slote, Social Philosophy and Policy 15(1) 1998.

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i A particularly striking example of this concern to identify a solution without regard to its distributive considerations is the following: In Health Care & Retirement Corporation of America v. Pittas (Pa. Super. Ct., No. 536 EDA 2011, May 7, 2012), the Pennsylvania Superior Court upheld a lower court decision which made the adult son of a woman who had received skilled nursing care and treatment at a Pennsylvania facility for a period of six months liable for the $93,000 bill. The court concluded that the state did not have the duty to consider the woman's other possible sources of payment, including a husband and two other adult children, or the fact that an application for Medicaid assistance was still pending. Instead, since the facility had adequately met its burden of proof that this particular son had the means to pay the $93,000 bill, the trial court was correct in holding the son responsible for paying it.