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JUSTICE, REALISM, AND FAMILY CARE FOR THE AGED

Published online by Cambridge University Press:  07 December 2016

Mark Philp*
Affiliation:
History and Politics, University of Warwick

Abstract:

Starting with a particular case of familial care for the aging, the discussion points to the difficulties in deriving practical judgments from ideal theory in cases where there seems to be injustice, but where there are multiple competing dimensions of value and cost. The essay argues that the problems discussed are deeply embedded in modern western cultures, where life expectancy has risen dramatically and has been coupled with a range of other social and demographic changes that make familial care for the aged difficult and burdensome, and where our thinking about justice and rights are integral to the conflicted ways in which people construct and experience these situations, rather than standing independently as a solution to them. The essay argues for a set of partial, limited, and “realist” responses that reduce some elements of burden, without pretending to provide a solution that is in any sense ideal or wholly just. The argument from a case is integral to the essay’s case for realism in moral and political philosophy.

Type
Research Article
Copyright
Copyright © Social Philosophy and Policy Foundation 2016 

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References

1 Mui, Ada C., “Caring for Frail Elderly Parents: A Comparison of Adult Sons and Daughters,” The Gerontologist 35, no. 1 (1995): 8693.CrossRefGoogle Scholar See also Jill Suitor, J. and Pillemer, Karl, “Support and Interpersonal Stress in Social Networks of Married Daughters Caring for Parents with Dementia,” Journal of Gerontology 48, no. 1 (1993): S1S8;CrossRefGoogle Scholar and Dura, Jason R., Stukenberg, Karl W., and Hiecolt-Glaser, Janice K, “Anxiety and Depression Disorders in Adult Children Caring for Demented Parents,” Psychology and Aging 6, no. 3 (1991): 467–73.CrossRefGoogle Scholar

2 Now the basis for an extensive literature, but see especially: Benbaji, Y., “Sufficiency or Priority?” European Journal of Philosophy 14 (2006): 327–48;CrossRefGoogle Scholar Huseby, R., “Sufficiency: Restated and Defended,” The Journal of Political Philosophy 18 (2010): 178–97;CrossRefGoogle Scholar and Casal, P., “Why Sufficiency is Not Enough,” Ethics 117 (2007): 296326.CrossRefGoogle Scholar

3 This essay starts from recent debates on realism in political theory, but develops the argument in a rather different setting. More direct critiques of ideal approaches can be found in my (and others’) contribution(s) to I. Robeyns and Adam Swift, special edition of Social Theory and Practice on “Social Justice: Ideal Theory, Nonideal Circumstances” 34, no. 3 (2008) and my “Realism without Illusions,” Political Theory 40 (2012): 629–49. (See also Ismael, in this collection). My target in the current essay is not ideal theory’s assumption of compliance but, rather, the problem of whether it can be action-guiding in contexts where there are multiple, competing values in play. But the essay also suggests that whereas “idealization” strips out the details of a situation in the interests of abstract, general principles, doing so fails to take our rootedness in such detail sufficiently seriously — where that rootedness may mean that there is no single “ideal” resolution. The commitment to “realism” lies in attention to historical context, path dependency, the preservation of psychological complexity, and the identification of action-guiding proposals within those constraints.

4 See Sen, Amartya, “What Do We Want from a Theory of Justice,” Journal of Philosophy 103 (2006), 215–38.CrossRefGoogle Scholar In the case of aging, multidimensionality might include values of security, welfare, liberty, autonomy, community, and so on. See also David Schmidtz, “Ideal Theory: What It Is and What It Needs To Be,” Ethics 121 (2011): 772–96.

5 Whether multiple conflicting values can deliver systematic grounds for trade-offs, prioritisation, cost delimitation thresholds, etc., remains controversial. Sen suggests not. As does Scanlon, T., What We Owe to Each Other (Cambridge, MA: Harvard University Press, 1998), 125.Google Scholar But see one suggestion from Sarch, A. F., “Multi-Component Theories of Well-Being and Their Structure,” Pacific Philosophical Quarterly 93 (2012): 439–71.CrossRefGoogle Scholar

6 “Traditional” appears in inverted commas, because there is inevitably some simplification, anachronism and over-generalization in such a claim.

7 I cannot engage with the now extensive literature on “care” in political theory, but my view is that this is unhelpful (a) where there are conflicting dimensions of value relating to care that need to be resolved; or (b) on how to resolve the genuine and deep conflicts between our expectations of ourselves in terms of achievement and individualism and the depth of our human relationships.

8 The matrix does not take into account differences in capacities to appreciate the needs of others, or to act on behalf of others, or to organize care and foresee and manage difficulties. There are differential abilities to meet challenges, as well as differential psychological disposition to accept challenges, which affect issues of responsibility and appraisal that I cannot explore here. Some of these components are randomly distributed or serendipitous; some are more historically and socially determined.

9 Atul Gawande’s Being Mortal: Illness, Medicine, and What Matters in the End (London: Profile Books, 2014) points to a range of experiments in the United States that seek to improve end of life care for the elderly, but with no sense that these are widely implemented or wholly successful. The wider structural problem is that achieving both high quality independent living facilities and being able to keep services local are in tension in a world in which families are highly mobile.

10 Anderson, Elizabeth, “What is the Point of Equality?” Ethics 109 (1999): 287337.CrossRefGoogle Scholar

11 Montaigne, “Of Diversion” The Complete Works, ed. D. Frame (Everyman, 2003), III. iv p. 772.

12 If we plot different sibling’s experiences of their parents and their dispositions using the matrix for response space sketched above in Section II, and factor in the impact that differential experience, divergent responses, and the distinct motives and expectations of each sibling, and if we add in the impact each sibling’s experiences and patterns of behavior had on the other siblings (where A may experience B in a way that C does not, and so forth), it is not difficult to see that relationships easily become strained.

13 I refer here to the language of Rawls’s Political Liberalism (New York: Columbia University Press, 1993), but without any expectation that, in these conditions, an overlapping consensus is a plausible objective.

14 See for example, Joseph Raz, “Death in Our Life,” Journal of Applied Philosophy 30, no. 1 (2013), which deals more with the terminal illness than with what I see as the different dynamic associated with the changing psychologies of the aged.

15 Williams, Bernard, In the Beginning Was the Deed (Princeton, NJ: Princeton University Press, 2005).Google Scholar Some brute bad luck — such as being the victim of lightning — does not strike us as unjust. But Mary’s situation may have components of sibling failure, maternal choice, and so on, that leave her facing brute luck that others benefit from, even if they cannot then compensate her for that. That looks like the type of brute luck that cannot be resolved and yet involves injustice.