A Good Life for the Sick and Elderly

Recently as I was caring for an elderly relative, I started to wonder what a good life would look like for her…and other elderly Americans. The number of Americans aged 65 or older has increased steadily over the last century with declining fertility and mortality rates and is projected to rise rapidly in the future. In 1994, one in eight Americans were 65 or older and, by 2050, as many as one in five Americans could be elderly. Diseases that affect the elderly such as dementia or Alzheimer’s also are projected to rise. 

It may be convenient for those of us who are younger and healthier now to assume there is an inverse relationship between our happiness and our health. The healthier we are the happier we are; the less healthy we are the less happy we are. We may fatalistically assume with age and illness will come less happiness.

Of course, our outlook depends on our conception of the good life. Consistent with some normative theories, happiness consists of a life lived well and a proper balance of the things that comprise our lives such as health, knowledge, life projects (e.g., careers), and the arts and entertainment (i.e., our hobbies). Maybe it is reasonable to believe that we will be—and even that we ought to be—less happy as we have less of the things that currently comprise our happiness. We may even argue for some version of ageism or ableism.

Ageism: we ought to prefer those who are younger.

Ableism: we ought to prefer those who able-bodied.

The problem with ageism and ableism is that certain features of our lives such as age and health generally are amoral or morally arbitrary. If we are committed to the view that a person should only be responsible for features over which she has some significant measure of control, then adopting a theory of the good life based on features over which a person has little or no control is morally problematic. In such cases, you may have a theory of life—a way of looking at life, but not a theory of a good life. A good life is evaluative of how a person lived given her circumstances, not simply an evaluation of the circumstances. We generally do not have any significant measure of control over our age at any given moment or whether we are able-bodied (although one may intentionally bring about an illness or disability, but such cases I assume are uncommon).

Moreover, the view that happiness depends on youth and health does not seem morally preferable. Barring unfortunate circumstances, we’ll all grow old and die. As part of our universal human condition, it would be preferable to have a more holistic and healthier approach. A more holistic and healthier outlook of our aging selves and the elderly in our lives may involve (1) recognizing that the balance of things that comprise our lives changes over time and (2) focusing more on life in its entirety rather than at any given moment.

First, the things that comprise a good life may include our careers and our hobbies, but as we grow older our priorities and the balance of these things changes. Rather than focusing on our careers, we may have more time for the arts and entertainment.

Second, and because for those who are approaching the end of their lives or those who suffer with disease or disability for whom even the pursuit of the arts and entertainment may be difficult, it may not be enough simply to reorganize one’s priorities. What I want to suggest is that greater happiness awaits us in our old age (or, for those of us who believe in life after physical death, even after death).

This is consistent with Aristotle’s conception of happiness. Aristotle wrote: “For this cause also children cannot be happy, for they are not old enough to be capable of noble acts; when children are spoken of as happy, it is in compliment to their promise for the future. Happiness, as we said, requires both complete goodness and a complete lifetime.” (Nicomachean Ethics, bk. 1, ch. 9, see also bk. 1, ch. 7). It is only at the end of a person’s life that we can know whether a person has lived well and thereby achieved happiness.¹ Happiness is not a feeling at a given moment but a completed life that has been lived well.

An elderly person in a nursing home who has lived to the fullest and who has lived for others is happy. The person may appreciate and enjoy this fact by reminiscing about the past, but subjective mental states (memories or a feeling of pleasure) are not necessary for happiness.² Even if a person suffers severe intellectual or physical disabilities and can no longer add to her happiness by actively exercising virtue, it is still true of the person who has lived well that she is happy. The person may be happy despite the “reverses and vicissitudes” of fortune.

For persons with severe intellectual and physical disabilities, the balance mentioned in (1) may look very differently but may still allow for a life lived well. The holistic approach in (2) requires, as it does in everyone’s case, a consideration of the person’s circumstances and social context. A life lived well has less to do with accomplishing great things as measured in absolute terms and more to do with doing your best with what you’ve been given. Some people with disabilities—such as Helen Keller—have lived far better lives by choosing to live well and to live for others than many fully abled persons.

Please don’t get me wrong; I am not saying that happiness is unaffected by age or illness. I am saying that we need to have a healthier outlook toward our aging selves and those who are elderly among us. One way³ to do this is to see (and respect) the elderly for the complete life that they’ve lived rather than the sick or aging person before us at a given moment.  

Chong Un Choe-Smith

Philosophy Department

Sacramento State

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1. See Paul Farwell, “Aristotle and the Complete Life,” History of Philosophy Quarterly 12(3): 247-263 (1995).

2. Kurt Pritzl, “Aristotle and Happiness After Death: Nicomachean Ethics 1.10-11,” Classical Philology 78(2): 101-111 (1983).

3. Another way is to live by this Christian imperative: “love your aging neighbor, as you love your aging self.” Frits de Lange, “Loving Later Life: Aging and the Love Imperative” Journal of the Society of Christian Ethics 33(2): 169-184 (2013).

A Puzzle About Future People

We ought to do something about climate change. One reason for thinking this is that if we continue the way we’re going, we will make future generations much worse off, and so we owe it to them to e.g. enact policies that will dramatically reduce greenhouse gas emissions. But such policies would have all sorts of other effects. Factories would be moved, rebuilt, or shut down. People would find jobs as regulators, inspectors, and lobbyists that they wouldn’t have otherwise. People would drive different cars, get different degrees, and buy different products. And all of these things would affect decisions about when, where, and with whom to procreate.

This generates a puzzle (the Nonidentity Problem). To see why, let’s zoom in a bit. Suppose that, if we do not implement new emissions policies, Baby X will be born to a couple in Sacramento a year from now. However, if we do adopt new policies, the couple will instead move to Washington, D.C. for new jobs with the EPA. They’ll agree to wait a few years to settle into these new jobs before having children, and they will have a different child, Baby Y, in 2023.

If we do not adopt the new emissions policies, who will be made worse off? Baby Y will not be made worse off, since Baby Y will never exist. The couple will raise Baby X as an only child in Sacramento, and Baby Y will never be around to suffer whatever consequences result from continued emissions at current levels. Nor will Baby X be made worse off by not adopting emissions restrictions, since, if we did adopt them, Baby X would never exist. On the (perhaps optimistic) assumption that Baby X’s life will not be so bad as to be worse than never existing at all, Baby X will be no worse off under our current policies than under the new ones.

The point generalizes. There are the people, the Xs, who will exist if we do not clean up our act, and the people, the Ys, who will exist if we do. Given the fragility of the circumstances under which a particular person is conceived, they are mostly not the same people. So, whom do we make worse off if we refuse to change our current policies? Not the Xs, since they will only exist if we maintain the status quo. And not the Ys, since they will never exist to suffer the consequences of our refusal to change.

We ought to do something about climate change. Maybe we even owe it to future generations to do something. But not because they will be worse off if we don’t. So, why?

Brandon Carey

Philosophy Department

Sacramento State

Hans Rosling’s Magic Washing Machine

This is another of several short pieces meant to preview this year’s Fall Ethics Symposium

Take about 8 minutes and watch this Ted Talk from Hans Rosling, the public health and statistics guru who tragically died from pancreatic cancer in 2017:.

There are a number of important lessons to take from his presentation (and you can watch the longer version HERE). I’ll focus on just two:

First, world population will increase. Predictions are controversial. Rosling has argued that it will go to about 11 billion by 2100 and then level off. At the time “The Magic Washing Machine” was recorded in 2010, world population was a hair under 7 billion; it’s now about 7.7 billion.

Some of this growth will occur in the poorest areas of the world. But this is because conditions for people in the poorest areas of the world are improving (as you can see HERE). When fewer of the children they have tragically die, population in these areas will increase a bit. Also, some of the growth will occur because people will continue to live a little longer. But most of the growth is explained by the fact that there are more people now who are below age 30 than above, and they will have children.

Second, more people will mean more energy consumption -- especially when there are more people who will be wealthier and have better lives (ones that will include magic washing machines). 

These inevitabilities inevitably raise climate worries, which have led to some pretty hard-nosed proposals to curb energy production and use. Is there a way to implement these proposals in a way that will allow everyone eventually to enjoy the magic of washing machines?

Kyle Swan

Philosophy Department

Sacramento State