Respecting One's Elders: In Search of an Ontological

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Respecting One's Elders: In Search of an Ontological Explanation for the Asymmetry Between the Proper Treatment of Dependent Adults and Children Audrey L. Anton a

a

Western Kentucky University

To cite this article: Audrey L. Anton (2012): Respecting One's Elders: In Search of an Ontological Explanation for the Asymmetry Between the Proper Treatment of Dependent Adults and Children, Philosophical Papers, 41:3, 397-419 To link to this article: http://dx.doi.org/10.1080/05568641.2012.743215

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Philosophical Papers Vol. 41, No. 3 (November 2012): 397-419

Respecting One’s Elders: In Search of an Ontological Explanation for the Asymmetry Between the Proper Treatment of Dependent Adults and Children Downloaded by [Audrey Anton] at 19:08 11 November 2012

Audrey L. Anton

Abstract: The infantilization of older adults seems morally deplorable whereas very young children are appropriate recipients of such treatment. Children, we argue, are not mentally capable of acting autonomously and reasoning clearly. However, we have difficulty reconciling this justification with the fact that many of the elders whom we respect are mentally deficient in those very same ways. In this paper, I try to make sense of this asymmetry between our justifications for infantilizing the young and our conviction that our elders ought to be respected. I argue that our intuitions against adult infantilization are non-consequentialist (i.e., deontic). I consider several candidates for the deontic factor that might explain the asymmetry of our judgments and practices. I argue that a very specific kind of dignity (one that is socially constructed and reified) grounds our disparate judgments and treatments of very young and very old persons with similar needs.

1. Introduction That the infantilization of the elderly constitutes improper and reproachable behavior is an ethical judgment made and defended by average people every day and in all parts of the world. Indeed, it is commonly held that infantilizing treatment of elders, like other obvious cases such as theft and murder is clearly wrong.1 If asked to identify the wrong-making feature of elder infantilization, the average person is likely to reply that it is disrespectful. Concerning this much we seem to 1 I do not mean to suggest that the acknowledgement of the wrongness of infantilization means the practice of infantilization is not widespread. Most people consider lying, ceteris paribus, to be morally wrong, though many people lie and do so for trivial reasons. Infantilization of the elderly in particular has only been acknowledged as an issue in Western culture for less than a century. For an early account of the wrongness of infantilization, see Murphy 1931. ISSN 0556-8641 print/ISSN 1996-8523 online © 2012 The Editorial Board, Philosophical Papers DOI: 10.1080/05568641.2012.743215 http://www.tandfonline.com

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be in agreement. But if pressed further as to why elder infantilization is disrespectful, many of us find ourselves at a standstill. A variety of answers may be common, but with closer scrutiny we might find that only a small subset is actually justified. In this paper, I shall examine this asymmetry between justification for infantilization of the young and prohibition of infantilization of the old whose mental lives and capacities are on par with those of very young persons. I shall explore a plethora of options for the justification of our intuitions. After eliminating some options, I shall conclude with the suggestion that our intuitions are grounded in a deontic factor—one that involves accumulation of respect that is treated by us as irrevocable. 2. The Problem of Asymmetry To start, let us consider the nature of infantilization and the problem it poses for interacting with mentally incapacitated elders.2 I take infantilization to mean the treatment of a person as if that person were a very young child. Naturally, the connotation of this term and its typical colloquial use imply a subjunctive counterfactual; the person in question is not in fact a very young child. For our purposes, however, we should ignore this fact since I aim to compare the justified treatment of very young children with the unjustified infantilization of incapacitated elders. The only way to make a fair comparison is if the treatment in question is constant. Therefore, while infantilization traditionally carries a negative connotation and is thought to constitute poor and improper treatment, let us neutralize the term. For our purposes, infantilization will mean:

2 I take it that infantilization of older adults who are merely physically incapacitated is obviously morally wrong and that the wrong-making feature of such treatment is the same as that which makes similar treatment of physically disabled adults of any age morally distasteful (for a cultural and historical account of infantilization of both the elderly and the physically disabled, see Hockey and James 1993, esp. p. 10). The asymmetry between infantilization of very young children and adults who are physically dependent on their caregivers is easily explained by the rational agency that physically disabled adults possess. For this reason, I leave this issue aside. Heretofore, any reference to ‘incapacitated elders’ or ‘infirm elders’ is meant as shorthand for mentally incapacitated or ill elders.

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The treatment of one as if that person were a very young child (even in cases where the person receives such treatment because the person is, in fact, a very young child). Still, this definition is uninformative. It presupposes that we already grasp the appropriate treatment of very young children. Therefore, we must augment this definition with some pre-theoretical and uncontroversial descriptions of the proper treatment of very young children. Here are some aspects of appropriate treatment of very young children I take to be widely accepted: (a)

Very young children are to be coddled.

(b) Very young children are to be protected. (c)

We ought not to expect very young children to understand.

(d) We ought to make decisions on behalf of very young children. (e)

We ought to humor the imaginations and confusions of very young children.

(f)

We ought not to hold very young children responsible for their behavior.

(g) Yet, despite the above, we often justify punishing very young children when they misbehave. (h) When thwarting or frustrating the immediate desires or plans of a very young child is called for, we may be justified in scolding, preventing behavior without explanation, or otherwise addressing the child in an overtly authoritarian manner. Though this list is not exhaustive, I do think it is sufficient for motivating an adequately robust operating notion of normal appropriate treatment of very young children. Let us now hypothesize some justification for why this kind of treatment is warranted. Very young children are helpless. They have no way to defend themselves and they do not seem to comprehend what

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constitutes a dangerous situation (b, c, d). In turn, they might be frightened and become distraught by what is not a dangerous situation (a). There is no obvious way to communicate such distinctions to them, since they are not cognitively sophisticated enough to receive and process such information (c, d, f). Therefore, attempts to elucidate or explain the reasons for such treatment are futile. When a very young child is determined to proceed in a course of behavior that a competent adult assesses to be dangerous or otherwise inappropriate, it is often the case that very young children only respond to authoritarian commands (g, h). Even still, they may not respond, and the adult is justified in forcing the child to behave in such a way that is contrary to the child’s will (h). Finally, kindness and the interest in their happiness require that we entertain certain imaginative endeavors. If a very young child talks to herself or imaginary friends, makes up stories, or believes in things such as Santa Clause, such behavior is not merely tolerated; it is encouraged. The problem of asymmetry arises from the fact that those factors that justify our treatment of very young children are oftentimes present in mentally infirm elders whom we are not to treat similarly. It is not the case that all infantilizing treatment of the mentally ill elderly is prohibitive. For example, if an elder were so mentally incapacitated that she could not protect herself from the harm of say, wandering onto a busy highway, we would expect guardians or caregivers to prevent such tragedies. If the elder is so mentally incapacitated that she cannot understand why she ought not walk across the busy highway, we do not treat her as though she ought to understand such things. We accept it as a fact that she cannot. As a result, we often find it morally obligatory to make decisions on behalf of elders with dementia. Be that as it may, we do not endorse all types of infantilizing treatment. For instance, we do not endorse punishing the elderly. We deplore scolding of the elderly. When we make decisions on their behalves, we often defer to our knowledge of an elder’s previous desires and tendencies and perhaps even legal documents expressing desires for certain treatment should the individual lose her capacity to manage

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herself autonomously. So whenever it is possible to ‘consult’ their personal preferences as they were when the person was rational, we do so. Finally, and less obviously, I think we do not humor elders’ imaginations the way we find it appropriate to humor that of a small child. If an elderly person begins to speak of buried treasure in the back yard, we are not compelled to provide her with a shovel. There is something undignified about tolerating such behavior. It is not as though we ought to punish the elder. The strange thing is that we often find ourselves trying to reason with her (despite the fact that we know this to be ineffective). Still, there seems to be some obligation to try this tactic first. Another similar kind of case involves avoiding deceit. When I was in college I served as an ombudsman for several nursing homes in Massachusetts. On a few occasions I would visit with elders whose memory was so deficient that they would experience moments when they believed themselves to be at a different stage in their lives than they actually were. For instance, it was not uncommon for such individuals (at times, in their nineties) to request to see their mothers. It was obvious to me that the mother of the individual before me was no longer alive. Lying to such individuals by claiming that their mothers would be along shortly was out of the question. However, it was equally evident that not every individual could handle being reminded that her mother had passed.3 Instead of either of these responses, I would often ask them to tell me about their mothers. Usually, they would share a story or two and either forget that they had asked to see her, or, recall that she was no longer with us. It would be disrespectful to lie to such a person. But it would also be cruel and perhaps condescending to force her to see the truth. 3 Similar strategies have been endorsed by gerontologists for many years in the United States. For instance, the Wisconsin Department of Health and Family Services suggests that when visiting an elder with dementia, one ought to ‘enter their world with them. Be an actor in their “play.” Remember that whatever they are expressing is actually where they are in time. (Their past is their present, the present is their future, and the future doesn’t exist because they can’t store memory.)’ (‘Guidelines for Initiating’ p. 5).

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The fact that certain infantilizing practices are deemed inappropriate for mentally ill elders even though they exhibit similar characteristics that justify such treatment of small children creates this puzzle of asymmetry. Therefore, for the remainder of this inquiry we shall focus on the specific forms of infantilizing treatment that are prohibited; such as punishment, condescension, scolding, and excessive humoring and encouragement of false beliefs. Why is it the case that we are inconsistent in our practices and our assessment of the appropriate treatment of two cohorts who seem to have similar needs and impediments regarding such issues? 3. Solving the Problem of Asymmetry I think there can be a few possible explanations for this asymmetry: 1

There is something about very young children that we have neglected to list that makes them apt recipients for such treatment.

2

There is something about mentally infirm elders that precludes them from being apt recipients for such treatment, despite their similarities to very young children.

3

We are mistaken as to what constitutes appropriate treatment of one or the other group, and we ought to adjust our practices so that whichever treatment is appropriate for the one, it is also appropriate for the other.

I shall argue that the explanation lies in the second possibility. Before delving into an exploration of the precluding factor of infirm elders, let us briefly address why the first and the third options are unlikely candidates. Could it be the case that there is something about very young children qualifying them as apt candidates for infantilizing treatment? I can think of but one such property—the fact that they are undergoing development into independent persons and, paradoxically, infantilizing

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them contributes to their education and development into autonomous beings. Since they are developing, the way that our treatment of them affects their development must be taken into consideration. For example, we may punish or blame children even though we do not expect them to fully understand the wrongness of their behavior and we do not hold them responsible for it. One hypothesis might be that we continue to employ blaming practices since they are effective at helping the child gain understanding of the wrongness of such behavior and discourage it in the future. Such practices would be ineffective for mentally ill elders who are likely to forget the experience and who are in a steady decline of ability rather than a developmental stage. This hypothesis seems right to me. It seems that this defense can serve as a justification for why punishing and scolding very young children is permissible. However, I remain unconvinced that the fact that such treatment would be ineffective in mentally ill elders is sufficient reason to explain why we do not condone such treatment of the elderly. My reasons for remaining skeptical involve the fact that such infantilizing treatment could actually be quite effective and profitable in the short-term. It is true that such practices would have no long-term positive effects on elderly persons whose short-term memory is so poor that integration of such experiences into a learning process is impossible.4 However, it does seem as though such treatment in isolated situations where the effects can be measured immediately upon implementation of the treatment would have positive consequences; yet such treatment remains prohibited. For example, consider Sally, an elder with dementia who has diabetes and happens to be allergic to chocolate. When Sally reaches for a piece of German chocolate cake, scolding her or yelling ‘bad, Sally! Put that down!’ will probably have the effect of Sally’s putting the cake down. Surely, it will not be enough for Sally to be deterred from similar behavior in the future. Nonetheless,

4 For an interesting discussion of possible positive health outcomes for elders who maintain a subjective sense of control, see Rodin 1989.

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such treatment could be effective and perhaps more so than the socially accepted response of gently and respectfully intercepting the cake and trying to explain that it will make Sally sick. Such a tactic might not be as successful and will surely involve more struggle and frustration than the infantilizing alternative. However, most of us consider ourselves obligated to take the polite and respectful route over infantilizing an elder—despite its difficulties.5 So while it does seem to me to be the case that there is something fundamentally distinct about growing up versus ‘growing down’ (i.e., aging in a declining fashion), this cannot be the reason why infantilizing treatment is acceptable when aimed towards the very young but not the very old. It cannot be the reason because, despite the fact that mentally ill elders cannot benefit developmentally from such treatment, their wellbeing can improve immediately from such treatment. Alas, in practice, such a benefit does not seem to outweigh the cost of some mysterious yet fundamental value we have of respecting the elderly. This brings us to the third option: are our practices in error? Does the asymmetry signal that we have only gotten half of the picture right? On the one hand, we might resolve the tension by abolishing all infantilizing treatment. Perhaps we ought to take an extreme (perverse?) Rousseauian approach and treat all children, even very small ones, as though they were adults. The difficulty with this suggestion is obvious. Children are not adults and, if left to their own devices, children will either fail to learn and develop or they will develop bad habits and inaccurate perceptions and beliefs. Treating pre-rational children as if they were rational does not seem prudent.6 5 This compulsion to treat all elders with respect is seen cross-culturally. For evidence of this fact, see: Cohen 1995, Demos 1978, Hockey and James 1993, Snyder 1997, and Werner 1981. 6 I acknowledge that, paradoxically, many children learn to be adults by first being treated as though they were adults. In fact, such evidence reflects the Aristotelian view that, when it comes to objects of practical reason, the only way to learn how to φ is to φ (where the second φ is merely an imperfect attempt of what the first denotes). Cf. Nicomachean Ethics, book II (esp. 1103a 32).

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The alternative implication of the third possibility is that we might consider purposely infantilizing such adults and dismissing our instincts to show them a certain degree of respect. But what good would that do? As we have already seen, such treatment would have no educational benefit for elders who are incapable of making significant additions to their cognitive repertoire. So the only remaining possibility is to dismiss our urges to honor and respect our elders and go for the immediate protective benefit despite its negative effects. I think there are several reasons for rejecting this alternative. First, we are at least in part compelled to treat mentally infirm elders with respect because we recognize the difficulty and suffering a declining mental life already brings them. We do not want to add to mental anguish, and if we make a habit of reprimanding such persons, their final days will be lived out in both pain and confusion. We cannot help that dementia causes confusion and panic for the elder in question. However, we can avoid adding to the panic by refraining from scolding or punishing the confused adult on top of what is surely already an unpleasant experience for them. So while their physical wellbeing might be easily protected by reproachful treatment, their mental wellbeing can only decrease as a result. For this last reason, I think the third option is out of the question as well. The very consequentialist justifications for infantilizing treatment have a counterpart set of reasons against the same behavior. While some consequences that result are better, others are worse. At best, they cancel one another out and we have the option of having two frustrated individuals (the caretaker and the elder) or one frustrated individual (the caretaker) and one slightly confused but otherwise content person (the elder). The consequentialist calculation is clear; it just is not worth the trouble to fuss over what cannot be fixed. But this is only part of the story. It is not just that reprimanding inappropriate behavior will fail to help the elder develop mentally, and it is not just the fact that reprimanding the elder is extremely unpleasant (even if only temporarily) for the elder. Our intuitions suggest that the elder does not deserve such treatment. In fact, they deserve to be protected from it.

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Children, in a strange way, deserve infantilizing treatment. They deserve to be coddled and humored. They deserve to be educated. It might just be the case that the education in question comes with hard lessons. Even if there are not objective (i.e., not socially constructed) reasons for avoiding infantilization of the elderly, it hardly seems as though our practices are in error. A sense of owing respect to our elders is present in all cultures of all time periods. Socially speaking, respecting elders appears to be functional for society. Unlike children, mentally infirm adults have a past wrought with clarity and autonomy. Children only have clarity and autonomy to look forward to. Elders, on the other hand, can look forward to old age only if they have some reasonable expectation that their final days can be joyous and peaceful. If elders could only look forward to ridicule and punishment in old age, we might see a significant increase in suicide rates. So, even if our value of respecting elders in a way that children are not to enjoy is a socially constructed one, that is no reason to suggest that we deconstruct it. So we are left with the second option—that there is something about mentally incapacitated elders that morally prohibits certain types and/or degrees of infantilizing treatment despite the fact that they have certain properties that typically warrant infantilization of young children. The second half of this paper is a philosophical search for this mysterious ‘something.’ 4. Possible Candidates: Types of Factors Now let us consider the kinds of moral factors that could warrant a prohibition on certain infantilizing treatment of the elderly and do not apply to small children. We have considered consequentialist moral factors such as protection from harm (in both cases) and practical education (in the case of young children). These explanations leave much to be desired. Perhaps the solution lies in some deontic feature that is not common to both cohorts. Deontic moral factors are moral concerns or considerations that we are not willing to adjust or relinquish even when we learn that honoring

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such factors might yield sub-optimal consequences. For example, were we to recognize a young child’s right to know the truth at all stages of life, we might advocate the dispelling of all myths (such as the popular stories of Santa Clause) regardless of the effects on the personalities or happiness of the disillusioned children. Deontic factors differ significantly from the consequentialist ones we have been considering. For instance, if dispelling young children of the myth of Santa Clause by the age of 4 would have the consequence of making most children curmudgeonly pessimistic and depressed persons, consequentially speaking, it ought not to be done. However, if such a practice were to have the opposite effect, our evaluation of the desirability of such a practice would change; we might want to initiate such practices. It seems to me that we are already in a position to dismiss the possibility of a consequentialist factor. In no way do I deny that there are consequentialist factors involved in the infantilization of the elderly. Indeed, the only explanation I can come up with for why we sometimes feel that it is appropriate to treat mentally infirm elders with infantilizing tactics is that so doing would produce desirable effects. We make decisions on behalf of these elders because we fear the consequences of their making their own decisions; we stop them from harmful and dangerous behaviors in order to protect them, and we place them in facilities or with caregivers based on what we take to be in their best interest. There is no doubt that there are consequentialist reasons involved in the justification of these treatments. However, what prevents us from certain infantilizing tactics is not consequentialist since, more often than not, honoring the code of respect for elders runs a higher risk of bad consequences to the elder and others. If elders are entitled to respectful treatment even in those cases where consequences resulting from such treatment are worse than the consequences that would ensue from infantilizing treatment, this entitlement despite the risks suggests a constraint on certain treatment. That is, certain treatment is either prohibited outright, or morality requires that a substantial threshold be met in order to justify behaving differently.

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5. Rights One possibility is that elders have rights to certain treatment, regardless of their capacities. Robert Goodin and Diane Gibson (1997) explore the possibility of elders having rights to certain treatment and benefits. Goodin and Gibson argue, convincingly I think, that rights terminology is irrelevant to issues concerning elders specifically, and alleged issues concerning rights ought to be cashed out in language more specific to the type of issue at hand. They argue that once one considers the types of rights theories in philosophy, none adequately suits the mentally ill elder. Goodin and Gibson claim that all rights theories can be divided into two main genera: choice theory doctrines and interest theory doctrines. According to choice theory, one has a right if and only if one has a legally respected choice. As Goodin and Gibson put it, ‘Rightsholders can either stand on their rights, demanding the treatment that is by rights due to them, or else they may waive that rightful treatment’ (1997, p. 186). Incapacitated elders do not have a right to respect in this sense; for they typically cannot demand that their rights be honored nor can they waive a right that they have. Furthermore, if a mentally incapacitated elder were capable of articulating his ‘right’ to say, wear a suit made entirely of peanut butter and wander the streets asking passersby if they have any chocolate syrup to ‘dress up’ his ensemble, no court would recognize this claim as a right. Instead, the court would recognize this odd and irrational desire as a mark of incompetence. Therefore, on choice theory, rights are those claims one can express demand for, waive, and be taken seriously as a coherent and rational claim by the general public. It is clear why Goodin and Gibson do not find this version of rights to be compatible with our respect for elders. Yet Goodin and Gibson are equally unsatisfied with interest theory. Interest theory holds that rights protect the interests of individuals by prohibiting the interference of others. It does not matter if the person asserts her interests and the right to them. It does not even matter if she can conceptualize her interests mentally in these terms. As Goodin and Gibson say, ‘what it is to be a right-holder, on this theory, is merely to be

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a direct-intended beneficiary of someone else’s duty-bound performance’ (1997, p. 188). So far, this theory of rights seems to accommodate the mentally ill elderly. However, claim Goodin and Gibson, a closer look at interests proves this assumption to be incorrect: ‘To say that something is in a person’s interest is to say that it is good for that person, in the sense that it will (or likely will) further that person’s purposes and projects’ (1997, p.189).7 But do elders with dementia have purposes and projects? If they do, are they purposes or projects that we should allow? Or are they harmful in some way or another? Goodin and Gibson discard this theory for these reasons as well as the practical challenge of discerning mentally ill elders’ projects. If Goodin and Gibson are correct, and all rights theories fall into one of these two camps, then the category of rights is not broad enough to accommodate why elders who are non-autonomous and disinterested still deserve a minimal amount of respect. Finally, that elders have rights to not be infantilized in certain ways does not seem to be the deontic factor we seek; for if the issue were a matter of rights, it is unclear why these rights are reserved by the elderly and not other age cohorts. For instance, why is it not the case that we treat very young children with the respect with which we treat elders? Why is it that they do not have these rights? What kind of rights appear at a certain point in the average person’s life course, but were nonexistent prior to that point? While philosophers frequently acknowledge special rights, or entitlements that one acquires through social interactions, such as promises and contracts, special rights do not fully explain the

7 For an alternative account, see Jaworska 1999. Jaworska argues that we ought to honor the wishes of the present self of a patient with dementia if and only if the agent values something, where value is a precise technical term that encompasses the following features of a person: ‘the person thinks she is correct in wanting what she wants; achieving what she wants is tied up with her sense of self-worth; and the importance of achieving what she wants is, for her, independent of her own experience’ (1999 p. 116). Jaworska argues that valuing does not require ‘a grasp of the narrative of one’s whole life’ (ibid.) and I agree with her. Still, I believe an elder with dementia deserves respectful treatment even if it can be shown that she does not value anything in Jaworska’s sense of the term.

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asymmetry at hand. First, any social contract between younger and older generations would have to be made universally and implicitly (a tenuous idea). Second, the problem addressed by Goodin and Gibson concerning the right-holder’s ability to make claims against rights violations remains. Finally, special rights are rights that can be forfeited and revoked either voluntarily or as a result of behaving in such a way deemed to be contract-defeating. For instance, one might voluntarily waive one’s right to remain silent when arrested, and that same person might have forfeited her right to vote in an election by committing a violent felony (a deal-breaker for the U.S. government). Mentally infirm adults cannot voluntarily waive a right and any contract-defeating behavior is likely to be caused by the person’s mental disorder, which will render such behavior beyond reproach. While I do not think that the factor we seek is a special right, I do think that the deontic factor will be sufficiently specific such that it includes all elders while excluding very young children; it cannot be a natural right. In addition, insofar as the deontic factor resembles special rights, we must be careful to explain why the entitlement to respectful treatment is not forfeited or revoked the way that so many other special rights are. 6. Obligation The deontic factor for which we search ought to be one such that it is clear why that factor applies to our relationship to elders and not a relationship to small children. One such possibility is that we feel this obligation towards the elderly for the same reason we often feel obligated towards anyone—we feel that we owe something to them. It is likely that each of us does feel such a sense of obligation to particular individuals such as those who raised us (i.e., parents, grandparents, etc.). After all, if it had not been for them, we would not have had the opportunities that we did, we would not have become the people we are today, and in the case of biological parents, we would not exist. Even if we feel as though reciprocation is warranted, reciprocation cannot be demanded. It would seem to be up to the beneficiary how to

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react to such gifts. For instance, in the popular film, Analyze This (1999), Robert De Nero’s character (Paul Vitti, a mafia boss) gives an ostentatious fountain to Billy Crystal’s character (Dr. Sobel, his therapist). For Vitti, this gift solidifies their relationship and he expects to be able to call on Sobel whenever he wants. Sobel, however, does not see it this way. This exchange is comical in the film because Vitti believes he can make Sobel indebted to him by giving him a gift he never wanted and did not consent to receiving. Likewise, it cannot be the case that we owe a debt to elders simply because they helped us to exist. First, it is nonsensical to say that one owes another for an unsolicited benefit. Unsolicited benefits are gifts if given kindly, and bribes if tied to ulterior motives. Neither of these possibilities comes with strings attached (even if the latter does come with consequences). In Analyze This, Dr. Sobel appears willing (or perhaps eager) to return the gift. Perhaps our reluctance to give up our unsolicited gifts explains something? For instance, the average American celebrates holidays such as the 4th of July and Memorial Day to honor and express gratitude towards those who suffered hardships and may have even lost their lives so that we could live and enjoy many liberties. In such cases, the young have benefited from the old and have contributed little or nothing to the benefits that they now reap. While the young may not have asked for such benefits, few (if any) would happily give them back. Therefore, the suggestion under consideration is the following: perhaps we implicitly consent to owing our elders by accepting their gifts. Alas, this view fails as well; for it is asking too much that disgruntled adults forfeit these gifts (including their own lives) in protest. What good would that do? Even if the older generation were to apologize, there would be no one left to apologize to. Just as a hostage hardly consents at gunpoint to acting as a human shield for a criminal, future generations cannot consent to any treatment by previous generations before they even existed. The stakes of protest are too high for us to consider a lack of protest indicative of implicit consent. Even if, for the sake of argument, we suppose that it is possible to

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incur moral debt against one’s will and even prior to one’s existence, this explanation comes with its own difficulties. First, if one owes anyone anything for being treated a certain way, it matters as to how that person was treated. Not all youths are treated well by elders. Yet, I can attest from personal experience, one feels compelled to speak kindly to the aged even if the aged person is not returning such kindness. In such instances, the grounding of the obligation seems utterly mysterious since the particular elder in question is behaving in ways we normally consider defeating of respect. Finally, even if we consider gifts that an entire generation bestows upon the next, we are again in trouble. For each generation gives both good and bad consequences to the next (in greater and lesser degrees). For instance, while my generation might be grateful for prior generations’ struggles for the protection of civil rights, my generation might resent the condition in which previous generations left the environment. In fact, if we pile on the resentment that insufficient social security returns are sure to spawn, we might see people resenting more than respecting their elders. But, do we expect the younger adults to launch a full-fledged movement of infantilization? I suspect we would not. Would such a movement be justified? Our intuitions suggest that no adult deserves to be ridiculed in the ways that infantilizing treatment seems to do. Therefore, it is likely that elders will remain an esteemed portion of any population. They have been viewed as such throughout history, and history has had its ups and downs. It seems as though gratitude is quite specific and is appropriate for particular people and to a specific degree. For instance, while it is surely permissible for me to feel gratitude towards an entire generation of people, it can hardly be morally required of me that I do. However, some relationships with elders do incur special moral obligations. As Jane English (1991) argues in her article ‘What Do Grown Children Owe Their Parents?’ these types of obligations are specific and substantial because they stem from some relationship of friendship between adult and elder. This sort of obligation is not a debt, but an obligation of care and friendship. It cannot possibly be the case that we have such

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relationships with every elder. Yet, we hold ourselves responsible for treating each and every elder in ways that avoid the unsavory aspects of infantilizing treatment. 7. Dignity This brings us to our final factor. After much thought, I have arrived at the conclusion that dignity is that which compels us to refrain from authoritarian and patronizing treatment of elders. However obvious this might sound, not all forms of dignity apply here. In this section, let us isolate the specific kind of dignity ascribed to all adult persons. In the philosophic tradition, dignity constitutes that property that makes rational agents superior to inanimate objects (and, on some accounts, animals). Immanuel Kant famously distinguished dignity from value.8 Value is fungible whereas dignity is never a commodity. We may trade apples for oranges but we ought not to sell persons. In this sense, we all have dignity. None of us should be treated merely as a means. Since this goes for children, this type of dignity is not what explains the asymmetry we are considering. This type of dignity applies to all human beings. There is a second notion of dignity that I think is a socially recognized property of persons that is accumulated over time. However, unlike other aspects of growth that depend upon their cause for subsistence, I contend that this dignity does not depreciate. It does not depreciate because, once recognized by society, dignity enjoys an independent ontological existence. The only way for us to legitimately abstain from treating adults with this dignity is if the adult does something warranting the forfeiture of the dignity (which is an aspect that this notion of dignity shares in common with special rights). But the fact that a mentally incapacitated adult cannot behave in a way warranting such forfeiture (since her illness precludes her from

8 See especially Kant 1998, pp. 42-43. Cf. Wayrytko 1982 for a comparison with Confucius’ views.

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responsible action) does not alter her desert of respectful treatment. There are many ways in which one might acquire dignity in this sense (hereafter called adult dignity). First are the ways that each normal person becomes competent. There is dignity in learning, developing skills, living autonomously and responsibly, and thinking for oneself. These are just examples of the basic requirements for being a dignified human being, and I suppose that the vast majority of humans achieve this much dignity in later childhood. Accomplishments such as learning to walk, talk, tie one’s shoes, ride a bike, read, and make choices about how to spend one’s time are shared by most adults by an early age. Such developmental achievements and ‘rights of passage’ signify a person’s ownership of herself. They distinguish the person from others even when that person’s life is still interwoven with those of others and even when, in many ways, she remains dependent on others. The point is that these very basic skills are not shared with very young children. Very young children have very little resources to be autonomous even if we were to let them try. Still, one might argue, it seems as though these autonomous factors disappear when an elder suffers from dementia. Many severely impaired elders cannot walk, talk, tie shoes, feed themselves, read, etc. It is likely for these reasons that they are compared to very young children in the first place. Why do we insist that they are superior to very young children and deserving of respect that very young children are justifiably denied? The answer to this question is this: adult dignity, as a socially constructed entity, is not dependent on its causal warrant to exist. That is, there are many facts about a person that warrant dignity. Once a person possesses such traits and abilities, we recognize the person as dignified. But as soon as we do this, we divorce the property of dignity from its cause. Like social ontologists such as John Searle have argued, once such an object is recognized by a society, it enjoys a status of existence that is not dependent on why or how it became recognized as

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such.9 For example, if George deposits $100 into his checking account, and later transfers it to pay off the balance of a credit card, it is not the case that a bank employee must go into the vault, retrieve a bundle of cash marked ‘George’s,’ and mail it to the credit card company’s main office in Nebraska. On the contrary, a few digits are changed on the screens of two computer websites and George has ‘transferred’ the funds. George acknowledges that the money is no longer in his account, and so does the bank. The credit card company acknowledges the payment and changes the status of the account accordingly. This network of trust and common implicit agreement to act as though something physical has moved reifies that something. We can easily envision such practices with commodities. Why not with dignity? A similar common practice is the honoring of a deceased person’s last wishes. Even Anne the atheist can sensibly honor the final wishes of Deb, her deceased friend, whom Anne no longer believes exists. Anne might even say something like ‘I owe her this much.’ How can one owe a nonbeing? To put it bluntly, thinking makes it so. However, the thinking at issue here is not a matter of willful imagination or even involuntary delusions. The thinking that is going on is a kind of recognizing. If a team votes for a captain and all recognize the winner of the vote as the captain, that person is the captain. Similarly, we recognize elders as deserving of respect. We may ground that respect in how they once were, but what is most important is that we recognize this status as irrevocable. For instance, an Olympic gold medalist is always an Olympic gold medalist. Once awarded an Olympic gold medal, a person is a medalist for the rest of her days—even if she can no longer physically perform the tasks that she once did with superior skill. Similarly, a person who has reached a stage of rational development and autonomy is always one deserving of respect, even if she is no longer rational or autonomous. One might object that we must respect incapacitated elders for precisely the same reasons why Anne owes Deb that much. The objection 9 Searle 1995. See especially chapter two, ‘Creating Institutional Facts.’

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would be that the respect is owed to a different version of the person before us, and therefore the current person (qua time-slice) does not warrant respect. But this objection rests on a misunderstanding of the social construction of the institution of owing all adults respect. Anne is not mistaken when she believes that she owes it to Deb to carry out Deb’s final wishes (she had a special obligation stemming from their friendship). Anne is also not mistaken in thinking that the person that she owes is the most recent version of Deb (even an imaginary one!). Anne belongs to a society where honoring ‘the memory’ of a person is taken quite seriously and viewed as a legitimate activity. So, we do not owe mentally incapacitated adults adult respect because we owe it to their younger selves. We may be morally required to treat them with respect in virtue of their younger selves. But the recipient of our obligation is the person present before us. The incapacitated elder is not a means to fulfilling an obligation to someone else; she is the person deserving of our present respectful treatment. If I am right and if regarding one another as dignified is not easily a reversible state, then adult dignity can explain why mentally incapacitated elders are entitled to a certain minimally dignified treatment, regardless of their present capacities or similarities to dependent children. It is for this reason that we often say that, ‘no one can take away your dignity.’ Once had, it cannot be lost. 8. Dignity and the Dignified It should be noted that the sense of dignity at hand is distinct also from a third sense of the term. When we consider a person to be dignified, we are thinking of personal and specific accomplishments and ways of conducting oneself that warrant even greater respect beyond the basic respect all humans deserve (even infants) and the basic respect that all adults deserve (the sense discussed throughout this paper). For example, one might say that Colin Powell is a dignified human being. He has won many honors, has much military experience, and he exhibited great honesty and character in publicly admitting his regret concerning his

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endorsement of the U.S. search for weapons of mass destruction in Iraq. He is a role model. It seems safe to say that his actions warrant respect above and beyond that of an average person. On the other hand, a person might conduct herself in a way that betrays human dignity, such as indulging in serious drug abuse. While it makes sense to conceptually rank persons based on the degree of respect they deserve in this sense, we must be careful to separate this sense from the one at hand. Few persons are dignified in this third sense. For this reason we admire them so much; these individuals are respectable because of how much better they have lived than the average person. The sense of dignity that we have been examining, adult dignity, is more egalitarian. It is a matter of the dignity acquired by most persons when they were capable, rational, adult human beings. This accomplishment is dignifying; that is, the accomplishment grounds the ongoing recognition of the fact that this person is a respectable human being. Perhaps there is nothing dignifying about old age. Perhaps being in a state of incontinence, forgetfulness, and confusion is, by itself, undignified. However, it is not sufficient for destroying dignity and respect that was previously earned by an individual. It might be thought that having gotten to old age is an accomplishment; and it seems as though it is one that could not have possibly been achieved without minimal achievements that do warrant dignity. Therefore, it is likely that each and every mentally ill elder has accumulated significant dignity prohibiting the crudest of infantilizing treatments. It would not take much accomplishment at all to be entitled to such respect. Simply living autonomously would do the trick. So while we do not consider dependent, confused, elders deserving of respect because they are dependent and confused, we still regard them as deserving of respect. If there is any validity to this practice, it must lie in cases that warrant the practice prior to the elder’s present state. Indeed, I think that the practice is justified and ought to be continued. It is a very important factor in motivation, development, trust, and the proper functioning of communities that we can all expect

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to enjoy respectful treatment from each other, come what may. So, in closing, I conclude that the age-old practice of respecting one’s elders is both prudent and justified. Western Kentucky University [email protected]

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References Cohen, Lawrence. (1995). Toward an Anthropology of Senility: Anger, Weakness, and Alzheimer’s in Banaras, India. Medical Anthropology Quarterly, New Series, 9 (3), 314-334. Deimling, Gary T; Virginia L. Smerglia. (1992). Involvement of Elders in Care-Related Decisions: A Black/White Comparison. Family Relations, 41(1), 86-90. Demos, John. (1978). Old Age in Early New England. The American Journal of Sociology, 84. Supplement: Turning Points: Historical and Sociological Essays on the Family, S248-S287. English, Jane. (1991). What Do Grown Children Owe Their Parents? in Aging and Ethics: Contemporary Issues in Biomedicine, Ethics, and Society, Nancy S. Jecker, ed. Humana Press: 147-154. Goodin, Robert E.; Diane Gibson. (1997). Rights, Young and Old. Oxford Journal of Legal Studies, 17(2) 185-203. Guidelines for Initiating Meaningful, Quality Home Visits With People Who Have Alzheimer’s Disease and Related Dementia. Wisconsin Department of Health and Family Services, Division of Disability and Elder Services, Bureau of Aging and Long Term Care Resources. (2002). Accessed on June 30, 2012. http://www.dhs.wisconsin.gov/aging/dementia/visits.pdf Herskovits, Elizabeth. (1995). Struggling over Subjectivity: Debates about the ‘Self’ and Alzheimer’s Disease. Medical Anthropology Quarterly, New Series, 9 (2) 146-164. Hockey, Jenny; Allison James. (1993). Infantilization as Social Discourse. In Growing Up and Growing Old: Aging and Dependency in the Life Course. London: Sage Publication, 9-44.

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Jaworska, Agnieszka. (1999). Respecting the Margins of Agency: Alzheimer’s Patients and the Capacity to Value. Philosophy and Public Affairs, 28(2), 105-138. Kant, Immanuel. (1998). Groundwork of the Metaphysics of Morals. Translated and edited by Mary Gregor. NY: Cambridge. Murphy, J. Prentice. (1931). Dependency in Old Age. Annals of the American Academy of Political and Social Science, 154, 38-41. Ramis, Harold (Director). (1999). Analyze This. [DVD]. Warner Bros. Rodin, Judith. (1989). Sense of Control: Potentials for Intervention, Annals of the American Academy of Political and Social Science, 503(1), 2942. Searle, John. (1995). The Construction of Social Reality. New York: The Free Press. Snyder, Katherine A. (1997). Elders’ Authority and Women’s Protest: The Masay Ritual and Social Change Among the Iraqw of Tanzania. The Journal of the Royal Anthropological Institute, 3(3), 561 -576. Wayrytko, Sandra A. (1982). Confucius and Kant: The Ethics of Respect. Philosophy East and West, 32(3), 237-257. Werner, Dennis. (1981). Gerontocracy among the Mekranoti of Central Brazil. Anthropological Quarterly, 54(1), 15-27.