Sunday, November 24, 2019

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

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).


  1. Thanks, Chong. Is this just a semantic dispute about "happiness"? One reason to think so is that I can love my aging neighbor (and my aging self), and can acknowledge and respect the full life they've lived without (always) agreeing that age-stricken people are (currently) scoring very high on the happiness scale.

    I guess you can use words however you want, but it could be confusing if you use terms in a non-standard way. I could see someone saying that we already have perfectly good terms to signal reasons for the kind of respect old people are due. Why should we have to say misleading things about their current experiences?

  2. Chong Choe-Smith:

    There are many ways to ground a duty of respect for the elderly, but that’s not all that I’m after here.

    Just a semantic dispute? Yes and no. It may begin with a dispute over meanings, but it affects how we think of our aging selves and the elderly around us.

    Why assume a standard account of happiness that is consistent with:

    1. My elderly relative with Alzheimer’s is not happy.

    2. When I’m old and less capable in body or mind, I’ll be less happy.

    Happiness, under the standard account, is equated with how one feels at the moment, but the common conception of happiness is too shallow.

    A person may be virtuous and have everything going for her and yet at times feel low—this person may feel unhappy. But, despite her present feelings, she has every reason to be happy.

    An elderly person may have lived well and lived for others but presently suffers from Alzheimer’s. She may feel unhappy, but if you look at her life in its entirety, she has every reason to be happy.

    When we think of happiness we should consider a life in its entirety—both in the things that comprise a person’s life under the circumstances (let’s call this “content holism”) and all the moments of a person’s life (“temporal holism”).
    The reason why this is more than a semantic dispute is that it is not only a differently way of defining happiness, it is a different way of looking at the world (and shaping the world).

    In the world that I have in mind, it would be absurd to call a person who has lived well throughout her life that, simply because she has a disease common to the elderly at the end of her life, that she is unhappy now. A person who has achieved happiness may be sick or feel low from time to time, but these things cannot take away her happiness (=no difference on the happiness scale).

    This may be non-standard, but it doesn’t seem any more misleading than to call a person who has lived well her entire life unhappy simply because in a fleeting moment she felt low.