Elizabeth Brake is an Associate Professor of Philosophy at Arizona State University. She was educated at The Universities of Oxford (B.A.) and St. Andrews (M. Litt., PhD) and previously taught at the University of Calgary, Canada. Her work is primarily in feminist ethics and political philosophy. Her book, Minimizing Marriage (Oxford University Press, 2012), won an Honorable Mention for the 2014 APA Book Prize. She has also written on parental rights and obligations, liberal theory, Kant and Hegel, and is currently working on a project on disaster ethics. She has held a Murphy Institute Fellowship at Tulane and a Canadian SSHRC Grant.
Just Care: What Society Owes the Elderly
“It’s been nice talking to you. Maybe you could come sit with me another day and I’ll tell you more about my life. What was your name again?”
In the last year and a half I’ve heard numerous variations of this request. There have been appeals for a trip to the mall, for rides to church, for my phone number, and, memorably, a suggestion that I buy the vacant condo next door (a real deal, apparently) so that we could see each other all the time. The idea that I’d make a great neighbor was a big leap of faith, given that it came from someone I’d seen once a week, for five minutes at a time, over the past year.
I got involved in meals on wheels by happenstance. I had become interested in issues of food justice – particularly, food insecurity spurred by increasing socio-economic inequality, and the resulting effects on the life chances of children without adequate nutrition. Convinced that the most immediately effective way to address food insecurity was on the local level, I contacted my local community action center to find out how to volunteer. Several emails and phone calls later, a jaded voice informed me that they didn’t really need help at the food bank, nor the community garden, but they did need drivers for meals on wheels (that is, the local municipal program for delivering hot meals to elderly people and others unable to leave their homes).
There was a pause. Given their difficulty in finding volunteers, I had the sense that the program supervisor had been turned down at this stage many times before. Delivering meals to the elderly certainly wasn’t the image I had had of addressing food insecurity; for one thing, I had imagined collecting and distributing large quantities of food, not bringing a tray to 12-20 people a week, and I had somehow imagined working with children or families, where the extra nutrition might make a real difference to educational outcomes and life chances. I simply hadn’t thought of working with older people. But the supervisor sounded desperate, and I felt a bit sheepish at having persevered in a request to volunteer through several layers of bureaucracy, and then changing my mind simply because the work wasn’t what I had expected.
That was how I started delivering meals on wheels. And while this work didn’t always address the food insecurity and socio-economic inequality which had originally sparked my desire to volunteer, the experience opened my eyes to a new set of claims of justice. Some of the people I served did, indeed, seem to be in relatively severe financial need; one man said he usually bought his food at the dollar store. These were cases of true food insecurity, meaning that our meal delivery provided them with assurance that they would have a meal that day – an assurance they might not otherwise have had. But many of the clientele seemed comfortably well-off, with well-stocked larders and a local support network; they just had no-one to bring them hot food daily or – for these people perhaps a more pressing need – to talk to.
“Remember,” my trainer said as I set off on my first day. “For many of these people you are the only person they will see all day – their only point of human contact. Your job isn’t just to give them food; it’s to notice whether they have bruises that might indicate a fall, whether they seem unusually confused, and whether they might need to see a doctor.”
In Minimizing Marriage, I argued for radical revision of marriage law. I argued that legally recognizing only different-sex, two-person, monogamous, amorous marriage wrongly discriminates against the various other caring relationships in which people live. So if there is to be a marriage-like law at all (on my account, a legal framework which provides the legal and social bases supporting such relationships), its instruments and benefits should be available to same-sex relationships, non-amorous friendships, polygamous or polyamorous relationships, care networks, and other caring relationships around which citizens structure their lives.
I further argued that there should be a marriage-like law, one supporting caring relationships in all their variety, because caring relationships are Rawlsian primary goods. To put it in non-Rawlsian terms, caring relationships are of such widespread importance in people’s lives, and so closely tied to psychological goods of mental health and self-respect, that their distribution is a matter of justice. In other words, there is a right to legal protections for relationships of the sort now provided through marriage, and this right extends to all caring relationships, be they amorous or not, dyadic or small-group, same- or different-sex. (And by “caring relationships,” I have in mind affectionate relationships with mutual concern for one another’s welfare; such relationships need not involve material caregiving, which is a distinct primary good.)
A crucial idea was that citizens in a liberal state have a right to certain legal protections for their caring relationships; care, in other words, is a matter of justice. But in my book, I focused on marriage law, sidestepping the question of how else the state might support caring relationships. I wanted to avoid potential reductios such as, “does your view then imply that the state should run dating agencies to distribute caring relationships?” However, delivering meals on wheels week after week brought home a major lacuna of my view.
Some of my clients seemed desperately lonely. Some spoke of faraway children or dead spouses or friends; some, despite being almost fully blind and deaf, kept up virtually one-way conversations, sharing their life stories and advice. Even though impairment had cut them off from seeing and hearing me, they struggled to create a connection. Social bonds were of paramount importance to these people, yet some were isolated in single-family homes they couldn’t leave on their own, and some couldn’t read e-mail or letters or talk on the phone, due to their limited vision and hearing.
The marriage rights I proposed were to protect relationships which already existed, in all their diversity. But caring relationships are just as important to those who have outlived friends and companions and lost the ability to engage in social events outside the home. On the view I developed, such people are lacking an important good, one whose distribution is a matter of justice.
This is a widespread problem. According to recent U.S. census data, 35% of elderly women and 19% of elderly men live alone. In fact, as the elderly population grows, the demand for care is so great that one prominent gerontologist has argued for robot caregivers. The thought is that such robots could not only perform material caregiving tasks such as cleaning, but they could also supply companionship. On my view, the distribution of social bases for caring relationships for the elderly – relationships which insensate robots cannot provide – is a matter of justice.
The state cannot, of course, distribute caring relationships directly. But it could provide social bases for caring relationships for people with mobility and social limitations. One solution is the senior center, a place where seniors can interact with other seniors. For people with severe limitations, transportation would be required. Housing codes and urban planning could encourage easy access to community interaction (someone in a wheelchair might be able to take herself out to a community space opening from her building). In designing infrastructure, municipalities could prioritize community and access.
But making community access physically easier will not spark caring relationships if citizens are indifferent to them. Could school curricula teach children skills of caring relationships? After all, if caring relationships are primary goods, citizens will need these skills to form and maintain relationships, just as they might need legal supports such as caretaking leave or special immigration eligibility. Could such curricula incorporate visitation to seniors, allowing relationships to form? Could the state create a Care Corps – a program along the lines of Teach for America or the Peace Corps, but directed at providing care for the elderly? Most tendentiously, could the provision of primary goods justify a draft into a “civilian service” of caregivers?
Designing such programs raises many practical questions. But there are also theoretical issues. A civilian service obviously is in tension with respect for liberties, such as freedom of occupation. But even the more modest proposals – even senior centers – have costs. How should society weigh promoting caring relationships for the elderly against increasing the life chances of children? Further, how would such policies affect gender inequality? Where caring occupations are paid less well and associated with women, what effects will promoting practices of care have on gender equality? Will it encourage men to do more caring work, or will it encourage more women, but not more men, to take up caring occupations? Would this justify gender quotas for a Care Corps? And given that care workers are poorly paid, would such programs disadvantage those already badly off by decreasing demand for their services?
Although I believe that a prosperous society can support adequate care for children and for seniors, I’m still working through these theoretical questions. But whatever the answers are concerning trade-offs with other goods or effects on gender and socio-economic equality, my main conclusion so far is that there is a claim of justice to the social bases of caring relationships.
One more moment from meals on wheels illustrates the importance of thinking of care (or, to be precise, the social bases of caring relationships) as a matter of justice. Clients were required to hand in a special form if they wanted Thanksgiving dinner. As I took the form from one elderly man, I noticed tears in his eyes. From our few conversations, I think the tears reflected a sense of indignity at being the recipient of charity. It is meaningful to people, important for their self-respect, that they have a right to something, as opposed to its being mere charity. It would be progress, I think, not only to recognize a right to basic nutrition, but a right, a claim of justice, that society organize itself to allow the elderly and isolated access to caring relationships.
 In fact, as I write, this piece on growing hunger in the U.S. appeared: < http://www.salon.com/2015/01/10/10_cities_where_an_appalling_number_of_americans_are_starving_partner/>
 Just to clarify: meals on wheels emphasizes the need for boundaries and discourages giving out one’s phone number or spending additional time with clients (at least in my jurisdiction). It is therefore distinct from the programs to promote caring relationships I will propose later in the paper.
 Elizabeth Brake, Minimizing Marriage, New York: Oxford University Press, 2012. See chapters 4-7 for the rather lengthy case for this, and the details. Here and throughout this post I sacrifice certain details to getting the overall point across briefly and readably.
 2013 census data; see U.S. Administration on Aging, http://www.aoa.gov/Aging_Statistics/. Also, only 45% of elderly women are married, compared to 71% of elderly men. While neither living alone nor being unmarried are equivalent to being without caring relationships, of course, these figures might be a rough guide to social isolation.
 Louise Aronson, “The Future of Robot Caregivers,” The New York Times, Sunday Review, July 19, 2014.
 See Cecile Fabre, Whose Body Is It Anyway? Justice and the Integrity of the Person (Oxford: Oxford University Press, 2006), pp. 55-71. I don’t mean to endorse this, but it is an idea worth noting.
 This reflects discussion with, among others, Andrew Williams and Ingrid Robeyns.