As in his earlier books Just health care and Am I my parent’s keeper? Norman Daniels’ Just health: meeting health needs fairly applies the prudential lifespan account (PLA) to the problem of justice between age groups (p163).1 The problem PLA addresses is this: the young pay more for the healthcare system and get less out of it than the old. How can this differential treatment be justified? Like the basic model, which economists use to analyse empirical and normative issues connected to aging, PLA focuses on consumption over the lifecycle. It rests on the idea that the healthcare system, in treating the young and the old differently, treats everyone equally over their lifespan, at least when institutions operate stably over time. The problem of justice between age groups should be conceived as the problem of budgeting one’s fair share of healthcare over one’s lifetime in order to protect the age-relative normal opportunity range (pp165–6).1

In what follows, I shall examine what may be called “the multiple self objection” to PLA. This objection asserts that preferences can and often do change so profoundly over the years that an individual has no appropriate basis for budgeting healthcare over her/his lifetime. It is called the multiple self objection because of the way in which the economic literature defines “person” or “self”. Persons or selves are conceived to be sets of preferences. In standard models, preferences are assumed to be stable over the lifecycle. Thus, an individual has by assumption one self or is one person within his or her life. With stable preferences, prudent budgeting of resources over the lifecycle is relatively unproblematic: one chooses a lifeplan in view of one’s preferences. If, however, preferences change profoundly within lifetime, it becomes unclear which set of preferences should be pivotal in devising the plan.

Richard Posner, an advocate of the multiple self approach, gives the example of his mother, who at age 65 expressed the preference to be dead rather than to be a frail old woman in a wheelchair. Twenty years later she had become a frail old woman in wheelchair, but it was quite obvious that she preferred to live (Posner 1995, p87).2 The multiple self objection to PLA claims that such conflicts between time-indexed sets of preferences (like the woman’s preference at 65–for–85 and the preference at 85–for–85) undermine the very possibility of devising a prudent plan for the whole lifespan.

Daniels has rejected the multiple self challenge to PLA, most extensively in Am I my parents keeper?3^–5 In Just health he only takes up the issue in one footnote, most likely because he is convinced that his previous discussions settled the matter (p166).1 I shall argue in this article, however, that Daniels underestimates the force of the multiple self challenge.

SIDGWICK’S QUESTIONS

In a famous passage of The methods of ethics, Henry Sidgwick asks why one should

sacrifice a present pleasure for a greater one in the future. Why should I concern myself about my own future feelings any more than about the feelings of other persons? (…) Grant that the Ego is merely a system of coherent phenomena, that the permanent identical “I” is not a fact but a fiction (…); why, then, should one part of the series of feeling into which the Ego is resolved be concerned with another part of the same series, any more than with any other series?6

Sidgwick’s questions contain a twofold challenge for PLA.

(1) PLA rests on the economic standard view, which is also accepted by many philosophers, that “rationality requires that we show equal concern for all parts of our (future) lives” (p148).3 The requirement of equal concern (REC) is pretty uncontroversial if it amounts to a rejection of what economists call a “pure time preference”. The mere temporal location of an identical type of experience should be of no relevance in evaluating a plan. The word “identical” is important here. For instance, it is not indicative of a pure time preference if an individual strongly prefers a lifeplan according to which s/he experiences the vida loca in her/his 20s to a lifeplan according to which it experiences the vida loca in her/his 60s. For, arguably, living the vida loca in one’s 60s is not the same kind of experience as living it in one’s 20s.i

However, having a “pure time-preference” is not the only explanation as to why people discount their future wellbeing. Take the example of Posner’s mother again: at 65, a future as a frail old woman in a wheelchair seems utterly worthless to her. Common sense, however, tells her that she will probably think differently as soon as she has become a frail old woman in a wheelchair. The multiple self objection to REC (and, thereby to PLA) argues that there is no neutral ground under such circumstances. One must act either against one’s present or against one’s future preferences. REC seems to ask people, like Posner’s mother, to give the same weight to what they now believe to be valuable and to what they now believe to be worthless. “This”, opines Derek Parfit, “is clearly irrational. It may even be logically impossible.”7

(2) Common sense alleges that prudent planning for one’s own future is rational in a sense in which altruism is not.

Now, what if the “ego” were not the same over the lifetime but, to use Sidgwick’s phrase, consists in “a system of coherent phenomena” that changed over the course of life? Under these circumstances, prudence and altruism might be closer to each other than common sense assumes. For, then, someone’s self at T₁ might often have no self-regarding reason to benefit his or her future self at T₂. But if intrapersonal and interpersonal transfers of resources are, under certain circumstances, on a par, the prudential lifespan account loses much of its attractiveness.

If reasons for being concerned about the wellbeing of my possible future self are not less problematic than reasons for being concerned about the wellbeing of other persons, not much seems to be won by replacing an issue of interpersonal distribution with an issue of intrapersonal planning. Prudent planning may turn out to be as conflict-ridden as interpersonal distribution. For then similar problems arise for distributions within a life as for distributions between them. In Am I my parents keeper? Daniels concedes that if this were true, “then the motivation for my strategy is undermined” (p157).3

DANIELS’ DEFENSE

Daniels’ defense of REC takes the form of a counterargument to Parfit’s theory of personal identity. According to Parfit, a “person’s existence just consists in the existence of a brain and body, and the occurrence of a series of interrelated physical and mental events” (Parfit 1984, p211).7 This view is reductionist in the sense that Parfit denies that persons are separately existing entities, distinct from brain and body. Moreover, he conceives personal identity exclusively in terms of psychological continuity and connectedness. Personal identity is no “deep further fact” (Parfit 1984, p210).7 I shall interpret this for the purpose of this article in the following sense: if the psychological connectedness between two selves P₁ and P₂ of a person is very weak (because “we have undergone any marked change in character, or conviction, or style of life”8), P₁ has only very weak self-regarding reasons to promote the wellbeing of P₂. P₁ has reason to take an attitude of non-identification towards P₂.

Daniels denies that Parfit’s theory of personal identity contributes to the rejection of REC. His first argument is this: if P₁ is justified in taking an attitude of non-identification towards P₂, then P₁ has no self-regarding reason to promote the wellbeing of P₂. Thus, if P₁ fails to promote the wellbeing of P₂, it does not violate REC. For REC demands that I promote my interests in the future. But the wellbeing of P₂ is not the wellbeing of P₁ at a later point in time. It is the wellbeing of a different self. Therefore, Parfit’s reason for discounting the interests of future selves leaves REC untouched. Daniels concludes accordingly that Parfit’s theory “is just identifying (isolating, more precisely) what counts as my future wellbeing. The dispute (…), it turns out, is only a dispute about what counts as my future, not a dispute about whether it is rational to be concerned about all parts of my future.”(p163)3

This argument is not persuasive. Parfit does not assert that taking an attitude of non-identification towards a future self amounts to claiming that this future self is not one’s own future self. Taking an attitude of non-identification means something quite different. It means that an individual I judges that having a certain set of preferences in the future does not give I rationale to make sure that these preferences can be fulfilled. At 65, Posner’s mother does not deny that her possible future life as a frail, old woman in a wheelchair is a possible future of hers. She comes to the conclusion, however, that her anticipated preferences as a frail, old woman in a wheelchair do not matter to her now.

Thus, the dispute seems to be not, as Daniels avers, about “what counts as my future”, but about whether the application of REC to the whole life of an individual is a requirement of rationality or not. Parfit denies that it is such a requirement, whereas Daniels claims the contrary. But he has not yet smoothed out Parfit’s objection.

Daniels has a second argument which, in contrast to the first, assumes that Parfit does not deny the idea of a rational lifeplan that aims at maximising the expected lifetime utility. But since the rational planner in Parfit’s sense (“discounter”) believes that what matters is psychological connectedness and continuity, he or she will not be equally concerned about all stages of life. The discounter assesses the interests at different points in time in proportion to the connectedness with the present self. For a “non-discounter”, it does not affect the utility value of an event whether it is occurring right now or will occur in the distant future or occurred in the remote past. The utility value of eating an apple on a particular Wednesday morning stays the same for the whole life of a non-discounter. For the discounter, however, the utility of past events diminishes in proportion to the diminishing degree of connectedness with his present self; and he cannot bring himself to see that it is irrelevant regarding to the utility value of the event whether his eating an apple on a particular Wednesday morning occurs today or in 20 years time.

Even a non-discounter may find it difficult to stick to his lifeplan since he is permanently tempted to save less for the future than his plan demands. In retrospect, however, he has reason to be content if he manages to stick to the plan. He now has more to consume. The discounter, by contrast, will come to regret having followed his lifeplan at earlier stages. He now has less to consume. Since he discounts the utility experienced by his younger self, too, he finds no consolation in the thought that he had it good then. Moreover, he will want to revise the original plan for the present and future stage since he is now more connected to them. The discounter lacks a coherent perspective on his life as a whole: “By making that assessment [of the wellbeing of a given point or stage in a life, MS] relative to the point in life at which the assessment is made, we lose the possibility that evaluations and plans will cohere over a lifetime.” (p168)3 So, arguably, the discounter is less content at most times of his life than the non-discounter since he permanently changes the utility values. On the whole, being a discounter is worse than being a non-discounter.

This argument for REC is convincing, as far as it goes. But Daniels has to get a further problem out of the way of PLA. A person might want to save less for her own future because she anticipates that saving resources for the future will be conducive to the realisation of values she presently rejects.9 Because she does not want this to happen, she is strongly biased towards the present. Parfit gives the example of “a 19^th century Russian who, in several years, should inherit vast estates. Because he has socialist ideals, he intends, now, to give the land to the peasants. But he knows that his ideals may fade.” (Parfit 1973, p145)8 The young Russian does not give equal weight to his present and his future conception of the good. It is far from evident, however, that he would act imprudently if he made sure that his present idealism prevailed over the moral laxity of a possible future self.

In view of this problem, one may want to restrict the scope of REC to cases in which no incompatible values are involved. REC would then be a requirement of rationality only for those people who have different but compatible sets of preferences over their lifetime. Daniels, however, does not want to restrict the scope of REC because this would also imply a restriction of the scope of the prudential lifespan account and so he takes a different tack. He argues that the prudent planner can avoid the problem of intertemporal value incompatibility by abstracting from his time-indexed set of preferences altogether. Following Daniels, a rational plan facilitates us to live at each stage of life T_i according to the conception of the good that we have at T_i. In order to achieve this, the rational planner must apply a “thin theory of the good” and measure wellbeing “by reference to an index of such primary social goods as basic liberties, opportunity, and income” (p75),3 (p166).1 Basing one’s life-plan on a thin theory of the good, argues Daniels, is a requirement of rationality since “I do not want to deny my future self the chance to pursue what I shall come to think as valuable and important” (p58).3

Why is Daniels convinced that the prudent planner will want to keep options open? A person who is biased towards her present value commitments, he suggests, is intolerant and dogmatic with regard to other conceptions of the good (p60).3 An obvious objection to such a view is this: what Daniels calls intolerance and dogmatism is precisely what makes a value commitment a value commitment. A person who is truly committed to value X is, thereby, committed to rejecting a value Y that is incompatible with X. I cannot be a true socialist or moralist and, at the same time, promote non-socialist or non-moral goals. Now, if I anticipate that I am going to support non-socialist or non-moral ideals in the future, my present socialist or moral worldview commits me to do something about it. If I refuse to do so, one might doubt that I am truly committed to socialism or morality.

It is, of course, imaginable that someone wants to foreclose the opportunities of his future self out of pure intolerance and dogmatism, though it is likewise imaginable that he has sufficiently good reasons to get in the way of his future self.

In order to warrant Daniels’ view, one may argue in the following way: no-one knows precisely his or her future beliefs and values. On a very general level, it is reasonable to assume that one’s attitudes will change. Sometimes this will be due to learning and experience. Keeping options open is prudent because we may later want to revise our present plans and values in the light of new insights. Parfit’s young Russian imprudently rules out the possibility of moral and intellectual progress.

This is a plausible argument, and it is, probably, what Daniels had in mind when he argued that it is a kind of intolerance and dogmatism to treat our current plan of life as the only possible perspective from which to judge lifetime wellbeing (p60).3

However, the forces of intellectual and moral progress compete with the forces of intellectual and moral corruption. The young Russian may judge that, if he comes to change his world-view, this will most likely be the result of intellectual and moral decay rather than progress. He may be wrong to be so convinced but he has to make up his mind ex ante, and there is no a priori argument to the effect that he will be wiser or better in the future.

Let me conclude my discussion: it is, perhaps, the case that most people consider REC or something similar to be a requirement of prudence. But Daniels makes a bolder claim. He contends that REC “is one of the demands of prudence itself” (p57)3 Prudence, he purports, “will not allow us to say: ‘in the future, I will no doubt be quite different from what I am like now, and so I now care much less about what will happen to me then than I care about what happens to me in the near future.’” (p57)3 The idea that “prudence itself” commits us to view our life in a way that excludes the possibility of intertemporal value incompatibility, is not convincing. What it is prudent for someone to do depends on what this person is like in the present and what he or she, presently, wants to be like in the future. Prudence depends, to use Bernard Williams’ concept, on someone’s ground-project. Depending on this ground-project, it can be prudent to bind oneself irrevocably to certain value commitments and to burn the bridges, so to speak. Most people, probably, do not want to do this. For them, life is “like a given rectangle that has to be optimally filled out”.10 They want to keep options open. But there is no a priori argument to the effect that those few who want to burn the bridges are imprudent. Thus, REC seems to be no requirement of “prudence itself”.

It would not be irrational, if Posner’s mother, who at 65 expresses the preference to be dead rather than to be a frail old woman in a wheelchair, installs a self-binding mechanism in order to make sure that her preference at 65–for–85 overrides her preference at 85–for–85. Seen from her point of view at 85, however, it would be decidedly imprudent indeed. In cases of intertemporal value incompatibility no prudent strategy exists with regard to the whole life-span of an individual.

For this reason, Posner argues that we cannot solve the problem as to how to allocate healthcare between age groups with recourse to prudence alone. Moral considerations are ineluctable. He doubts that it would be morally justified to withhold expensive end-of-life treatments from the very old since their former self made a prudential commitment to this effect (Posner 1995, pp267–9).2 According to Posner, the self that made the commitment is, in important respects, not the same self that would have to suffer from withholding the treatment (Posner 1995, pp84–95).2 Thus, the problem of how to allocate resources between the young and the old cannot be reduced to one of budgeting resources over the lifetime. It is a matter of deep moral conflict.

CONCLUSION

One may wonder in what way the status of the multiple self objection is affected by the modifications to PLA, which Daniels made in Just health. The original strategy behind PLA was to solve the age group problem by reducing an interpersonal (moral) issue to an intrapersonal (prudential) one. This strategy committed him to rejecting multiple self theories. Daniels now believes that PLA “offers a reasonable, but restricted approach” (p170)1; it cannot completely solve the age group problem; nonetheless, it “brings an important line of argument to bear on the deliberation that takes place” (p170)1 within a fair deliberative process.

Since Daniels upholds his criticism of Parfit’s rejection of REC (p166),1 he is seemingly not inclined to concede that multiple self approaches, too, provide rationale for reasonable disagreement and have a role to play in the process of deliberation about the age group problem. Proponents of multiple self theories may want to register protest against this. Based on their arguments against the idea that the question of justice between age groups can be conceived as a matter of prudent budgeting, multiple self theorists may well claim a say in the process of deliberation about the age group problem.