Perspectives in Biology and Medicine

APPEALS TO NATURE IN THEORIES OF AGE-GROUP JUSTICE NANCY S. JECKER* An elderly dame, too, dwells in my neighborhood, invisible to most persons , in whose odorous herb garden I love to stroll sometimes, gathering simples and listening to herfables; for she has a genius of unequalled fertility, and her memory runs backfarther than mythology, and she can tell me the original of every fable, and on whatfact every one is founded, for the incidents occurred when she was young. A ruddy and lusty old dame, who delights in all weathers and seasons, and is likely to outlive all her children yet.—Thoreau [1, p. 95] Appeals to nature are heard with greater frequency in contemporary bioethics literature. Often such appeals ground arguments defending limits to health care for older age-groups. This essay examines how the language of nature enters moral arguments and raises problems for theories of age-group justice. Normal Species Functioning The idea of nature evokes no single image or meaning, but instead is common ground to a considerable range of ideas. On the whole, different senses of nature elicit positive images. High [2], for example, enumerates seven different senses of natural death in ordinary language. Each either attributes positive value to nature directly or does so indirectly , by representing nature as orderly or by suggesting that what is This paper was prepared while the author was a research fellow al the University of Texas Medical Branch, Institute for the Medical Humanities. Appreciation is expressed to institute faculty, especially Sally Gadow and Anne Hudson Jones. A version of this paper was presented at a meeting of the American Society on Aging in San Francisco, April 1990. *Department of Medical History and Ethics, School of Medicine, University of Washington , SB-20, Seattle, Washington 98195.© 1990 by The University of Chicago. AU rights reserved. 003 1-5982/90/3304-0690$01 .00 Perspectives in Biology and Medicine, 33, 4 ¦ Summer 1990 \ 517 natural is as it should be. Thus, a natural death is thought to result from biological processes of age or disease rather than from accidents or violence. Or a natural death suggests that dying is natural for biological beings. Other conceptions view a natural death as inherent or spontaneous , rather than contrived or prolonged; easy, peaceful, and comfortable ; expected, not startling or surprising; a necessary destiny or what is universal to a species, not contingent; and expressing the law-abiding harmony of nature. That nature is considered in a positive light in ordinary language motivates its skillful use in philosophical argument. Philosophers who appeal to concepts or images of nature can rely on its diverse favorable connotations to lend support to their arguments. For example, adjoining the word "natural" to "death" already suggests a good death. Likewise, the idea of a natural life span already prompts the thoughts that such a span of life is fitting and right and that living beyond it is suspect. Similarly, calling certain functioning "species typical" carries with it the idea that improving functioning beyond this point is extraordinary, not obligatory. Thus, although the history of ethics teaches that ought statements cannot be derived from is statements [3,4], this does little to deter such appeals. For, despite ourselves, we tend to think that what is ought to be. The upshot of this is that those attuned to the added force that appeals to nature give often refer to is statements in order to lend support to ought statements. A good illustration of this is found in Norman Daniels's recent work on distributive justice in health care [5]. Daniels begins by introducing several basic concepts that ground a theory about justice between agegroups . He first defines diseases as "deviations from the natural functional organization of a typical member of a species" and health as "the absence of disease" ([6], p. 166). These definitions suggest to Daniels a reason why meeting health-care needs is important: the presence of health or disease dramatically influences individuals' normal species functioning, which in turn affects the range of opportunities normally open to people. Daniels calls the opportunities that are normal at each stage of life the "age-relative normal opportunity range" [7, p. 74...