Death is the great equalizer that affects all of the world, the young and the old, the rich and the poor, but not all deaths are equal and not all deaths gain recognition and publicity in the same way.[i] In the this approach to the hierarchy of life and death, the two major points of interest are the beginning and the end: the bookends of life. Both events have become increasing medicalized due to advancing technology and influx of research[ii] and in some cases become topics of public debate. So which death matters more: the death of an infant or the death of an elderly person? The ranking of lives may seem unethical and an uncomfortable topic to discuss but subconsciously an answer to this question may already have formed in your head. The research gathered will show that in general the deaths of infants matter more in US society than that of the elderly. Evidence is found by examining people’s attitudes and general opinions regarding both scenarios, comparing the popularity of the topic and amount of legislature surrounding abortion and the care of infants versus geriatric care, and by analyzing how the US society views/handles older people and infants compared to other cultures.
Barring the initial pause, one may have in deliberating as to whether infants’ deaths are more pressing than deaths of the elderly, we must examine the ethics of the argument and then the dilemmas such a conclusion may cause.
Is it ethical to intrinsically care more for infants as they develop than for the elderly as they wither? Analyzing the societal standards for care between the groups is pertinent in assessing that there is a discrepancy in care. As revealed by Teller’s article on parenthood religion, the “baby on board” placards that have become ubiquitous in American culture reveal the extreme attention given to infant care[iii]. If it were not intrinsically coordinated that an infant’s life was superior and important to others, such a sign would not exist. The absence of signs cautioning others of onboard, fragile elders also details the internal US belief that human life is most valued at birth. Further, the actual fragility of children is not as important as most think. This is especially in the comparison of the elderly as infant mortality rates fall worldwide, and are as low 2% (>36 weeks)[iv].
It seems the evidence and analytics point to a strict emotional attachment to infancy death which forces individuals to care about infant’s deaths more so than death of the elderly. In an ethical evaluation, it does not make sense to value such infancy lives more.
To further exemplify how US society ranks the death of infants higher than that of the elderly, it is important to examine the way other cultures compare. One of the biggest indicators of the cultural differences is seeing how elderly foreigners here in the US respond to western medical practices. The US comprises of many immigrants whose children were born here and their views align more to a modern way of living which at times can be starkly different than their older generation’s traditional ways.[v] Conflicts and dilemmas arise when an older foreign person is being treated in a hospital and feels disregarded due to the lack of communication, perhaps from a literal language barrier, or from the vast difference in perspectives on how the US cares for the elderly. For example, a Chinese man stopped taking his medication and showing up to his medical appointments because they were invasive, cold, and did not align with his cultural views. An older Filipino man was in poor condition and the doctors recommended to his daughters that he should be moved to hospice care. The daughters wanted the doctors to tell their father it was their professional decision and mandatory he be moved because they knew he didn’t want to be taken from his home per Filipino cultural values and he would be disappointed in his daughters for not standing by his needs or holding the values to the same standard. The doctors couldn’t tell comply with the daughters wishes and the situation was hard to resolve. Western medical practices relating to the care of the elderly are seen by others as trying to return the patient to productive, economically rewarding work, controlling of practice, procedure, and information, and strictly monitoring the patient and altering practices to standardize outcome.[vi] This further supports that there is less care and less priority given to the deaths of the elderly and their care up until that point.
One standardized way of handling the elderly is through the use of nursing homes or life care facilities but do the elderly really want to spend their final days isolated from the rest of society? Research supports that living in care homes can be humiliating for the elderly and further the idea that they are a burden on society due to their lack of independence which is so highly valued in US culture.[vii] Though many elderly live in nursing homes or by themselves, not all do and many live with and rely on their families though this can still highlight their dependence on others and further their self-view as a burden. Studies also show that social disconnectedness is associated with worse mental and physical health and leads to increased rates of mortality and morbidity regardless of if the feelings are prompted from being abandoned or perceived lack of social support from family.[viii]
Seniors view nursing homes as a place to go to die and once you go in you don’t leave, but they comply because they don’t want to burden their families or lose pride by admitting they cannot do what they once could. Because of the heavy reliance on nursing homes and in care facilities, seniors are more isolated from society which leads to higher mortality rates and feelings of loneliness.
This mindset of burden others is an Anglo American view and is virtually nonexistent in other cultures.[ix] Due to increased medicalization in the US, people’s perspectives on aging are shifting and seniors are expected to be independent longer and their care and inevitable deaths are less emphasized, however other cultures put extreme emphasis on respect and dignity for their elders.[x] Japan has cultural values of high respect for the elderly ingrained into their society. They even have a day dubbed Respect for the Aged Day which is far more serious than it may seem; neighborhood volunteers take free food to the elderly and some villages hold special performances and ceremonies for the elderly.[xi] Many generations live together under one roof which may contribute to the long life spans attributed with happiness and longevity and higher population of elderly that have become characteristic of the country. Japan also engages in death rituals and places significance on respecting ancestors.[xii] Nearly 90% of the Japanese observe the custom of annual visits to ancestral graves and ancestor worship is a fundamental principle of culture and identity which has remained a priority despite changes in modernization and economic growth.[xiii] Similarly, rituals and respect for the elders are a crucial part of Chinese society. In fact, paying respect to the elderly by way of emotional and financial support is now a part of Chinese law.[xiv] Parents can sue their own children if they feel they are not receiving what has been culturally deemed appropriate. This societal value may stem from the ancestral value placed on the dead because many Chinese believe they continue to influence the fortunes of the living from the grave.[xv] Therefore, respect is shown throughout an elder’s life and by performing these rituals because of the continued relationship between the living and the dead.
The United States is a comparatively young nation to other countries. Thus, our belief system in treating our populace varies vastly from foreign countries. As pointed out culturally, this includes how we treat our elderly vs. our infants. Both parties are humans and should be, in theory, entitled to the same treatment. However, the elderly are a learned party that usually only needs assistance due to a handicap of ability. Infants are blank slates that must be looked after and educated. It may be this inability to experience life and learn from it that puts individuals in a moral conundrum– it is unfair that this poor infant won’t be able to experience life and will be taken away early without ability to fulfill any sort of aspiration. The absence of opportunity pushes us to care for infants more. Does this fit in an ethical framework? No, the death of an adult person is a tragedy because a sophisticated unique consciousness has been lost; a life in progress, of plans and ideals and relationships with other persons, has been broken off. The death of a young child, is also a tragedy, but it seems a comparatively one-sided one, the loss of a tremendously important part of the parents’ lives[xvi]. It seems the Chinese have taken this frame of thought and accurately applied it to their way of caregiving and weight of importance in deaths. They have learned and appreciate the value of a lifetime of experience and knowledge. This comparison between the US and other cultures brings to light how different the ranking of the elderly fall in the hierarchy of death. Because of the ritual traditions that are a fundamental part of society and the belief that ancestors can still have some power after death, other societies such as Japan and China, put great importance on the care for the elderly and their subsequent deaths. Since the US does not have a singular culture or a long history, these traditions and values are lost and the general focus falls on economic progress and self-sustainability which leaves the elderly forgotten, less respected and cared for and their deaths seen as inevitable events.
As for deaths surrounding infants, it’s easy to see why it should rank higher than that of an elderly in the sense that a baby is young, pure, and innocent with its whole life ahead of it. But another reason the US can be perceived as putting so much emphasis on infant deaths can stem from the immense popularity surrounding abortion legislation. This topic has been majorly divisive in the US with both sides becoming increasingly vocal and has even gained a foothold in political campaigns.[xvii] In contrast, the US lacks adequate health care and legislation surrounding geriatric care and as lifespans increase, many elderly have to stay employed longer because they cannot afford to retire.[xviii] The debate surrounding abortion and whether or not this should be considered the killing of an infant is also found worldwide.
Though it is worth noting that the US created legislation surrounding the Roe vs. Wade case that bars criminalizing abortion.[xix] Some believe overturning the decisions from that case could result in laws that look more like some foreign countries’ where there are tight restrictions and outright bans.[xx] While laws and regulations differ among the world, the US places great emphasis on this topic and supporters of both sides make their voices known through bumper stickers or t-shirts.[xxi] This sort of popularity and prominence is not found regarding the deaths of the older generations, there are no political campaigns or movements that make supporting t-shirts for their cause. A contrasting cultural view is in Alto do Cruzeiro where many infants die each year due to starvation and dehydration and chances of survival are slim. The society gives seemingly little attention to these deaths. In fact, women have been found to view their infants’ death as a blessing or great relief saying they feel “unburdened and free”.[xxii] These views are not because they are cold and unfeeling but much in the way it is natural and expected for an older person to die, this is the case for the infants in Alto do Cruzeiro. From these findings it can be concluded that the death of an infant in the US, whether by choice or not, will rank higher and have more care and emotion surrounding it than the death of an elderly person.
After examining the cultural ramifications and the ethics of the Hierarchy of Death, one must also consider the science behind why people value infant deaths more than those of the elderly. The underlying reasons that have influenced cultures around the world stem from biology and evolution. Ethology is the area of study that focuses on animal or human behavior from a biological perspective. While not as popular a science as ecology or chemistry, it provides vital insight into why humans care so much for their infants. Ethologists are particularly concerned with the evolutionary reasons behind why species engage in certain behaviors and the work of Konrad Lorenz is essential in the current understanding of how and why parents bond with their child. Cuteness is a very subjective term that is used to describe the attractiveness that is typically associated with youthful features. Kindchenschema, as described by Lorenz is defined as the common infantile features such as a large head, round face, and big eyes that many perceive as cute.[xxiii] He proposed that these features induce caretaking behavior from other humans. Indeed, cuteness acts a promoter of sociality, and the bonds formed as a result of this endows the cute entity with greater moral consideration. For instance, cuteness27 can directly affect the neural network in such a manner that promotes adults to have a sense of carefree playfulness around babies.[xxiv]
A 1978 study by Hildebrandt KA revealed that the initial response of adults towards babies is increased facial zygomaticus muscle activity, or more succinctly put, a smile.[xxv] A more recent study, also found that Kindchenschema is present across both species and ethnicities.[xxvi] Participants were given three categories: African babies, Caucasian babies, and puppies. There were about 100 pictures collected for each category and in each category, the participant would rate the cuteness of the infant face on a scale from 1 to 7. The order of the pictures was set up such that the cute and less cute pictures were paired together but the two presented pictures were always in the same category. To clarify, the participants never compared an African baby with a Caucasian baby or with a dog. Their purpose in doing that was to increase the probability that the difference in cuteness between two pictures could be perceived. What they found was that the mean cuteness was the same for all three different groups.
When a child is born there is a flush of oxytocin in the mother that helps to facilitate the mother-child bonding process. Fathers do not always instantly fall in love, and oxytocin levels only surge when the father can spend time caring for the children. Regardless of the difference in how the bond is initially formed, assuming that it is a stable family, fathers still feel a deep emotional attachment to their child. The loss of an infant can be a deafening blow to the family. They created a bond with the child and not too long after the creation of that bond, the child is taken from them.
Technology has afforded many people access to greater prenatal and neonatal health care. The commonly cited statistic that the life expectancy during medieval times was 30 has led to a gross misunderstanding of what life was back then. The alarmingly short life-span of 30 years is a result[xxvii] of the fact that pre-modern civilizations had high amounts of infant mortality, thus skewing the result. If infantile death was more common before modern medicine, then could newlywed couples be expected to have to bury a child? If so then there may[xxviii] be less emotional attachment involved in the early years of raising children. Nowadays, infants are expected to live to adulthood and a great deal of biomedical technology is focused on sustaining life as long as possible.[xxix]
After explaining through ethology why infants are so valued by society, one may ask where that leaves the geriatric population. While some people have taken to calling the elderly cute, they don’t carry the Kindchenschema that makes people want to take care of them. Unfortunately, that does not alter the fact that many elderly people still need close care towards the end of their life, and they are underrepresented in clinical research. The lack of representation means that it is easier for the geriatric population to slip through the cracks of scientific academia.[xxx] Beyond the weight of importance assigned to the lives/deaths of the elderly and infants is how care in the stages prior to the death of each differ and why the difference between the two is not fair nor ethical in practice. In terms of care, elderly are usually confined to homes or hospices that will take care of their daily needs and house them as they deteriorate. There has not been much innovation in the US healthcare system in regards to elderly end of life care. In fact, most of the technology implemented to assist the caregiving of the elderly has been remote-centric[xxxi]. That is, partitioning caregivers even further away from patients. This type of care is completely opposite of that given to infants. Infants are often put in care centers and with professionals which have proven positive effects[xxxii]. These effects include increased academic scoring, sociability, and resistance to communicable disease. While the elderly are not necessarily in need of improvement to academic sociability, the likeness of the other factors would surely benefit their health. It is unethical to not offer the same sort of care to the elderly on a similar scale. The availability of such a system might force US culture to value deaths of the elderly more as investment in them increases. Evolution and biology values organisms that are fit to have reproductive success. In a strikingly similar but more cultural vein, humans have an innate affinity to value other humans that have a capacity to contribute to society. Babies of course cannot contribute to society in the same capacity that an adult could, but thanks to their “cute” features, they don’t have reason to worry about how well they can perform their societal role.
When considering the scientific mechanisms behind how humans can bond with their children, it becomes apparent that babies have been refined by evolution in such a manner that it causes the parent to instinctively want to be a caregiver. The elderly have no such biological function and have to rely on the social bonds that they have already made. It is because of this that scientific evidence points towards infantile death being given more attention than geriatric death.
Madeleine Smith, Alexander Rassouli, Tyler Dunston
[iii] Teller, Danielle. “How American parenting is killing the American marriage”. Quartz. Sept. 30, 2014. Accessed April 5, 2019.
[iv] Bairoliya N, Fink G (2018) “Causes of death and infant mortality rates among full-term births in the United States between 2010 and 2012: An observational study”. PLoS Med 15(3): e1002531. Mar. 20, 2018. Accessed April 5, 2019.
[viii] Cornwell, Erin York, and Linda J. Waite. “Social Disconnectedness, Perceived Isolation, and Health among Older Adults.” Journal of Health and Social Behavior. March 2009. Accessed April 03, 2019. Link.
[x] “How Society Misunderstands the Elderly.”
[xvi] Wells, Thomas Rodham. “Children are special, but not particularly important”. 3QuartsDaily. Jan. 19, 2015. Accessed April 5, 2019.
[xix] Scheper-Hughes, Nancy. “Death Without Weeping.” In Death Without Weeping: The Violence of Everyday Life in Brazil, 179-89. Berkeley, CA: University of California Press, 1992.
[xxii] Glocker, Melanie L., Daniel D. Langleben, Kosha Ruparel, James W. Loughead, Ruben C. Gur, and Norbert Sachser. “Baby Schema in Infant Faces Induces Cuteness Perception and Motivation for Caretaking in Adults.” Ethology : Formerly Zeitschrift Fur Tierpsychologie. March 2009. Accessed April 08, 2019. Link.
[xxiii] Golle, Jessika, Fabian Probst, Fred W. Mast, and Janek S. Lobmaier. “Preference for Cute Infants Does Not Depend on Their Ethnicity or Species: Evidence from Hypothetical Adoption and Donation Paradigms.” PLOS ONE. Accessed April 08, 2019. Link.
[xxiv] Senese, Vincenzo Paolo, Simona De Falco, Marc H. Bornstein, Andrea Caria, Simona Buffolino, and Paola Venuti. “Human Infant Faces Provoke Implicit Positive Affective Responses in Parents and Non-Parents Alike.” PLoS ONE 8, no. 11 (2013). Accessed April 8, 2019. doi:10.1371/journal.pone.0080379.
[xxv] Senese, “Human Infant Faces Provoke Implicit Positive Affective Responses in Parents and Non-Parents Alike.”.
[xxvi] Golle, “Preference for Cute Infants Does Not Depend on Their Ethnicity or Species: Evidence from Hypothetical Adoption and Donation Paradigms.”
[xxvii] Senese, “Human Infant Faces Provoke Implicit Positive Affective Responses in Parents and Non-Parents Alike.”.
[xxviii] Senese, “Human Infant Faces Provoke Implicit Positive Affective Responses in Parents and Non-Parents Alike.”.
[xxix] Institute of Medicine (US) Committee on Palliative and End-of-Life Care for Children and Their Families. “BEREAVEMENT EXPERIENCES AFTER THE DEATH OF A CHILD.” When Children Die: Improving Palliative and End-of-Life Care for Children and Their Families. January 01, 1970. Accessed April 08, 2019. Link.
[xxxi] Tao, Hang; McRoy, Susan. “Caring for and keeping the elderly in their homes”. College of Nursing, University of Wisconsin Milwaukee. College of Engineering, University of Wisconsin Milwaukee. Aug. 29, 2015. Accessed April 5, 2019.
[xxxii] Bradley RH, Vandell DL. “Child Care and the Well-being of Children”. Arch Pediatr Adolesc Med. July 2007. 161(7):669–676. Accessed April 5, 2019.