If only we had adequate nursing facilities, you know – families like us with bedridden elderly could have our peace of mind. We would have our peace of mind, but, still – we'd be neglecting them, wouldn't we? I think, well – they can't go there.
Waka's ambivalence about relying on formal institutions for her husband's care is frequently shared among families with physically dependent elderly persons, both in Japan and the United States. The decision to entrust such care to institutional services requires much appraisal of moral obligations, priorities, and capacity, for caregivers like Waka and others. As such, the question of support responsibility is a normative evaluation as well as an assignment of instrumental tasks. The appraisal hinges on our values about who ought to help, and how we ought to order our priorities and interests to do our “fair” share. The rights and responsibilities in the social contract are forged by such normative considerations grounded in the context of specific political and fiscal conditions.
As Robert Pinker noted, public policies ultimately rest on fundamental assumptions about the order of a “good society.” The legal framework of the social contract is created by human choices that derive from these fundamental assumptions and institutional constraints. This chapter explores the normative conditions and institutional frameworks that underlie the social contract for the elderly in the public domain.