What Do Children Owe Elderly Parents?

n the spring of 1983 the Reagan administration announced that states may under Medicaid legally require children to contribute to the support of their elderly parents. At the time a number of states were considering or enacting just such laws. The administration, one spokesman said, was not proposing anything inherently new. It was simply responding to a state request for clarification of the existing Medicaid law, and wanted only to say that state statutes enforcing family responsibility laws were not in conflict with federal policy.' As it turned out, the administration's initiative was a policy shift whose time had not come. While a number of states flirted for a time with new family responsibility policies, only a few (Virginia, Idaho, and Mississippi, for example) actually adopted them, and even fewer seem to be enforcing them. As pressing as the state Medicaid nursing home burden is, it rapidly became clear that there is little general sentiment to force children to provide financially for their elderly parents. Nonetheless, Reagan's initiative was an important social and policy event and raises significant moral issues. In one form or another, the idea is likely to arise again. Anything that can be done to raise revenue to reduce the Medicaid burden probably will be done. Three questions are thus worth considering. What kind of a moral obligation do children have toward the welfare of their elderly parents? Can it be said that the changed health, longevity, and social circumstances of the elderly justify a shift in traditional moral obligations? Even if children do have some significant duties to parents, is it still legitimate to ask the state to take over much of the direct burden of care? The first question is of course an old one. Each generation has had to make its own sense of the biblical injunction that we should our fathers and mothers. It neither tells us in what honor consists nor how far filial obligation should be carried. As a piece of practical advice, however, it once made considerable sense. In most traditional and agricultural societies, parents had considerable power over the lives of their offspring. Children who did not their parents risked not only immediate privation, but also the loss of the one inheritance that would enable them to raise and support their own families-land they could call their own.