FAIR INNINGS GREG BOGNAR Keywords priority setting, age, utilitarian ageism, prioritarianism, fairness ABSTRACT In many societies, the aging of the population is becoming a major problem. This raises difficult issues for ethics and public policy. On what is known as the fair innings view, it is not impermissible to give lower priority to policies that primarily benefit the elderly. Philosophers have tried to justify this view on various grounds. In this article, I look at a consequentialist, a fairness- based, and a contractarian justification. I argue that all of them have implausible implications and fail to correspond to our moral intuitions. I end by outlining a different kind of consequentialist justification that avoids those implications and corresponds better to our considered moral judgments. 1. INTRODUCTION Many societies, especially in the developed world, have a ‘greying problem’. Their populations are aging. Depend- ency ratios (the ratio of the numbers of those who are not in the labour force and those who are) are getting higher, and fertility rates in many of these countries have fallen below replacement levels. As people live longer and fewer children are born, the elderly make up an ever larger share of the population, putting increasing pressure on healthcare and pension systems. According to projections by the United Nations, about one billion working-age adults and about 1.25 billion people aged over 60 will be added to the global popula- tion by 2050, while the number of people under 25 will remain about 3 billion. By the middle of the century, over a fifth of humanity will be over 60, doubling the current 11%. The developed countries, however, have already reached this level. By 2050, nearly one third of their population will be over 60. Currently, on average in OECD countries, 65-year old women can expect to live another 19.9 years and men can expect to live another 16.4 years. By 2050, life expectancy at 65 for women is forecast to increase to 23.5 years, and for men 19.5 years. In these countries, spending on pensions is projected to grow 40% faster than GDP in the next several decades, doubling the proportion of national income spent on old-age income support. There is universal agreement that current trends are unsustainable and significant reforms are needed. 1 The trends in spending on health care are broadly similar. In many developed countries, government healthcare spending per capita has been increasing by almost twice the size of per capita GDP growth for several decades. In the United States, government spend- ing on health care could amount to one-third of GDP by 2050, unless current trends are reversed. Already in 1999, over a third of healthcare expenses were spent on people aged 65 and over (their share in Japan has already increased to more than half). These costs increase with age: the average healthcare spending on a person over 80 is over 11 times more than the average healthcare spend- ing on a person between 50 and 64. As more and more 1 There are, of course, significant variations between the situation of individual countries. For detailed data, see United Nations, World Population Aging 2009, Working Paper ESA/P/WP/212, UN Depart- ment of Economic and Social Affairs, Population Division, New York, 2009, and OECD, Pensions at a Glance 2011: Retirement-income Systems in OECD and G20 Countries, OECD Publishing, 2011, http:// dx.doi.org/10.1787/pension_glance-2011-en; for an overview of policy options, see J. Bongaarts. Population Aging and the Rising Cost of Public Pensions. Popul Dev Rev 2004; 30: 1–23. Address for correspondence: Prof. Greg Bognar, Department of Politics, Philosophy, and Legal Studies, La Trobe University, Melbourne, VIC 3086, Australia. Email: greg.bognar@gmail.com Conflict of interest statement: No conflicts declared. Bioethics ISSN 0269-9702 (print); 1467-8519 (online) doi:10.1111/bioe.12101 Volume 29 Number 4 2015 pp 251–261 © 2014 John Wiley & Sons Ltd