Intergenerational healthcare ethics: considering conceptualizations of generations and their collective and temporal dimensions

Current challenges in medicine and healthcare raise new questions regarding the moral relations between generations, thus highlighting the increasing relevance of intergenerational perspectives in healthcare ethics. However, the underlying notions of generations often remain vague and heterogeneous. This contribution aims to clarify the scope of conceptual meanings of 'generation' through explication and differentiation in order to advance the analytical potential of intergenerational perspectives in healthcare ethics. We argue that the concept of generations needs theoretical elaboration with regard to the dimensions of collectivity and temporality. We first introduce three approaches towards the theoretical conceptualization of generations: a genealogical, a chronological, and a socio-cultural approach. Regardless of their differences, all three essentially share an understanding of generations as collectives situated in time. Accordingly, we then examine the scope of underlying notions of collectivity and temporality, touching upon fundamental ontological, epistemological, and moral philosophical implications. We distinguish a skeptical individualist, an aggregationist, and an entity view of collectivity, as well as a formal, linear, a subjective, existential-narrative, and a socio-cultural understanding of temporality. The combination of these dimensions allows the development of a systematic matrix of conceptions of generations and intergenerational relations in healthcare ethics whose analytical potential we illustrate with regard to three paradigmatic examples. We provide a systematic summary of our considerations and outline a research agenda that addresses desiderata for intergenerational perspectives in healthcare ethics, encompassing clinical ethics, research ethics, and public health ethics, as well as meta-ethical questions.