Despite widespread support for the claim that death can harm the one who dies, debate continues over how to rescue this harm thesis (HT) from Epicurus’s challenge. Disagreements focus on two of the three issues that any defense of HT must resolve: the subject of death’s harm and the timing of its injury. About the nature of death’s harm, however, a consensus has emerged around the view that death harms a subject (when it does) (...) by depriving her of the goods life would’ve afforded had she continued living. This deprivation view of death’s harm (DV) derives some of its credibility from the general deprivation theory of which it is an instance: mortal harm is subject to the same kind of analysis plausibly given of other non-mortal harms. Furthermore, note that the weak formulation of HT—asserting only that death can inflict harm, not that it always or necessarily does—accommodates the intuition that instances of rational suicide and justifiable euthanasia present cases in which death fails to harm. DV is equipped to explain how in these cases the harms involved in continued existence outweigh the goods of which death deprives the subject. I agree that suicide can be rational and that euthanasia can be justifiable. Likewise I accept both HT and DV as far as they go. But they do not go far enough. Specifically, I argue here that death harms even those who die as a result of rational suicide or justifiable euthanasia; that death’s harm is neither undifferentiated nor wholly contingent, but multifaceted and partly necessary; that the necessary part of death’s harm is distinctive, inflicting a peculiar restriction on the autonomy of one who dies; and, regarding the timing and subject issues, that this restriction harm is inflicted on the antemortem subject prior to her death. (shrink)

Most philosophers in the death literature believe that death can be bad for the person who dies. The most popular view of death’s badness—namely, deprivationism—holds that death is bad for the person who dies because, and to the extent that, it deprives them of the net good that they would have accrued, had their actual death not occurred. Deprivationists thus face the challenge of locating the time that death is bad for a person. This is known as the Timing (...) Problem, which is thought to be one of the biggest challenges facing views holding that death can be bad for the person who dies. Every possible answer to this question has been defended in the literature, yet each answer can seemingly be shown to be subject to compelling objections. In this paper, I argue that the force of the Timing Problem is illusory. Specifically, I argue that the problem, as formulated in the literature, is underspecified. Any adequately precise form of the question ‘When is death bad for the person who dies?’ is one to which there is a clear, decisive, and unproblematic answer. (shrink)

Recently, Stephan Blatti has argued that a deprivationist view (DV) of death’s harm is incomplete, and he presents a view such that the kind of distinctive harm that death brings to an individual involves the restriction of that individual’s autonomy.2 Not only does death deprivation-harm us, but it also restriction-harms us. Let us label such an account—one that includes both deprivation and restriction as comprising death’s harm—as a ‘deprivationist-restrictionist view’ (or ‘DRV’). Blatti favors DRV (...) because it avoids several worries that beset DV. In this paper, I present several objections to DRV; in particular, I raise some problems for the claim that death restriction-harms us and show that even DRV does not avoid the worries of DV—so there is no reason to prefer DRV over DV. (shrink)

Epicurus (in)famously argued that death is not harmful and therefore our standard reactions to it (like deep fear of death and going to great lengths to postpone it) are not rational, inaugurating an ongoing debate about the harm of death. Those who wish to resist this conclusion must identify the harm of death. But not any old harm will do. In order to resist both the claim that death is not harmful and the claim that our standard (...) reactions to it are irrational, we must identify a harm associated with death that rationalizes our standard reactions. We can divide the potential harm properties death might have along two axes: intrinsic/extrinsic and instrumental/final. This gives us four places to search for the harm of death. I argue that it is nowhere to be found. (shrink)

This book brings together the relevant interdisciplinary and method elements needed to form a conceptual framework that is both pragmatic and rigorous. By using the best, and often the latest, work in thanatology, psychology, neuroscience, sociology, physics, philosophy and ethics, it develops a framework for understanding both what death is - which requires a great deal of time spent developing definitions of the various types of identity-in-the-moment and identity-over-time - and the values involved in death. This pragmatic framework answers questions (...) about why death is a form of loss; why we experience the emotional reactions, feelings and desires that we do; which of these reactions, feelings and desires are justified and which are not; if we can survive death and how; whether our deaths can harm us; and why and how we should prepare for death. Thanks to the pragmatic framework employed, the answers to the various questions are more likely to be accurate and acceptable than those with less rigorous scholarly underpinnings or which deal with utopian worlds.. (shrink)

I cannot possibly do justice to James Taylor's main contention that full-blooded epicureanism is true. But if it is true then, as he notes, this ‘bold’ philosophical position promises to revise our thinking about many areas in bioethics which presuppose that death is bad.1 Of course if Epicureanism is true, the implications run much wider and deeper than bioethics. Any human activity that in any way presupposes the badness of death will be groundless—killing or being killed in war will be (...) morally inconsequential, saving people from death will be without merit and execution could not count as punishment. But, Taylor assures us, the truth of Epicureanism need not force such drastic practical changes for two reasons: excising the mistaken non-epicurean portion of those practical matters might not exhaust our concerns with those questions, and in any case we might be hard-wired to think that death is bad, so we would be stuck with a view that we see on reflection is false .2 However, that much of our common sense practical thinking about life and death might remain intact despite being groundless is small comfort, since we would then be something like Christians trying to carry on who realise, on reflection, that there is no God.Taylor seeks to mitigate …. (shrink)

If death is a harm then it is a harm that cannot be experienced. The proponent of death’s harm must therefore provide an answer to Epicurus, when he says that ‘death, is nothing to us, since when we are, death is not present, and when death is present, then we are not’. In this paper I respond to the two main ways philosophers have attempted to answer Epicurus, regarding the subject of death’s harm: either (...) directly or via analogy. The direct way argues that there is a truth-maker (or difference-maker) for death’s harm, namely in virtue of the intrinsic value the subject’s life would have had if they had not died. The analogy argues that there are cases analogous to death, where the subject is harmed although they experience no pain as a result. I argue that both accounts beg the question against the Epicurean: the first by presupposing that one can be harmed while experiencing no displeasure as a result and the second by conflating a de re with a de dicto reading of death’s harm. Thus, I argue, until better arguments are provided, one is best to agree with Epicurus and those who follow him that death is not a harm. (shrink)

The desire-satisfactionist defense of the existence of posthumous harm faces the problem of changing desires. The problem is that, in some cases where desires change before the time of their objects, the principle underlying the desire-satisfactionist defense of posthumous harm yields implausible results. In his prominent desire-satisfactionist defense of posthumous harm, David Boonin proposes a solution to this problem. First, I argue that there are two relevantly different versions of the problem of changing desires, and that Boonin's (...) proposed solution addresses only one of them. Second, I argue that modifying the underlying principle is a better approach to overcoming the problem of changing desires since it addresses both versions of the problem. I defend this approach against objections by showing that the problems raised are problems for the principle as a general theory of harm, not for the principle as part of the desire-satisfactionist defense of posthumous harm. (shrink)

Given that a person's death is bad for her,whenis it bad? I defendsubsequentism, the view that things that are bad in the relevant way are bad after they occur. Some have objected to this view on the grounds that it requires us to compare the amount of well-being the victim would have enjoyed, had she not died, with the amount she receives while dead; however, we cannot assign any level of well-being, not even zero, to a dead person. In the (...) population ethics literature, many philosophers have argued along similar lines that bringing someone into existence can neither harm nor benefit her. Working within the comparative framework (on which harms make us worse off), I respond by proposing a good sense in which we can say that dead people, and actual people at alternatives in which they do not exist, have a well-being level of zero. (shrink)

Those who endorse the view that death is in some cases bad for the deceased—a view that, as I shall explain, has considerable bearing on many bioethical issues—need to address the following, Epicurean question: When is death bad for the one who dies? The two most popular answers are "before death" (priorism) and "after death" (subsequentism). Part of the support for these two views consists in the idea that a third answer, "at no time" (atemporalism), makes death unsatisfyingly different from (...) other evils. I argue that this objection is mistaken, and that priorism and subsequentism face problems that atemporalism avoids. Moreover, I argue that if it is nonetheless insisted that we must find a time at which my death is bad for me, we can appeal to periods that begin before my death and end after my death. I end with some implications for posthumous harm. (shrink)

In this essay, we consider questions arising from cases in which people request medical assistance in dying (MAiD) in unjust social circumstances. We develop our argument by asking two questions. First, can decisions made in the context of unjust social circumstance be meaningfully autonomous? We understand ‘unjust social circumstances’ to be circumstances in which people do not have meaningful access to the range of options to which they are entitled and ‘autonomy’ as self-governance in the service of personally meaningful goals, (...) values and commitments. People in these circumstances would choose otherwise, were conditions more just. We consider and reject arguments that the autonomy of people choosing death in the context of injustice is necessarily reduced, either by restricting their options for self-determination, through their internalisation of oppressive attitudes or by undermining their hope to the point that they despair.Second, should MAiD be available to people in such circumstances, even when a sound argument can be made that the agents in question are autonomous? In response, we use a harm reduction approach, arguing that even though such decisions are tragic, MAiD should be available. Our argument engages with relational theories of autonomy as well as recent criticism raised against them and is intended to be general in application, although it emerges in response to the Canadian legal regimen around MAiD, with a focus on recent changes in Canada’s eligibility criteria to qualify for MAiD. (shrink)

In his recent book, Death, Posthumous Harm, and Bioethics (Routeledge 2012), James Stacey Taylor challenges two ideas whose provenance may be traced all the way back to Aristotle. The first of these is the thought that death (typically) harms the one who dies (mortal harm thesis). The second is the idea that one can be harmed (and wronged) by events that occur after one’s death (posthumous harm thesis). Taylor devotes two-thirds of the book to arguing against both (...) theses and the remainder to working out the implications of their falsity for various bioethical concerns, including euthanasia, suicide, organ procurement, etc. In this brief article, I concentrate on Taylor’s case against the mortal harm thesis and suggest that his main argument against this claim begs the question. (shrink)

I defend a theory of the way in which death is a harm to the person who dies that fits into a larger, unified account of harm ; and includes an account of the time of death's harmfulness, one that avoids the implications that death is a timeless harm and that people have levels of welfare at times at which they do not exist.

I argue for the possibility of posthumous harm based on an account of the harm of murder. I start with the deep-seated intuition that when someone is murdered he (or she) is harmed (over and above the pain of injury or dying), and argue that Feinberg's account that assumes that harm is an invasion of an interest cannot plausibly accommodate this intuition. I propose a new account of the harm of murder: it is an irreversible loss (...) of functions necessary for worthwhile existence. I suggest a (partial) loss analysis of harm in general, and then go on to apply it to posthumous harm and defend the idea that there can be posthumous losses. (shrink)

This chapter contains sections titled: The Epistemology of Murder Violence and Human Nature The Gestation of Terrorists and Serial Killers Conclusions.

This book is a concise, clearly written, and rigorously argued discussion of the main question regarding the metaphysics of death. In defending the view that death can harm the person who dies, Jack Li refutes Epicurean and Lucretian arguments that death cannot harm us and that it is irrational to fear death. Epicurus held that a person can be harmed only when he exists. Because death is the end of a person’s existence, death cannot harm him. Therefore, (...) death should be “nothing to us”. Lucretius offered the following symmetry argument. No one is harmed by, and no one fears, prenatal non-existence. Postmortem non-existence is symmetrical to prenatal non-existence. Therefore, no one can be harmed by postmortem non-existence, and it is irrational to fear this state.To show that the Epicurean and Lucretian arguments are flawed, Li examines three different theories proposed by such philosophers as Thomas Nagel, Joel Feinberg, Jeff McMahan, and Fred Feldman. The first is the “desire thwarting” theory, which says that death can harm us because it thwarts our unconditional desire to continue living. The second is the “deprivation” theory, which says that death can harm us because it deprives us of the goods we would have enjoyed had we …. (shrink)

Lucretius argues that death does not harm the person who dies. Harm could occur only if a person’s future non-existence were harmful. But one’s future non-existence is no more harmful than one’s non-existence prior to being born. Since a person is not harmed by lacking existence prior to being born, it follows that one is not harmed by lacking existence after dying. There is thus no need to fear death’s sting.

As we aggressively pursue research to cure and prevent Alzheimer’s disease, we encounter important ethical challenges. None of these challenges, if handled thoughtfully, would pose insurmountable barriers to research. But if they are ignored, they could slow the research process, alienate potential study subjects and do damage to research recruits and others. These challenges are the necessity of very large cohorts of research subjects, recruited for lengthy studies, probably ending only in the subjects’ death; the creation of cohorts of ’study (...) ready' volunteers, many of whom will be competent to consent at the beginning of the process, but move into cognitive impairment later; reliance on adaptive trial design, creating challenges for informed consent, equipoise and justice; the use of biomarkers and predictive tests that describe risk rather than certainty, and that can threaten participants’ welfare if the information is obtained by insurance companies or long-term care providers; the use of study partners that creates unique risks of harm to the relationship of subject and study partner. We need greater attention, at all levels, to these complex ethical issues. Work on these issues should be included in research plans, from the federal to the local, and should be supported through NIH in the same way that it supported work on the ethical, legal and social implications of genetic research. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Ethics & the Environment 8.2 (2003) 106-125 [Access article in PDF] Leopold's NovelThe Land Ethic in Barbara Kingsolver's Prodigal Summer Peter S. Wenz Introduction Like many good novels, Prodigal Summer's 1 account of love, tragedy, conflict, and choice in human relationships conveys an overall message about how life should be lived. In this case the message corresponds to Aldo Leopold's call for "a land ethic [that] changes the role (...) of Homo sapiens from conqueror of the land-community to plain member and citizen of it." People should "respect... fellow-members and also... the community as such." 2 Barbara Kingsolver explains Leopold's key ideas and updates the Land Ethic by showing how it might guide people today. The present paper selectively displays this relationship, and then suggests some pedagogical advantages of fiction.Prodigal Summer tells three interconnected stories that take place from May through July one year in contemporary rural Kentucky. One story features Deanna Wolfe, who has spent the last 25 months working for the U.S. Forest Service in a wilderness area on Zebulon Mountain where she restores trails and impedes illegal hunting. She has just discovered that coyotes have arrived, but so has Eddie Bondo, a handsome man from the West who hates coyotes because they sometimes kill livestock. [End Page 106]Another story features Lusa Landowski and her husband Cole Widener. Lusa is an entomologist who taught at the University of Kentucky before marrying Cole and moving to his family's tobacco farm that adjoins the national forest where Deanna works. Cole dies early in the novel and Lusa tries to save the family farm.Finally, Nannie Rawley is a senior citizen who grows organic apples nearby and has conflicts with her more senior neighbor, Garnett Walker, who wants to kill weeds with chemicals to keep his property looking neat. Garnett's goal is to cross-fertilize chestnut trees to create an American chestnut that is immune to chestnut blight. Ecocentrism, Hunting, the Biotic Pyramid, and Exotic Species Aldo Leopold's Land Ethic is famously holistic and ecocentric. The ecosystem, a holistic entity, has value over and above, and in most cases more than, the value of its individual components. This ecocentric perspective is summed up in the maxim: "A thing is right when it tends to preserve the integrity, stability, and beauty of the biotic community. It is wrong when it tends otherwise" (1970, 262).Ecocentrism explains Leopold's attitude toward hunting. In many passages, such as the October account of hunting ruffed grouse (58-62) and partridge (62-69), Leopold describes the hunt with approval. However, he disapproves of programs to eradicate keystone predators because their elimination impoverishes ecosystems. His classic account, "Thinking Like a Mountain," concerns wolf eradication. He writes, "I thought that because fewer wolves meant more deer, that no wolves would mean hunters' paradise" (138). But he found that wolf eradication harms mountains, that is, ecosystems. I have watched the face of many a newly wolfless mountain, and seen the south-facing slopes wrinkle with a maze of new deer trails. I have seen every edible bush and seedling browsed, first to anaemic desuetude, and then to death. I have seen every edible tree defoliated to the height of a saddle horn.... In the end the starved bones of the hoped-for deer herd, dead of its own too-much, bleach with the bones of the dead sage, or molder under the high-lined junipers. (139-40) Leopold's concept of a biotic pyramid explains why wolf eradication harms ecosystems. According to Leopold, the energy that plants absorb from the sun: [End Page 107]... flows through a circuit called the biota, which may be represented by a pyramid consisting of layers. The bottom layer is the soil. A plant layer rests on the soil, an insect layer on the plants, a bird and rodent layer on the insects, and so on up through the various animal groups to the apex layer, which consists of the larger carnivores.... Proceeding upward, each successive layer decreases in numerical... (shrink)

The recent tragic and widely publicised death of Jesse Gelsinger in a gene therapy trial has many important lessons for those engaged in the ethical review of research. One of the most important lessons is that ethics committees can give too much weight to ensuring informed consent and not enough attention to minimising the harm associated with participation in research. The first responsibility of ethics committees should be to ensure that the expected harm associated with participation is reasonable. (...) Jesse was an 18-year-old man with a mild form of ornithine transcarbamylase (OTC) deficiency, a disorder of nitrogen metabolism. His form of the disease could be controlled by diet and drug treatment. On September 13 1999 a team of researchers lead by James Wilson at the University of Pennsylvania's Institute for Human Gene Therapy (IHGT) injected 3.8 X 1013 adenovirus vector particles containing a gene to correct the genetic defect. He was the eighteenth and final patient in the trial. The virus particles were injected directly into the liver. He received the largest number of virus particles in a gene therapy trial.1 Four days later he was dead from what was probably an immune reaction to the virus vector. This was the first death directly attributed to gene therapy. It resulted in worldwide publicity, an independent investigation, the Federal Drug Administration (FDA) suspending all trials at the IHGT, an FDA, and a senate subcommittee investigation. At a special public meeting at the National Institutes of Health (NIH) in December 1999, James Wilson, also the director of the IHGT, said they still did not understand fully what had gone wrong.2 Even though a massive dose had been used, only 1% of transferred genes reached the target cells. (None of the patients in the trial showed significant gene expression. Art …. (shrink)

In a recent article in this journal, John Martin Fischer defends the view that death harms its victim after she dies. More specifically, he develops a “truthmaking” account in order to solve what he calls the Problem of Predication for this view. In this reply, we argue that Fischer’s proposed solution to this problem is unsuccessful.

The gamer’s dilemma, initially proposed by Luck (Ethics and Information Technology 11(1):31–36, 2009) posits a moral comparison between in-game acts of murder and in-game acts of paedophilia within single-player videogames. Despite each activity lacking the obvious harms of their real-world equivalents, common intuitions suggest an important difference between them. Some responses to the dilemma suggest that intuitive responses to the two cases are based on important differences between the acts themselves or their social meaning. Others challenge the fundamental assumptions of (...) the dilemma. In this paper, we identify and explore key imaginative and emotional differences in how certain types of in-game violence are experienced by players, consider how these differences factor into the moral lives of players, and use these insights to resolve the dilemma. The view we develop is that the key moral emotion in offensive video gameplay is self-repugnance. This is not repugnance of the act one directs a game character to perform in the game, nor repugnance of the character one plays. It is repugnance of oneself in playing the game. If self-repugnance is a fitting emotional response to playing a videogame, then this is prima facie grounds for thinking it is wrong to play the videogame. Our approach to the gamer’s dilemma is to distinguish the fittingness conditions of self-repugnance from the fittingness conditions of other moral emotions as they pertain to playing videogames. We argue that because of the virtual character of the actions performed in video games, self-repugnance is a fitting response to particular kinds of offensive gameplay. On the other hand, in-game murder is not invariably a fitting ground for self-repugnance. We argue that this difference is grounded in imaginative responses to the harm of death and the harms of profound suffering. Our task is to explain and justify this difference in fittingness conditions and use this to resolve the gamer’s dilemma. (shrink)

Philosophers have said less than is needed about the nature of premature death, and about the badness or otherwise of that death for the one who dies. In this paper, premature death’s nature is clarified in Epicurean terms. And an accompanying argument denies that we need to think of such a death as bad in itself for the one who dies. Premature death’s nature is conceived of as a death that arrives before ataraxia does. (Ataraxia’s nature is also (...) clarified. It is a pervasive inner peace that is a kind of purity and completeness in how one is living.) Whatever harm we might attribute to a premature death is better attributed to a life’s being lived at that time without ataraxia. The paper ends by explaining how its Epicurean account, more so than comparativist or narrativist accounts, could allow a person to know that her death will not be premature. (shrink)

Death is something we mourn or fear as the worst thing that could happen―whether the deaths of close ones, the deaths of strangers in reported accidents or tragedies, or our own. And yet, being dead is something that no one can experience and live to describe. This simple truth raises a host of difficult philosophical questions about the negativity surrounding our sense of death, and how and for whom exactly it is harmful. The question of whether death is bad has (...) occupied philosophers for centuries, and the debate emerging in philosophical literature is referred to as the "badness of death." Are deaths primarily negative for the survivors, or does death also affect the deceased? What are the differences between death in fetal life, just after birth, or in adolescence? In order to properly evaluate deaths in global health, we must find answers to these questions. -/- In this volume, leading philosophers, medical doctors, and economists discuss different views on how to evaluate death and its relevance for health policy. This includes theories about the harm of death and its connections to population-level bioethics. For example, one of the standard views in global health is that newborn deaths are among the worst types of death, yet stillbirths are neglected. This raises difficult questions about why birth is so significant, and several of the book's authors challenge this standard view. -/- This is the first volume to connect philosophical discussions on the harm of death with discussions on population health, adjusting the ways in which death is evaluated. Changing these evaluations has consequences for how we prioritize different health programs that affect individuals at different ages, as well as how we understand inequality in health. (shrink)

The most popular philosophical account of how death can harm (or be bad for) the deceased is the deprivation account, according to which death is bad insofar as it deprives the deceased of goods that would have been enjoyed by that person had the person not died. In this paper, the author surveys four main challenges to the deprivation account: the No-Harm-Done Argument, the No-Subject Argument, the Timing Argument, and the Symmetry Argument. These challenges are often raised by (...) Epicureans, who (following Epicurus) claim that death cannot harm the deceased, and each challenge is addressed in Thomas Nagel’s classic essay, “Death,” which has been very influential on recent developments in the literature on the philosophy of death. The author of this paper summarizes some of these recent developments as the challenges are considered. (shrink)

Epicurus notoriously argued that death at no time is a harm because before death there is no harm and after death there is no victim. The denial that death can be a harm to the one who dies has been challenged by various claims including (1) death is eternally bad for the victim (Feldman), (2) it is before death that it is bad for the victim (Feinberg and Pitcher), (3) death is bad for the victim but at (...) no particular time (Nagel), and (4) it is at the time of death that death is bad for the victim (Lamont). Nagel's account is more plausible and is consistent with the view that the temporal location of the harm of untimely death is best understood as the time when the decedent might otherwise have lived. (edited). (shrink)

Desire satisfaction theories of well-being and deprivationism about the badness of death face similar problems: desire satisfaction theories have trouble locating the time when the satisfaction of a future or past-directed desire benefits a person; deprivationism has trouble locating a time when death is bad for a person. I argue that desire satisfaction theorists and deprivation theorists can address their respective timing problems by accepting fusionism, the view that some events benefit or harm individuals only at fusions of moments (...) in time. Fusionism improves on existing solutions to the timing problem for deprivationism because it locates death’s badness at the same time as both the victim of death and death itself, and it accounts for all of the ways that death is bad for a person. Fusionism improves on existing solutions to the problem of temporally locating the benefit of future and past-directed desires because it respects several attractive principles, including the view that the intrinsic value of a time for someone is determined solely by states of affairs that obtain at that time and the view that intrinsically beneficial events benefit a person when they occur. (shrink)

The purpose of this article is not to affirm or deny particular philosophical positions, but to explore the limits of intelligibility about what post-mortem harm means, especially in the light of improper post-mortem procedures at Bristol and Alder Hey hospitals in the late 1990s. The parental claims of post-mortem harm to dead children at Alder Hey Hospital are reviewed from five different philosophical perspectives, eventually settling on a crucial difference of perspective about how we understand harm to (...) the dead. On the one hand there is the broadly 'analytical' tradition1 of thinking that predicates the notion of harm on the basis of an existing subject. Since the dead are non-existent persons, it makes little sense to view the dead as being harmed. On the other hand, there is a phenomenological perspective, where the dead, in respect to the experience of grief, are existentially absent. This forms the basis that it is possible to harm grieving parent's experiences of how their dead are treated. The article ends with a short examination of what harming the dead implies for traditional bioethical concerns, namely, obtaining informed consent from significant others when planning medical research on the newly dead. (shrink)

It has sometimes been claimed (usually without evidence) that the harm caused by an individual's participation in a greenhouse-gas-intensive economy is negligible. Using data from several contemporary sources, this paper attempts to estimate the harm done by an average American. This estimate is crude, and further refinements are surely needed. But the upshot is that the average American is responsible, through his/her greenhouse gas emissions, for the suffering and/or deaths of one or two future people.

Singer claims that there are two ways of challenging the fact that brain-dead patients, from whom organs are usually retrieved, are in fact biologically alive. By means of the first, the so called dead donor rule may be abandoned, opening the way to lethal organ donation. In the second, it might be posited that terms such as “life” and “death” do not have any primary biological meaning and are applicable to persons instead of organisms. This second possibility permits one to (...) acknowledge that brain-dead patients are deceased because they are irreversibly unconscious. In the commentary which follows, I will argue that Singer’s second option is preferable since it provides a higher amount of organs available for transplant, and is better suited to the meaning of “death” which occurs in ordinary language. I will also defend such a concept of death against the objections raised by Michael Nair-Collins in the article Can the brain-dead be harmed or wronged? On the moral status of brain death and its implications for organ transplantation. (shrink)

One of the many arguments against capital punishment is that execution is irrevocable. At its most simple, the argument has three premises. First, legal institutions should abolish penalties that do not admit correction of error, unless there are no alternative penalties. Second, irrevocable penalties are those that do not admit of correction. Third, execution is irrevocable. It follows that capital punishment should be abolished. This paper argues for the third premise. One might think that the truth of this premise is (...) self-evident. But in his paper “Is the Death Penalty Irrevocable?” Mike Davis argues that it is false: the death penalty is not irrevocable. While Davis’ argument is itself somewhat compelling, it receives additional support from work in the metaphysics of death, specifically the literature on posthumous harm. Strengthened in this way, the argument deserves careful consideration. I begin with a quick sketch of Davis’ argument, then show how the Pitcher-Feinberg theory of posthumous harm enables a more robust argument against the irrevocability of capital punishment, defending their theory of harm against standard objections in the literature. Having established the coherency of the robust argument, I conclude that it nevertheless fails to make the case against irrevocability. This is because it ignores the full set of practical requirements incumbent on legal institutions that wrongly punish someone. (shrink)

In his recent book, Harm to Others, Joel Feinberg addresses the question whether a person can be harmed after his or her own death, that is, whether posthumous harm is a logical possibility. There is a very strong tendency to suppose that harm to the dead is simply inconceivable. After all, there cannot be harm without a subject to be harmed, but when death occurs it appears to obliterate the subject thus excluding the possibility of (...) class='Hi'>harm. On the other hand, there is an inclination to believe that harmful events can indeed occur posthumously. As Aristotle observed, “a dead man is popularly believed to be capable of having both good and ill fortune—honour and dishonour and prosperity and the loss of it among his children and descendants generally—in exactly the same way as if he were alive but unaware or unobservant of what was happening”. Feinberg sides with Aristotle on this issue and develops an intriguing theory purporting to show how posthumous harms are possible. My intention in this paper is to argue that Feinberg's account meets with such serious difficulties that we must either develop an alternative theory or agree with those who claim that death logically excludes the possibility of harm. I shall begin in §2 with a brief sketch of Feinberg's provocative theory. This will be followed in §3 by my comments and criticisms. Section 4 will close with suggestions about where Feinberg's account goes wrong and how it might be repaired. (shrink)

This essay explores the unique perspective of medical students regarding the ethical challenges of providing full disclosure to patients and their families when medical mistakes are made, especially when such mistakes lead to tragic outcomes. This narrative underscores core precepts of the healing profession, challenging the health care team to be open and truthful, even when doing so is uncomfortable. This account also reminds us that nonabandonment is an obligation that assumes accountability for one’s actions in the healing relationship and (...) that apologizing for mistakes can serve to heal. It argues that even medical students have an obligation to speak up when actions violate their moral beliefs, even if this means confronting a superior. Ethical principles cannot be abandoned in fear of adverse evaluation or failure to conform. Healthcare workers have an obligation to address mistakes made around the time of a patient’s death with the patient’s family. This responsibility trumps any selfish desire to avoid unpleasant feelings of guilt or regret. Such events often bring closure to already anguished relatives and spouses, and may help to facilitate the grieving process. This includes pressing forward the need to apologize to patients and/or their families when mistakes are made and when decisions are made that lead to poor outcomes for the patient, even when benevolently intended. (shrink)

Research involving recently deceased humans that are physiologically maintained following declaration of death by neurologic criteria—or ‘research involving the recently deceased’—can fill a translational research gap while reducing harm to animals and living human subjects. It also creates new challenges for honouring the donor’s legacy, respecting the rights of donor loved ones, resource allocation and public health. As this research model gains traction, new empirical ethics questions must be answered to preserve public trust in all forms of tissue donation (...) and in the practice of medicine while respecting the legacy of the deceased and the rights of donor loved ones. This article suggests several topics for immediate investigation to understand the attitudes and experiences of researchers, clinical collaborators, donor loved ones and the public to ensure research involving the recently deceased advances ethically. (shrink)

The harm thesis says that death may harm the individual who dies. The posthumous harm thesis says that posthumous events may harm those who die. Epicurus rejects both theses, claiming that there is no subject who is harmed, no clear harm which is received, and no clear time when any harm is received. Feldman rescues the harm thesis with solutions to Epicurus' three puzzles based on his own version of the deprivation account of (...) harm. But many critics, among them Lamont, Grey, Feit and Bradley, have rejected Feldman's solution to the timing puzzle, offering their own solutions in its place. I discuss these solutions to the timing puzzle, and defend the view that while we are alive we may incur harm for which death and posthumous events are responsible. (shrink)

It has been argued, and not without emotional detachment, that the Holocaust is unlike other events in world and Jewish history. Those who offer such arguments also claim that comparisons between events of ethnic cleansing, mass murder and other sorts of criminal behavior are not meant to purvey a kind of moral one-upmanship. The suffering and harm in one instance is as morally repugnant as those in any other instance, whether it is a Jewish child gassed and cremated by (...) the Nazis, a black child lynched in the southern United States, an Armenian child deliberately poisoned in a Turkish hospital, a Ukrainian child starved to death in a Stalinist blockade, a Native American child shot to death by Conquistadors, a Rwandan child hacked to death, or a Bosnian child blown to pieces by a land mine or sniper. (shrink)

It is commonly asserted that “death is not a welfare issue” and this has been reflected in welfare legislation and policy in many countries. However, this creates a conflict for many who consider animal welfare to be an appropriate basis for decision-making in animal ethics but also consider that an animal’s death is ethically significant. To reconcile these viewpoints, this paper attempts to formulate an account of death as a welfare issue. Welfare issues are issues that refer to evaluations concerning (...) an animal’s interests. This includes evaluations that refer only to comparisons between the presence and absence of states, including positive states. This means that an animal’s death may be a welfare issue insofar as it leads to the exclusion of relevant positive states. This allows us to deny that death is necessarily not a welfare issue. (shrink)

Aim: Explore nurses’ values and perceptions regarding the practice of medical aid in dying. Background: Medical aid in dying is becoming increasing legal in the United States. The laws and American Nurses Association documents limit nursing involvement in this practice. Nurses’ values regarding this controversial topic are poorly understood. Methodology: Cross-sectional electronic survey design sent to nurse members of the American Nurses Association. Inductive thematic content analysis was applied to open-ended comments. Ethical Considerations: Approved by the institutional review board (#191046). (...) Participants: 1213 nurses provided 3639 open-ended comments. More than 80% of participants self-identified as white 58% held a graduate degree; and half were of Christian faith. Results: Values ranged on a continuum expressed through four themes: “Honoring Patient Autonomy without Judgment,” “Honoring with Limitations,” “Not until...,” and “Adamantly against.” Some felt it was a duty to honor the patients’ wishes, set aside own beliefs, and respect patients’ choices often with a spiritual connotation. Nurses held concerns about the process, policy, potential psychological harm, legal risk, and the need to learn more about MAID. Nurse who were adamantly against MAID associated the practice with murder/suicide and against religious beliefs. Disparate values were expressed about changing the MAID legislation to allow patient support with taking MAID medications and allowing MAID via advance directive. Conclusions: Nurses desire more education on MAID. There is not one universally held position on the nurse’s role during MAID. Healthcare policy/standards need to accommodate the wide variation in nurses’ values. Implications: Nurses desire education regarding their role in MAID. Nurses are encouraged to participate in policy discussions as the practice becomes increasingly legal. Managers need to expect that nurses, patients, and families will need psychological support to participate in MAID. Careful construction of policy/standards is needed to minimize conflict, moral distress, and psychological harm amongst nurses. Further research is needed. (shrink)

In clinical ethics, there remains a great deal of uncertainty regarding the appropriateness of attempting cardiopulmonary resuscitation (CPR) for certain patients. Although the issue continues to receive ample attention and various frameworks have been proposed for navigating such cases, most discussions draw heavily on the notion of harm as a central consideration. In the following, I use emerging philosophical literature on the notion of harm to argue that the ambiguities and disagreement about harm create important and oft-overlooked (...) challenges for the ethics of CPR. I begin by elucidating the standard account of harm, called the Counterfactual Comparative Account (CCA). I then show that three challenges to the CCA—preemptive harms, the harm of death, and non-experiential harms—are particularly salient when assessing potential harms for candidates of CPR and likely impact-related decision-making and communication. I extend this argument to explore how the ambiguities of harm might extend to other realms of clinical decision-making, such as the use and limitations of life-sustaining treatments. To address these challenges, I propose two strategies for identifying and minimizing the impact of such uncertainty: first, clinicians and ethicists ought to promote pluralistic conversations that account for different understandings of harm; second, they ought to invoke harm-independent considerations when discussing the ethics of CPR in order to reflect the nuances of such conversations. These strategies, coupled with a richer philosophical understanding of harm, promise to help clinicians and ethicists navigate the prevalent and difficult cases involving patient resuscitation and many other harm-based decisions in the clinical setting. (shrink)

Firearm injuries are a significant public health problem. Prior studies have analyzed firearm death data or adult firearm injury data, but few studies have analyzed firearm injury data specifically among youth. To inform the current debate surrounding gun policy in the United States, this study aims to provide an estimate of the immense burden of youth firearm injury and its associated risk factors. Therefore, we performed a descriptive analysis of the Nationwide Emergency Department Sample, the largest all-payer emergency department database (...) in the United States, from January 2006 to September 2015. All patients age < 21 who presented with any diagnosis of firearm-related injuries were included. There were an estimated 198,839 incidents of firearm-related emergency department visits for patients age < 21 from 2006 through 2015. After presenting to the ED, an estimated 11,909 cases resulted in death. The population adjusted rate of firearm-related emergency department visits was highest in the South and Midwest. This study demonstrates the significant burden of firearm injury among youth. Having a reliable estimate of the number of children harmed by firearms each year is a critical tool for policymakers — and may make common-sense gun safety measures more politically possible. (shrink)

Charlotte Unruh has recently put forward a hybrid account of what it is to suffer harm – one that combines comparative and non-comparative elements. We raise two problems for Unruh's account. The first concerns killing and death; the second concerns the causing of temporarily low or high welfare.

In various areas of Anglo-American law, legal liability turns on causation. In torts and contracts, we are each liable only for those harms we havecausedby the actions that breach our legal duties. Such doctrines explicitly make causation an element of liability. In criminal law, sometimes the causal element for liability is equally explicit, as when a statute makes punishable any act that has “caused… abuse to the child….” More often, the causal element in criminal liability is more implicit, as when (...) criminal statutes prohibitkillings, maimings, rapings, burnings, etc. Such causally complex action verbs are correctly applied only to defendants who have caused death, caused disfigurement, caused penetration, caused fire damage, etc. (shrink)

The foreskin is a complex structure that protects and moisturizes the head of the penis, and, being the most densely innervated and sensitive portion of the penis, is essential to providing the complete sexual response. Circumcision—the removal of this structure—is non-therapeutic, painful, irreversible surgery that also risks serious physical injury, psychological sequelae, and death. Men rarely volunteer for it, and increasingly circumcised men are expressing their resentment about it.Circumcision is usually performed for religious, cultural and personal reasons. Early claims about (...) its medical benefits have been proven false. The American Academy of Pediatrics and the Centers for Disease Prevention and Control have made many scientifically untenable claims promoting circumcision that run counter to the consensus of Western medical organizations.Circumcision violates the cardinal principles of medical ethics, to respect autonomy, to do good, to do no harm, and to be just. Without a clear medical indication, circumcision must be deferred until the child can provide his own fully informed consent.In 2012, a German court held that circumcision constitutes criminal assault. Under existing United States law and international human rights declarations as well, circumcision already violates boys› absolute rights to equal protection, bodily integrity, autonomy, and freedom to choose their own religion. A physician has a legal duty to protect children from unnecessary interventions. Physicians who obtain parental permission through spurious claims or omissions, or rely on the American Academy of Pediatrics' position, also risk liability for misleading parents about circumcision. (shrink)

To help eliminate perinatal HIV transmission, the US Department of Health and Human Services recommends against breastfeeding for women living with HIV, regardless of viral load or combined antiretroviral therapy status. However, cART radically improves HIV prognosis and virtually eliminates perinatal transmission, and breastfeeding's health benefits are well-established. In this setting, pregnancy is increasing among American women with HIV, and a harm reduction approach to those who breastfeed despite extensive counseling is suggested. We assess the evidence and ethical justification (...) for current policy, with attention to pertinent racial and health disparities. We first review perinatal transmission and breastfeeding data relevant to US infants. We compare hypothetical risk of HIV transmission from breastmilk to increased mortality from sudden infant death syndrome, necrotizing enterocolitis and sepsis from avoiding breastfeeding, finding that benefits may outweigh risks if mothers maintain undetectable viral load on cART. We then review maternal health considerations. We conclude that avoidance of breastfeeding by women living with HIV may not maximize health outcomes and discuss our recommendation for revising national guidelines in light of autonomy, harm reduction and health inequities. (shrink)

In this reply, I seek to summarize fairly the criticisms advanced by each of my four critics, Jonathan Schaffer, Gideon Yaffe, John Gardner, and Carolina Sartorio. That there is so little overlap either in the aspects of the book on which they focus or in the arguments they advance about those issues has forced me to reply to each of them separately. Schaffer focuses much of his criticisms on my view that absences cannot serve as causal relata and argues that (...) this commits me to the view that double preventions cannot be causal of events such as deaths. I deny that double preventions such as beheadings are not causal, while admitting that other double preventions are not causal but denying that this latter conclusion is unwelcome in its implications. Yaffe criticizes my view that a person substantially causing some harm H is sufficient for that person having performed the activity of H-ing, whereas I affirm that causing H is sufficient for doing the action of H-ing even if it is not sufficient for intentionally H-ing. Gardner takes issue with my “experiential argument” for the relevance of causation to moral blame; he urges that we cannot infer that we are more guilty from either the psychological fact that we feel more guilty or from the moral fact that it is virtuous to feel such heightened guilt, because it is viciously circular: we feel such guilt only because we have already judged that we are more guilty, and it is virtuous to feel such guilt only because we in fact are more guilty. I deny such circularity exists. Sartorio takes issue with my thesis that in omissive overdetermination cases neither omitter is morally responsible for the harm. I trade intuitions with Sartorio about a range of related cases that we each think bears on the issue. (shrink)