The Rachels–Temkin spectrum arguments against the transitivity of better than involve good or bad experiences, lives, or outcomes that vary along multiple dimensions—e.g., duration and intensity of pleasure or pain. This paper presents variations on these arguments involving combinations of good and bad experiences, which have even more radical implications than the violation of transitivity. These variations force opponents of transitivity to conclude that something good is worse than something that isn’t good, on pain of rejecting the good altogether. That (...) is impossible, so we must reject the spectrum arguments. (shrink)

What moral reasons, if any, do we have to ensure the long-term survival of humanity? This article contrastively explores two answers to this question: according to the first, we should ensure the survival of humanity because we have reason to maximize the number of happy lives that are ever lived, all else equal. According to the second, seeking to sustain humanity into the future is the appropriate response to the final value of humanity itself. Along the way, the article discusses (...) various issues in population axiology, particularly the so-called Intuition of Neutrality and John Broome’s ‘greediness objection’ to this intuition. (shrink)

We analyze the role of ethical values in the determination of the social cost of carbon, arguing that the familiar debate about discounting is too narrow. Other ethical issues are equally important to computing the social cost of carbon, and we highlight inequality, risk, and population ethics. Although the usual approach, in the economics of cost-benefit analysis for climate policy, is confined to a utilitarian axiology, the methodology of the social cost of carbon is rather flexible and can be expanded (...) to a broader set of social-welfare approaches. [Open access]. (shrink)

We present a new “reason-based” approach to the formal representation of moral theories, drawing on recent decision-theoretic work. We show that any moral theory within a very large class can be represented in terms of two parameters: a specification of which properties of the objects of moral choice matter in any given context, and a specification of how these properties matter. Reason-based representations provide a very general taxonomy of moral theories, as differences among theories can be attributed to differences in (...) their two key parameters. We can thus formalize several distinctions, such as between consequentialist and non-consequentialist theories, between universalist and relativist theories, between agent-neutral and agent-relative theories, between monistic and pluralistic theories, between atomistic and holistic theories, and between theories with a teleological structure and those without. Reason-based representations also shed light on an important but under-appreciated phenomenon: the “underdetermination of moral theory by deontic content”. (shrink)

Consider Phoebe and Daphne. Phoebe has credences in 1 million propositions. Daphne, on the other hand, has credences in all of these propositions, but she's also got credences in 999 million other propositions. Phoebe's credences are all very accurate. Each of Daphne's credences, in contrast, are not very accurate at all; each is a little more accurate than it is inaccurate, but not by much. Whose doxastic state is better, Phoebe's or Daphne's? It is clear that this question is analogous (...) to a question that has exercised ethicists over the past thirty years. How do we weigh a population consisting of some number of exceptionally happy and satisfied individuals against another population consisting of a much greater number of people whose lives are only just worth living? This is the question that occasions population ethics. In this paper, I go in search of the correct population ethics for credal states. (shrink)

It is notoriously difficult to find an intuitively satisfactory rule for evaluating populations based on the welfare of the people in them. Standard examples, like total utilitarianism, either entail the Repugnant Conclusion or in some other way contradict common intuitions about the relative value of populations. Several philosophers have presented formal arguments that seem to show that this happens of necessity: our core intuitions stand in contradiction. This paper assesses the state of play, focusing on the most powerful of these (...) ‘impossibility theorems’, as developed by Gustaf Arrhenius. I highlight two ways in which these theorems fall short of their goal: some appeal to a supposedly egalitarian condition which, however, does not properly reflect egalitarian intuitions; the others rely on a background assumption about the structure of welfare which cannot be taken for granted. Nonetheless, the theorems remain important: they give insight into the difficulty, if not perhaps the impossibility, of constructing a satisfactory population axiology. We should aim for reflective equilibrium between intuitions and more theoretical considerations. I conclude by highlighting one possible ingredient in this equilibrium, which, I argue, leaves open a still wider range of acceptable theories: the possibility of vague or otherwise indeterminate value relations. (shrink)

Larry Temkin famously argues that what he calls spectrum arguments yield strong reason to reject Transitivity, according to which the ‘all-things-considered better than’ relation is transitive. Spectrum arguments do reveal that the conjunctions of independently plausible claims are inconsistent with Transitivity. But I argue that there is very strong independent reason to reject such conjunctions of claims, and thus that the fact that they are inconsistent with Transitivity does not yield strong reason to reject Transitivity.

Orthodox decision theory gives no advice to agents who hold two goods to be incommensurate in value because such agents will have incomplete preferences. According to standard treatments, rationality requires complete preferences, so such agents are irrational. Experience shows, however, that incomplete preferences are ubiquitous in ordinary life. In this paper, we aim to do two things: (1) show that there is a good case for revising decision theory so as to allow it to apply non-vacuously to agents with incomplete (...) preferences, and (2) to identify one substantive criterion that any such non-standard decision theory must obey. Our criterion, Competitiveness, is a weaker version of a dominance principle. Despite its modesty, Competitiveness is incompatible with prospectism, a recently developed decision theory for agents with incomplete preferences. We spend the final part of the paper showing why Competitiveness should be retained, and prospectism rejected. (shrink)

This paper argues that we can benefit or harm people by creating them, but only in the sense that we can create things that are good or bad for them. What we cannot do is to confer comparative benefits and harms to people by creating them or failing to create them. You are not better off (or worse off) created than you would have been had you not been created, for nothing has value for you if you do not exist, (...) not even neutral value. (shrink)

If A is better than B and B is better than C, then A is better than C, right? Larry Temkin and Stuart Rachels say: No! Betterness is nontransitive, they claim. In this paper, I discuss the central type of argument advanced by Temkin and Rachels for this radical idea, and argue that, given this view very likely has sceptical implications for practical reason, we would do well to identify alternative responses. I propose one such response, which employs the idea (...) that rational agents might regard some options as incommensurate in value, and will reasonably employ a heuristic of status quo maintenance to avoid suboptimal choices from incommensurate goods. (shrink)

The spectrum argument purports to show that the better-than relation is not transitive, and consequently that orthodox value theory is built on dubious foundations. The argument works by constructing a sequence of increasingly less painful but more drawn-out experiences, such that each experience in the spectrum is worse than the previous one, yet the final experience is better than the experience with which the spectrum began. Hence the betterness relation admits cycles, threatening either transitivity or asymmetry of the relation. This (...) paper examines recent attempts to block the spectrum argument, using the idea that it is a mistake to affirm that every experience in the spectrum is worse than its predecessor: an alternative hypothesis is that adjacent experiences may be incommensurable in value, or that due to vagueness in the underlying concepts, it is indeterminate which is better. While these attempts formally succeed as responses to the spectrum argument, they have additional, as yet unacknowledged costs that are significant. In order to effectively block the argument in its most typical form, in which the first element is radically inferior to the last, it is necessary to suppose that the incommensurability is particularly acute: what might be called radical incommensurability. We explain these costs, and draw some general lessons about the plausibility of the available options for those who wish to save orthodox axiology from the spectrum argument. (shrink)

This paper casts doubts on John Broome's view that vagueness in value comparisons crowds out incommensurability in value. It shows how vagueness can be imposed on a formal model of value relations that has room for different types of incommensurability. The model implements some basic insights of the ‘fitting attitudes’ analysis of value.

Is there some large number of very mild hangnail pains, each experienced by a separate person, which would be worse than two years of excruciating torture, experienced by a single person? Many people have the intuition that the answer to this question is No. However, a host of philosophers have argued that, because we have no intuitive grasp of very large numbers, we should not trust such intuitions. I argue that there is decent intuitive support for the No answer, which (...) does not depend on our intuitively grasping or imagining very large numbers. (shrink)

Philosophers interested in the fitting attitude analysis of final value have devoted a great deal of attention to the wrong kind of reasons problem. This paper offers an example of the reverse difficulty, the wrong kind of value problem. This problem creates deeper challenges for the fitting attitude analysis and provides independent grounds for rejecting it, or at least for doubting seriously its correctness.

Intuition says that choosing to create a miserable person is wrong, but choosing not to create a happy one is not; this is ‘the Asymmetry’. There is a complete theory which agrees – the ‘Harm Minimization’ theory. A well-known objection is that this theory rejects Parfit’s principle of ‘No Difference’. But No Difference has less intuitive support than the Asymmetry, and there seems to be no complete theory which agrees with both. There is, however, a more serious problem for Harm (...) Minimization: it says it is wrong to create happy people if we could have made some of them happier at the expense of others. The purpose of this note is to describe a complete theory which agrees with the Asymmetry and avoids this unacceptable consequence; like Harm Minimization, it rejects No Difference. (shrink)

Ruth Chang has defended a concept of "parity", implying that two items may be evaluatively comparable even though neither item is better than or equally good as the other. This article takes no stand on whether there actually are cases of parity. Its aim is only to make the hitherto somewhat obscure notion of parity more precise, by defining it in terms of the standard value relations. Given certain plausible assumptions, the suggested definiens is shown to state a necessary and (...) sufficient condition for parity, as this relation is envisaged by Chang. (shrink)

It is often said that while we have a strong reason not to create someone who will be badly off, we have no strong reason for creating someone who will be well off. In this paper I argue that this asymmetry is incompatible with a plausible principle of independence of irrelevant alternatives, and that a more general asymmetry between harming and benefiting is difficult to defend. I then argue that, contrary to what many have claimed, it is possible to harm (...) or benefit someone by bringing her into existence. (shrink)

John Broome has argued that incomparability and vagueness cannot coexist in a given betterness order. His argument essentially hinges on an assumption he calls the ‘collapsing principle’. In an earlier article I criticized this principle, but Broome has recently expressed doubts about the cogency of my criticism. Moreover, Cristian Constantinescu has defended Broome’s view from my objection. In this paper, I present further arguments against the collapsing principle, and try to show that Constantinescu’s defence of Broome’s position fails.

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)

A standard liberal claim is that freedom of choice is not only instrumentally valuable but also intrinsically valuable, that is, valuable for its own sake. I argue that each one of five conditions is plausible if freedom of choice is intrinsically valuable. Yet there exists a counter-example to the conjunction of these conditions. Hence freedom of choice is not intrinsically valuable.

A notorious debate in the ethics of healthcare rationing concerns whether to address rationing decisions with substantial principles or with a procedural approach. One major argument in favour of procedural approaches is that substantial principles are indeterminate so that we can reasonably disagree about how to apply them. To deal with indeterminacy, we need a just decision process. In this paper I argue that it is a mistake to abandon substantial principles just because they are indeterminate. It is true that (...) reasonable substantial principles designed to deal with healthcare rationing can be expected to be indeterminate. Yet, the indeterminacy is only partial. In some situations we can fully determine what to do in light of the principles, in some situations we cannot. The conclusion to draw from this fact is not that we need to develop procedural approaches to healthcare rationing, but rather that we need a more complex theory in which both substantial principles and procedural approaches are needed. (shrink)

This article argues for the elimination of the concept of life worth living from philosophical vocabulary on three complementary grounds. First, the basic components of this concept suffer from multiple ambiguities, which hamper attempts to ground informative evaluative and classificatory judgments about the worth of life. Second, the criteria proposed to track the extension of the concept of life worth living rest on unsupported axiological assumptions and fail to identify precise and plausible referents for this concept. And third, the concept (...) of life worth living is not shown to serve any major evaluative or classificatory purpose besides those served by already available axiological concepts. By eliminating the concept of life worth living, philosophers will free themselves of the task of addressing ill-posed axiological questions and ground reflection about the worth of life on more rigorous conceptual foundations. (shrink)

Atomically precise manufacturing (APM) is the assembly of materials with atomic precision. APM does not currently exist, and may not be feasible, but if it is feasible, then the societal impacts could be dramatic. This paper assesses the net societal impacts of APM across the full range of important APM sectors: general material wealth, environmental issues, military affairs, surveillance, artificial intelligence, and space travel. Positive effects were found for material wealth, the environment, military affairs (specifically nuclear disarmament), and space travel. (...) Negative effects were found for military affairs (specifically rogue actor violence and AI. The net effect for surveillance was ambiguous. The effects for the environment, military affairs, and AI appear to be the largest, with the environment perhaps being the largest of these, suggesting that APM would be net beneficial to society. However, these factors are not well quantified and no definitive conclusion can be made. One conclusion that can be reached is that if APM R&D is pursued, it should go hand-in-hand with effective governance strategies to increase the benefits and reduce the harms. (shrink)

Most believe that it is worse for a person to die than to continue to exist with a good life. At the same time, many believe that it is not worse for a merely possible person never to exist than to exist with a good life. I argue that if the underlying properties that make us the sort of thing we essentially are can come in small degrees, then to maintain this commonly-held pair of beliefs we will have to embrace (...) an implausible sort of evaluative hypersensitivity to slight nonevaluative differences. Avoidance of such hypersensitivity pressures us to accept that it can be worse for merely possible people never to exist. If this conclusion is correct, then the standard basis for giving no or less priority to merely possible persons would disappear (i.e., that things cannot be better or worse for them). Though defenders of Person-Affecting Views and their opponents may still disagree in theory, they could arrive at the same answers to many monumentally important practical questions. (shrink)

This book chapter is not available in ORA, but you may download, display, print and reproduce this chapter in unaltered form only for your personal, non-commercial use or use within your organization from the ANU E Press website.

It seems better to have a life that begins poorly and ends well than a life that begins well and ends poorly. One possible explanation is that the very shape of a life can be good or bad for us. If so, this raises a tough question: when can the shape of our lives be good or bad for us? In this essay, I present and critique an argument that the shape of a life is a non-synchronic prudential value—that is, (...) something that can be good or bad for us in a way that is not good or bad for us at any particular time. After distinguishing two interpretations of ‘the shape of a life’, I argue that the first type of shape can be good or bad for us at particular moments while the other cannot be good or bad for us at all. This suggests that the shape of a life gives us no reason to posit non-synchronic prudential values. (shrink)

Some environmental ethicists and economists argue that attributing infinite value to the environment is a good way to represent an absolute obligation to protect it. Others argue against modelling the value of the environment in this way: the assignment of infinite value leads to immense technical and philosophical difficulties that undermine the environmentalist project. First, there is a problem of discrimination: saving a large region of habitat is better than saving a small region; yet if both outcomes have infinite value, (...) then decision theory prescribes indifference. Second, there is a problem of swamping probabilities: an act with a small but positive probability of saving an endangered species appears to be on par with an act that has a high probability of achieving this outcome, since both have infinite expected value. Our paper shows that a relative concept of infinite value can be meaningfully defined, and provides a good model for securing the priority of the natural environment while avoiding the failures noted by sceptics about infinite value. Our claim is not that the relative infinity utility model gets every detail correct, but rather that it provides a rigorous philosophical framework for thinking about decisions affecting the environment. (shrink)

This article argues that values that apply to health care allocation entail the possibility of “spectrum arguments,” and that it is plausible that they often fail to determine a best alternative. In order to deal with this problem, a two-step process is suggested. First, we should identify the Strongly Uncovered Set that excludes all alternatives that are worse than some alternatives and not better in any relevant dimension from the set of eligible alternatives. Because the remaining set of alternatives often (...) contain more than one element, we need some complementary method of selecting a unique alternative. In order to address this issue, I suggest that we must invoke caps on the values that are used to evaluate alternatives, and that these caps must be grounded in collective commitments. (shrink)

In the Global Burden of Disease study, disease burden is measured as disability-adjusted life years (DALYs). The paramount assumption of the DALY is that it makes sense to aggregate years lived with disability (YLDs) and years of life lost (YLLs). However, this is not smooth sailing. Whereas morbidity (YLD) is something thathappens toan individual, loss of life itself (YLL) occurs when that individual’s life has ended. YLLs quantify something that involves no experience and does not take place among living individuals. (...) This casts doubt on whether the YLL is an individual burden at all. If not, then YLDs and YLLs are incommensurable. There are at least three responses to this problem, only one of which is tenable: a counterfactual account of harm. Taking this strategy necessitates a re-examination of how we count YLLs, particularly at the beginning of life. (shrink)

In this paper, I argue against defining either of ‘good’ and ‘better’ in terms of the other. According to definitions of ‘good’ in terms of ‘better’, something is good if and only if it is better than some indifference point. Against this approach, I argue that the indifference point cannot be defined in terms of ‘better’ without ruling out some reasonable axiologies. Against defining ‘better’ in terms of ‘good’, I argue that this approach either cannot allow for the incorruptibility of (...) intrinsic goodness or it breaks down in cases where both of the relata of ‘better’ are bad. (shrink)

Philosophical discussions of prioritarianism, the view that we ought to give priority to those who are worse off, have hitherto been almost exclusively focused on cases involving a fixed population. The aim of this paper is to extend the discussion of prioritarianism to encompass also variable populations. I argue that prioritarianism, in its simplest formulation, is not tenable in this area. However, I also propose several revised formulations that, so I argue, show more promise.

Utilitarians must think collectively about the future because many contemporary moral issues require collective responses to avoid possible future harms. But current rule utilitarianism does not accommodate the distant future. Drawing on my recent books Future People and Ethics for a Broken World, I defend a new utilitarianism whose central ethical question is: What moral code should we teach the next generation? This new theory honours utilitarianism’s past and provides the flexibility to adapt to the full range of credible futures (...) – from futures broken by climate change to the digital, virtual and predictable futures produced by various possible technologies. (shrink)

Utilitarianism and prioritarianism make a strong assumption about the uniqueness of measures of how good things are for people, or for short, individual goodness measures. But it is far from obvious that the presupposition is correct. The usual response to this problem assumes that individual goodness measures are determined independently of our discourse about distributive theories. This article suggests reversing this response. What determines the set of individual goodness measures just is the body of platitudes we accept about distributive theories. (...) When prioritarianism is taken to have an ex ante form, this approach vindicates the utilitarian and prioritarian presupposition, and provides an answer to an argument due to Broome that for different reasons to do with measurement, prioritarianism is meaningless. (shrink)

This article discusses the possibility of a rationally justified choice between two options neither of which is better than the other while they are not equally good either (‘3NT’). Joseph Raz regards such options as incomparable and argues that reason cannot guide the choice between them. Ruth Chang, by contrast, tries to show that many cases of putative incomparability are instead cases of parity—a fourth value relation of comparability, in addition to the three standard value relations ‘better than’, ‘worse than’ (...) and ‘equally good as’. It follows, she argues, that many choice situations in which rationally justified choice seems precluded are in fact situations within the reach of practical reason. This article has three aims: (1) it challenges Chang’s argument for the possibility of parity; (2) it demonstrates that, even if parity would exist, its problematic implications for practical reason would not differ from those of Raz’s incomparability; (3) it discusses the underlying cause of hard cases of comparison: the fact that none of the three standard value relations applies (‘3NT’). It will be shown that the problematic implications for the rational justification of the choice are due to 3NT itself, irrespective of whether 3NT is explained as incomparability or parity. (shrink)

A popular view about why death is bad for the one who dies is that death deprives its subject of the good things in life. This is the “deprivation account” of the evil of death. There is another view about death that seems incompatible with the deprivation account: the view that a person’s death is less bad if she has lived a good life. In The Ethics of Killing, Jeff McMahan argues that a deprivation account should discount the evil of (...) death for previous gains in life. I argue against discounting evils, and show how a version of the deprivation view can accommodate McMahan’s examples. (shrink)

Two related asymmetries have been discussed in relation to the ethics of creating new lives: First, we seem to have strong moral reason to avoid creating lives that are not worth living, but no moral reason to create lives that are worth living. Second, we seem to have strong moral reason to improve the wellbeing of existing lives, but, again, no moral reason to create lives that are worth living. Both asymmetries have proven very difficult to account for in any (...) coherent moral framework. I propose an impersonal population axiology to underpin the asymmetries, which sidesteps the problematic issue of whether or not people can be harmed or benefited by creation or non-creation. This axiology yields perfect asymmetry from a deliberative perspective, in terms of expected value. The axiology also yields substantial asymmetry for large and realistic populations in terms of their actual value, beyond deliberative relevance. (shrink)

While different worries about population size are present in public debates, political philosophers often take population size as given. This paper is an attempt to formulate a Rawlsian liberal egalitarian approach to population size: does it make sense to speak of ‘too few’ or ‘too many’ people from the point of view of justice? It argues that, drawing on key features of liberal egalitarian theory, several clear constraints on demographic developments – to the extent that they are under our control (...) – can be formulated. Based on these claims, we can clarify both the grounds and content of our obligations to future generations. (shrink)

This paper defines and analyses the concept of a 'ranking problem'. In a ranking problem, a set of objects, each of which possesses some common property P to some degree, are ranked by P-ness. I argue that every eligible answer to a ranking problem can be expressed as a complete and transitive 'is at least as P as' relation. Vagueness is expressed as a multiplicity of eligible rankings. Incommensurability, properly understood, is the absence of a common property P. Trying to (...) analyse incommensurability in the same framework as ranking problems causes unnecessary confusion. (shrink)

We know that Homo sapiens will not exist forever. Given this, how should our species end? What are the reasons, if any, to delay our extinction? In this paper, I show that the pre-eminent reasons which favour prolonging the existence of the species are partial: they will arise from the particular attachments and projects of the final few generations. While there may also be impartial reasons to prolong the species, these reasons are liable, with time, to reverse their valence: we (...) can be reasonably confident that they will ultimately recommend hastening the demise of the species. Consequently, it is likely that our descendants will eventually face a difficult -- possibly tragic -- conflict, between partial duties that recommend living on, and an impartial duty to extinguish the species. (shrink)

Metaethics is often dominated by both realist views according to which moral claims are made true by either non-natural or natural properties and by non-cognitivist views according to which these claims express desire-like attitudes. It is sometimes suggested that constructivism is a fourth alternative, but it has remained opaque just how it differs from the other views. To solve this problem, this article first describes a clear constructivist theory based on Crispin Wright’s anti-realism. It then outlines an argumentative strategy that (...) can be used to argue against constructivist views about practical reasons. The rest of the article explains how the outlined constructivist metaethical framework, reasons, and contractualism in normative ethics can still be used to create a new viable metaethical constructivist position about right and wrong. (shrink)

There exists a derived negative right to procreative freedom, including a right to in vitro fertilisation (IVF) and to the exercise of selective techniques such as preimplantation genetic diagnosis. This is an extensive freedom, including not only the right to the exercise of a responsible parenthood, but also, in rare cases, to wrong decisions. It includes also a right for less than perfect parents to the use of IVF, and for IVF doctors to assist them, if they want and can (...) agree about the terms. (shrink)

Items are incommensurate if it is false that one is better than the other or that they are exactly as or equally good. John Broome claims that there are no incommensurate items (in some domain), but that there is vagueness. Wlodek Rabinowicz casts doubt on this claim because he rejects a principle which Broome adopts in advancing it. I argue that Robert Sugden's discussion can be interpreted as advancing a version of this claim which does not depend on the relevant (...) principle and which can respond to certain objections. (shrink)

Definition of the problem The creation and selection of children as tissue donors is ethically controversial. Critics often appeal to Kant’s Formula of Humanity, i.e. the requirement that people be treated not merely as means but as ends in themselves. As many defenders of the procedure point out, these appeals usually do not explain the sense of the requirement and hence remain obscure. Arguments This article proposes an interpretation of Kant’s principle, and it proposes that two different instrumental stances be (...) distinguished. I argue that the creation of “saviour children” is a form of instrumentalization that I dub “preemptive instrumentalization” and that it is categorically different from earlier forms of instrumental attitudes concerning human reproduction. Conclusion Critics are wrong to claim that Kant’s principle is either compatible with the selection of saviour siblings or too vague to serve as an ethical principle. (shrink)

In this paper I argue that resource allocation in publicly funded medical systems cannot be done using a purely substantive theory of justice, but must also involve procedural justice. I argue further that procedural justice requires institutions and that these must be “local” in a specific sense which I define. The argument rests on the informational constraints on any non-market method for allocating scarce resources among competing claims of need. However, I resist the identification of this normative account of local (...) justice with the actual approach to local decision-making taken within the UK National Health Service. I illustrate my argument with reference to the case of provision of In Vitro Fertilisation within the UK NHS. (shrink)

Substitute decision-makers for severely disabled neonates who can be kept alive but who will require constant medical interventions and will die at the latest in their teens are faced with a difficult decision when trying to decide whether to keep the infant alive. By and large, the primary focus of their decision-making centers on what is in the best interests of the newborn. The best-interests criterion, in turn, is importantly conditioned by quality-of-life considerations. However, the concept of quality of life (...) is logically and ethically different for patients with a developing as opposed to a developed awareness. Unfortunately, this difference is ignored by current quality-of-life considerations, there are no quality-of-life measures that take this difference into account, and decision-making proceeds entirely without acknowledging this fact. This note outlines why this is a problem and why there is a need for a new set of tools that incorporates this distinction if the substitute decision-makers are to apply the best-interest criterion in a meaningful way. (shrink)