Perhaps death’s badness is an illusion. Epicureans think so and argue that agents cannot be harmed by death when they’re alive nor when they’re dead. I argue that each version of Epicureanism faces a fatal dilemma: it is either committed to a demonstrably false view about the relationship between self-regarding reasons and well-being or it is involved in a merely verbal dispute with deprivationism. I first provide principled reason to think that any viable view about the badness of death must (...) allow that agents have self-regarding reason to avoid death if doing so would increase their total well-being. I then show that Epicurean views which do not preserve this link are subject to reductio arguments and so should be rejected. After that, I show that the Epicurean views which accommodate this desideratum are involved in a merely verbal dispute with deprivationism. (shrink)

In recent years, it has become commonplace among the Global Burden of Disease study authors to regard the disability-adjusted life year primarily as a descriptive health metric. During the first phase of the GBD, it was widely acknowledged that the DALY had built-in evaluative assumptions. However, from the publication of the 2010 GBD and onwards, two central evaluative practices—time discounting and age-weighting—have been omitted from the DALY model. After this substantial revision, the emerging view now appears to be that the (...) DALY is primarily a descriptive measure. Our aim in this article is to argue that the DALY, despite changes, remains largely evaluative. Our analysis focuses on the understanding of the DALY by comparing the DALY as a measure of disease burden in the two most significant phases of GBD publications, from their beginning to the most recent releases. We identify numerous assumptions underlying the DALY and group them as descriptive or evaluative. We conclude that while the DALY model arguably has become more descriptive, it remains, by necessity, largely evaluative. (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)

David Boonin argues that in a choice between creating a person whose life would be well worth living and creating a different person whose life would be significantly worse, but still worth living, each option is morally permissible. I show that Boonin's argument for this view problematically implies that in a choice between creating a person whose life would be well worth living and creating another person whose life would not be worth living, each option is also morally permissible.

A powerful argument against the counterfactual comparative account of harm is that it cannot distinguish harming from failing to benefit. In reply to this problem, I suggest a new account of harm. The account is a counterfactual comparative one, but it counts as harms only those events that make a person occupy his level of well-being at the world at which the event occurs. This account distinguishes harming from failing to benefit in a way that accommodates our intuitions about the (...) standard problem cases. In laying the groundwork for this account, I also demonstrate that rival accounts of harm are able to distinguish harming from failing to benefit only if, and because, they also appeal to the distinction between making upshots happen and allowing upshots to happen. One important implication of my discussion is that preserving the moral asymmetry between harming and failing to benefit requires a commitment to the existence of a metaphysical and moral distinction between making and allowing. (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)

This paper defends the claim that if a person P exists, there can be true positive comparisons between P's existence and P's never having existed at all in terms of what is better or worse for P. If correct, this view will have significant implications for various fundamental issues in population ethics. I try to show how arguments to the contrary fail to take note of a general ambiguity in comparisons when compared alternatives contain their own different standards (or, in (...) the case of non-existence, a lack thereof) on which to base these comparisons. After having answered arguments against the possibility of making positive comparisons, the paper develops a positive account of how to make existence/non-existence comparisons in terms of personal value whilst accepting that a person's non-existence fails to make any contact with the relevant categories of personal value. The guiding idea is the following: When some item satisfies some relevant standard, we can, I argue, infer that it satisfies this standard better than something that fails to satisfy this standard (be this failure due to empirical or conceptual reasons). (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)

If a person’s death is bad for him for the reason that he would have otherwise been intrinsically better off, as the Deprivation Approach says, does it not follow that his prenatal nonexistence is bad for him as well? Recently, it has been suggested that the “A-theory” of time can be used to support a negative answer to this question. In this paper, I raise some problems for this approach.

The counterfactual comparative account of harm (cca) faces well-known problems concerning preemption and omission. In a recent article in this journal, Daniel Immerman proposes a novel variant of cca, which he calls the worse than nothing account (wtna). According to Immerman, wtna nicely handles the preemption and omission problems. We seek to show, however, that wtna is not an acceptable account of harm. In particular, while wtna deals better than cca with some cases that involve preemption and omission, it has (...) implausible implications in other similar cases – cases that, moreover, pose no problems for cca. (shrink)

In this paper, we present and defend an analysis of harm that we call the Negative Influence on Well-Being Account (NIWA). We argue that NIWA has a number of significant advantages compared to its two main rivals, the Counterfactual Comparative Account (CCA) and the Causal Account (CA), and that it also helps explain why those views go wrong. In addition, we defend NIWA against a class of likely objections, and consider its implications for several questions about harm and its role (...) in normative theorizing. (shrink)

The problem of justified harm is the problem of explaining why it is permissible to inflict harm for the sake of future benefits in some cases but not in others. In this paper I first motivate the problem by comparing a case in which a lifeguard breaks a swimmer’s arm in order to save her life to a case in which Nazis imprison a man who later grows wiser as a result of the experience. I consider other philosophers’ attempts to (...) explain why the lifeguard’s action was permissible but the Nazis’ action was not. After arguing that principles having to do with consent, expected utility, and the types of harms and benefits at issue do not fully solve the problem, I argue for a causal solution to the problem. The causal solution includes both a causal account of harming and a distinction between causes and mere conditions. It then distinguishes between the lifeguard and Nazi cases with following principle: A harmful action that causes greater benefits can sometimes be justified by those benefits, but a harmful action that does not cause greater benefits cannot be justified by any subsequent benefits that the action, itself, does not cause. (shrink)

Epicureans believe that death cannot harm the one who dies because they hold the existence condition, which states that a subject is able to be harmed only while they exist. I show that on one reading of this condition death can, in fact, make the deceased worse off because it is satisfied by the deprivation account of death’s badness. I argue that the most plausible Epicurean view holds the antimodal existence condition, according to which no merely possible state of affairs (...) can be good or bad relative to the subject who dies. I go on to show how this condition, as well as any other condition that denies the deprivation account, results in skepticism about practical reason. Thus, the Epicurean faces a dilemma. Either our practical reasoning is hopelessly mistaken or death can make us worse off. Given that our practical reasoning seems at least mildly reliable, we should conclude that death can make us worse off. (shrink)

On a view most secularists accept, the deceased individual goes out of existence. How, then, can death be a bad thing for, or harm, the deceased? I consider the doctrine of subsequentism, according to which the bad thing for the deceased, or the harm of death to the deceased, takes place after he or she has died. The main puzzle for this view is to explain how we can predicate a property at a time (such as having a misfortune or (...) being harmed) to an individual who does not exist at that time. This is the Problem of Predication. I consider alternative attempts to solve this puzzle, including one suggested by Ben Bradley, and I argue that they do not succeed. I go on to provide a new way of addressing the Problem of Predication and thus defending subsequentism against this specific threat, contrasting my approach with others currently on offer. (shrink)

According to Jerome Wakefield’s harmful dysfunction analysis of medical disorder, the inability of some internal part or mechanism to perform its natural function is necessary, but not sufficient, for disorder. HDA also requires that the part dysfunction be harmful to the individual. I consider several problems for HDA’s harm criterion in this article. Other accounts on which harm is necessary for disorder will suffer from all or almost all of these problems. Comparative accounts of harm imply that one is harmed (...) when one is made worse off, that is, worse off than one otherwise would have been. Non-comparative accounts imply that one is harmed when one is put into some kind of condition or state that is, in some way, bad in itself. I argue that whether harm is construed comparatively or non-comparatively, HDA’s harm criterion is problematic. I tentatively conclude that an analysis of medical disorder should not make use of the concept of harm. (shrink)

According to the Timing Argument, death is not bad for the individual who dies, because there is no time at which it could be bad for her. Defenders of the badness of death have objected to this influential argument, typically by arguing that there are times at which death is bad for its victim. In this paper, I argue that a number of these writers have been concerned with quite different formulations of the Timing Argument. Further, and more importantly, I (...) show that their objections to the Timing Argument fail as attempts to refute the argument in its most challenging form. (shrink)

A central claim in abortion ethics is what might be called the Harm Claim – the claim that abortion harms the fetus. In this article, we put forward a simple and straightforward reason to reject the Harm Claim. Rather than invoking controversial assumptions about personal identity, or some nonstandard account of harm, as many other critics of the Harm Claim have done, we suggest that the aborted fetus cannot be harmed for the simple reason that it does not occupy any (...) well-being level. (shrink)

A central claim in abortion ethics is what might be called the Harm Claim – the claim that abortion harms the fetus. In this article, we put forward a simple and straightforward reason to reject the Harm Claim. Rather than invoking controversial assumptions about personal identity, or some nonstandard account of harm, as many other critics of the Harm Claim have done, we suggest that the aborted fetus cannot be harmed for the simple reason that it does not occupy any (...) well-being level. (shrink)

This article discusses the relationship between two theories about the badness of death, the Life-Comparative Account and the Gradualist Account, and two methods of operationalizing severity in health care priority setting, Absolute Shortfall and Proportional Shortfall. The aim is that theories about the badness of death can influence and inform the idea of the basis of severity as a priority setting criterion. I argue that there are strong similarities between the Life-Comparative Account and Absolute Shortfall, and since the Life-Comparative Account (...) is one of the most reasonable accounts of the badness of death, this provides some support for using Absolute Shortfall. I also argue that it is difficult to find support for Proportional Shortfall from theories about the badness of death, and also, that it is difficult to find support for Gradualist Account from theories about severity. (shrink)

There is a significant debate over the moral status of human embryos. This debate has important implications for practices like abortion and IVF. Some argue that embryos have the same moral status as infants, children, and adults. However, critics claim that the frequency of pregnancy loss/miscarriage/spontaneous abortion shows a moral inconsistency in this view. One line of criticism is that those who know the facts about pregnancy loss and nevertheless attempt to conceive children are willing to sacrifice embryos lost for (...) the healthy children they ultimately have. I respond to this criticism and argue that on the most plausible accounts of well-being, these embryos are not made worse off and thus not “sacrifices.” I then make some more general remarks about what people’s typical views about pregnancy loss show about their views toward the moral status of embryos. (shrink)

Philosophers often identify needing something with requiring it to avoid harm. This view of need is roughly accurate, but no adequate analysis of the relevant sort of requirement has been given, and the relevant notion of harm has not been clarified. Further, the harm-avoidance picture must be broadened, because we also need what is required to reduce danger. I offer two analyses of need (one probabilistic) to address these shortcomings. The analyses are at a high level of generality and accommodate (...) our ordinary notion of need as well as narrower conceptions. I also explain why the only extant, detailed modal account of need, David Wiggins’s (1987/1998), is inadequate. My analyses imply that to have a need for something is to have the (expected) quality of one’s life depend counterfactually on it in a certain way. The analyses shed some light on need’s distinctive normative significance. (shrink)

In a recent Utilitas article, Neil Feit argues that every person occupies a well-being level of zero at all times and possible worlds at which she fails to exist. Views like his face the problem of the subject': how can someone have a well-being level in a scenario where she lacks intrinsic properties? Feit argues that this problem can be solved by noting, among other things, that a proposition about a person can be true at a possible world in which (...) neither she nor the proposition exists. In this response, we argue that Feit has not solved the problem of the subject, and also raise various related problems for his approach. (shrink)

In a recent article in this journal, I claimed that the widely held counterfactual comparative account of harm violates two very plausible principles about harm and prudential reasons. Justin Klocksiem argues, in a reply, that CCA is in fact compatible with these principles. In this rejoinder, I shall try to show that Klocksiem’s defense of CCA fails.

The counterfactual comparative account of harm faces problems in cases that involve overdetermination and preemption. An influential strategy for dealing with these problems, drawing on a suggestion made by Derek Parfit, is to appeal to _plural harm_—several events _together_ harming someone. We argue that the most well-known version of this strategy, due to Neil Feit, as well as Magnus Jedenheim Edling’s more recent version, is fatally flawed. We also present some general reasons for doubting that the overdetermination and preemption problems (...) for the counterfactual comparative account can be satisfactorily solved by appealing to plural harm. (shrink)

A popular view of harming is the causal account (CA), on which harming is causing harm. CA has several attractive features. In particular, it appears well equipped to deal with the most important problems for its main competitor, the counterfactual comparative account (CCA). However, we argue that, despite its advantages, CA is ultimately an unacceptable theory of harming. Indeed, while CA avoids several counterexamples to CCA, it is vulnerable to close variants of some of the problems that beset CCA.

This paper argues that Epicureanism about death is consistent with grounding the wrongness of killing in the interests of the victim. Both defenders and critics of Epicureanism should agree that, if we knew Epicureanism to be false, then we would have a moral reason not to kill people. We would have this reason because we would know that killing people harms them. And even Epicureans should agree that, given their evidence, Epicureanism could be false. Given that it could be false, (...) and given that we would harm people by killing them if it were, we in fact have a moral reason not to kill them—a reason which, as this paper will show, is both grounded in their interests and consistent with the failure of death to be in any way bad. The latter part of the paper discusses some advantages that this approach enjoys over two other attempts to reconcile Epicureanism with the wrongness of killing, by David Hershenov and Mikel Burley, respectively. (shrink)

Can existence benefit or harm a person? I argue that it cannot. In order for existence to harm a person it has to be the case that existence is worse for the person than never existing. This claim could only be true if it is understood as a claim about the actual, extrinsic value of existence for a person. However, understanding harm in terms of actual extrinsic value comes at the cost of depriving benefits and harms of their normative relevance. (...) I show that a person who is guided by promoting actual extrinsic value can face situations where an outcome is extrinsically better for her but where the same outcome would be extrinsically worse for her were it to obtain. A person who is guided by promoting extrinsic value will in such situations not be able to deliberate about what she should do, prudentially or morally. I conclude that extrinsic value is therefore not something we should be guided by when deliberating about what we should do, and that if harm and benefit is understood in terms of extrinsic value, then we should not be guided by these notions either. (shrink)