Often lurking below the surface of many clinical ethical issues are questions regarding background metaphysical, epistemological, meta-ethical, and political beliefs. In this issue, authors critically examine the effects of background beliefs on conscientious objection, explore ethical issues through the lenses of particular theoretical approaches like pragmatism and intersectional theory, rigorously explore the basic concepts at play within the patient safety movement, offer new theoretical approaches to old problems involving decision making for patients with dementia, explicate and explore the problems and (...) promises of machine learning in medicine, and offer us a non-rights-based argument for the just distribution of healthcare resources. (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)

BackgroundThe state of the world is one with scarce medical resources where longevity is not equally distributed. Given such facts, setting priorities in health entails making difficult yet unavoidable decisions about which lives to save. The business of saving lives works on the assumption that longevity is valuable and that an early death is worse than a late death. There is a vast literature on health priorities and badness of death, separately. Surprisingly, there has been little cross-fertilisation between the academic (...) fields of priority setting and badness of death. Our aim is to connect philosophical discussions on the badness of death to contemporary debates in health priorities.DiscussionTwo questions regarding death are especially relevant to health priorities. The first question is why death is bad. Death is clearly bad for others, such as family, friends and society. Many philosophers also argue that death can be bad for those who die. This distinction is important for health priorities, because it concerns our fundamental reasons for saving lives. The second question is, ‘When is the worst time to die?’ A premature death is commonly considered worse than a late death. Thus, the number of good life years lost seems to matter to the badness of death. Concerning young individuals, some think the death of infants is worse than the death of adolescents, while others have contrary intuitions. Our claim is that to prioritise between age groups, we must consider the question of when it is worst to die.ConclusionsDeprivationism provides a more plausible approach to health priorities than Epicureanism. If Deprivationism is accepted, we will have a firmer basis for claiming that individuals, in addition to having a health loss caused by morbidity, will have a loss of good life years due to mortality. Additionally, Deprivationism highlights the importance of age and values for health priorities. Regarding age, both variants of Deprivationism imply that stillbirths are included in the Global Burden of Disease. Finally, we suggest that the Time-Relative Interest Account may serve as an alternative to the discounting and age weighting previously applied in the Global Burden of Disease. (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)

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)

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)