Some suggest that gene editing human embryos to prevent genetic disorders will be in one respect morally preferable to using genetic selection for the same purpose: gene editing will benefit particular future persons, while genetic selection would merely replace them. We first construct the most plausible defence of this suggestion—the benefit argument—and defend it against a possible objection. We then advance another objection: the benefit argument succeeds only when restricted to cases in which the gene-edited child would have been brought (...) into existence even if gene editing had not been employed. Our argument relies on a standard account of comparative benefit which has recently been criticised on the grounds that it succumbs to the so-called ‘pre-emption problem’. We end by considering how our argument would be affected were the standard account revised in an attempt to evade this problem. We consider three revised accounts and argue that, on all three, our critique of the benefit argument stands. (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 Counterfactual Comparative Account of Harm says that an event is overall harmful for someone if and only if it makes her worse off than she otherwise would have been. I defend this account from two common objections.

Many of us agree that we ought not to wrong future people, but there remains disagreement about which of our actions can wrong them. Can we wrong individuals whose lives are worth living by taking actions that result in their very existence? The problem of justifying an answer to this question has come to be known as the non-identity problem.[1] While the literature contains an array of strategies for solving the problem,[2] in this paper I will take what I call (...) the harm-based approach, and I will defend an account of harming—which I call the existence account of harming—that can vindicate this approach. -/- Roughly put, the harm-based approach holds that, by acting in ways that result in the existence of individuals whose lives are worth living, we can harm and thereby wrong those individuals. An initially plausible way to try to justify this approach is to endorse the non-comparative account of harming, which holds that an event harms an individual just in case it causes her to be in a bad state, such that the state’s badness does not derive from a comparison between that state and some alternative state that the individual would or could have been in. However, many philosophers argue that the non-comparative account of harming is inadequate,[3] and one might be tempted to infer from this that any harm-based approach to the non-identity problem will fail. My proposal, which I call the existence account of harming, will show that this inference is faulty: we can vindicate the harm-based approach without relying on the non-comparative account of harming. (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.

According to the standard version of the counterfactual comparative account of harm, an event is overall harmful for an individual if and only if she would have been on balance better off if it had not occurred. This view faces the “preemption problem.” In the recent literature, there are various ingenious attempts to deal with this problem, some of which involve slight additions to, or modifications of, the counterfactual comparative account. We argue, however, that none of these attempts work, and (...) that the preemption problem continues to haunt the counterfactual comparative account. (shrink)

ABSTRACT When does a state of affairs constitute a harm to someone? Comparative accounts say that being worse off constitutes harm. The temporal version of the comparative account is seldom taken seriously, due to apparently fatal counterexamples. I defend the temporal version against these counterexamples, and show that it is in fact more plausible than the prominent counterfactual version of the account. Non-comparative accounts say that being badly off constitutes harm. However, neither the temporal comparative account nor the non-comparative account (...) can correctly classify all harms. I argue that we should combine them into a hybrid account of harm. The hybrid account is extensionally adequate and presents a unified view on the nature of harm. (shrink)

In recent years, philosophers have proposed a variety of accounts of the nature of harm. In this paper, I consider several of these accounts and argue that they are unsuccessful. I then make a modest case for a different view.

Because harm is an important notion in ethics, it’s worth investigating what it amounts to. The counterfactual comparative account of harm, commonly thought to be the most promising account of harm, analyzes harm by comparing what actually happened with what would have happened in some counterfactual situation. But it faces the preemption problem, a problem so serious that it has driven some to suggest we abandon the counterfactual comparative account and maybe even abandon the notion of harm altogether. This paper (...) defends a version of the counterfactual comparative account that solves the preemption problem, a version called the “worse than nothing account.” It says that you harm someone just in case you leave them worse off than if you’d done nothing at all. (shrink)

In this paper, I consider the problem of omission for the counterfactual comparative account of harm. A given event harms a person, on this account, when it makes her worse off than she would have been if it had not occurred. The problem arises because cases in which one person merely fails to benefit another intuitively seem harmless. The account, however, seems to imply that when one person fails to benefit another, the first thereby harms the second, since the second (...) person would have been better off if the first had benefited her. I argue that the cases of failing to benefit at issue are in fact cases of harming. They are cases of preventive harm. I also argue that we can explain away the intuition that no harm occurs in these cases, and that the relevant implication of the counterfactual comparative account is consistent with a variety of plausible views about the moral significance of harm. (shrink)

Consider a duty of beneficence towards a particular individual, S, and call a reason that is grounded in that duty a “beneficence reason towards S.” Call a person who will be brought into existence by an act of procreation the “resultant person.” Is there ever a beneficence reason towards the resultant person for an agent to procreate? In this paper, I argue for such a reason by appealing to two main premises. First, we owe a pro tanto duty of beneficence (...) to future persons; and second, some of us can benefit some of those persons by procreating. In support of the first premise I reject the presentist account of time in favor of the view that future persons are just as real as presently existing persons. I then argue that future persons are like us in all the morally relevant ways, and since we owe duties of beneficence to each other, we also owe duties of beneficence to future persons. In support of the second premise I offer an account of benefiting according to which an individual can be benefited by an action even if it makes her no better off than she would have been, had the action not been performed. This account of benefiting solves what I call the “non-identity benefit problem.” Finally, I argue that having a life worth living is a benefit, and some of us can cause some persons that benefit by causing them to exist. (shrink)

According to the person-affecting view, the ethics of welfare should be cashed out in terms of how the individuals are affected. While the narrow version fails to solve the non-identity problem, the wide version is subject to the repugnant conclusion. A middle view promises to do better – the Interpersonal Comparative View of Welfare (ICV). It modifies the narrow view by abstracting away from individuals’ identities to account for interpersonal gains and losses. The paper assesses ICV’s merits and flaws. ICV (...) solves the non-identity problem, avoids the repugnant conclusion, and seems to accommodate the person-affecting intuition. But it cuts too many things along the way: ICV obstructs the advantage of the wide view to account for all future individuals’ welfare, abandons the intuitions that underlie the narrow view, and even violates its own presuppositions by turning out to be merely pseudo person-affecting. (shrink)

The counterfactual comparative account of harm and benefit has several virtues, but it also faces serious problems. I argue that CCA is incompatible with the prudential and moral relevance of harm and benefit. Some possible ways to revise or restrict CCA, in order to avoid this conclusion, are discussed and found wanting. Finally, I try to show that appealing to the context-sensitivity of counterfactuals, or to the alleged contrastive nature of harm and benefit, does not provide a solution.

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.

A prominent objection to the counterfactual comparative account of harm is that it classifies as harmful some events that are, intuitively, mere failures to benefit. In an attempt to solve this problem, Duncan Purves has recently proposed a novel version of the counterfactual comparative account, which relies on a distinction between making upshots happen and allowing upshots to happen. In this response, we argue that Purves’s account is unsuccessful. It fails in cases where an action makes the subject occupy a (...) high well-being level though one of the available alternatives would have made it even higher. In fact, it fails even in some cases where each of the available alternatives to the action that was actually performed would have made the subject’s well-being level lower. (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)

In the literature about harm, the counterfactual comparative account has emerged as a main contender. According to it, an event constitutes a harm for someone iff the person is worse off than they would otherwise have been as a result. But the counterfactual comparative account faces significant challenges, one of the most serious of which stems from examples involving non-harmful omitted actions or non-occurring events, which it tends to misclassify as harms: for example, Robin is worse off when Batman does (...) not give him a new set of golf clubs, but Batman has not harmed him. In this article, I will clearly state the counterfactual comparative account; state and explain this objection to the account; canvass several unsatisfactory responses; and attempt to show how the account can overcome the objection. This solution involves distinguishing between principles concerning the existence of harm and principles concerning attributions of responsibility for harm. (shrink)

Luck egalitarianism is a responsibility-sensitive theory of distributive justice. Its application to health and healthcare is controversial. This article addresses a novel critique of luck egalitarianism, namely, that it wrongfully discriminates against those responsible for their health disadvantage when allocating scarce healthcare resources. The philosophical literature about discrimination offers two primary reasons for what makes discrimination wrong (when it is): harm and disrespect. These two approaches are employed to analyze whether luck egalitarian healthcare prioritization should be considered wrongful discrimination. Regarding (...) harm, it is very plausible to consider the policies harmful but much less reasonable to consider those responsible for their health disadvantages a socially salient group. Drawing on the disrespect literature, where social salience is typically not required for something to be discrimination, the policies are a form of discrimination. They are, however, not disrespectful. The upshot of this first assessment of the discrimination objection to luck egalitarianism in health is, thus, that it fails. (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 and benefit (CCA) has faced a barrage of objections from cases involving preemption, overdetermination, and choice. In this paper I provide a unified diagnosis of CCA’s vulnerability to these objections: CCA is susceptible to them because it evaluates each act by the same criterion. This is a mistake because, in a sense I make precise, situations raise prudential questions, and only some acts—the relevant alternatives—are directly relevant to these questions. To answer the objections, we (...) must revise CCA so that its evaluations foreground the relevant alternatives. The result is a question-centered account of harm and benefit. (shrink)

In this paper, we put forward two novel arguments against the counterfactual comparative account (CCA) of harm and benefit. In both arguments, the central theme is that CCA conflicts with plausible judgements about benefit and prudence.

Many legal, social, and medical theorists and practitioners, as well as lay people, seem to be concerned with the harmfulness of discriminative practices. However, the philosophical literature on the moral wrongness of discrimination, with a few exceptions, does not focus on harm. In this paper, I examine, and improve, a recent account of wrongful discrimination, which divides into a definition of group discrimination, and a characterisation of its moral wrong-making feature in terms of harm. The resulting account analyses the wrongness (...) of discrimination in terms of intrapersonal comparisons of the discriminatee’s actual, and relevantly counterfactual, well-being levels. I show that the account faces problems from counterfactuals, which can be traced back specifically to the orthodox - comparative, counterfactual, welfarist - concept of harm. I argue that non-counterfactual and non-comparative harm concepts face problems of their own, and don’t fit easily with our best understanding of discrimination; hence they are unsuitable to replace the orthodox concept here. I then propose a non-orthodox - comparative, counterfactual, hybrid - concept of harm, which relies on counterfactual comparisons of ways of being treated. I suggest how such a concept can help us handle the problems from counterfactuals, at least for my account of discrimination. I also show that there are similar proposals in other harm-related debates. An upshot of the paper is thus to corroborate the case for a non-orthodox, hybrid concept of harm, which seems better able to fulfil its functional roles in a variety of contexts. (shrink)

The counterfactual comparative account of harm has emerged as the main contender in the recent literature on the nature of harm. But Erik Carlson argues that the account violates plausible normative principles connecting harm with our reasons to perform certain actions and to prefer certain outcomes. According to Carlson, the account implies that we have reason to perform actions and to prefer outcomes that we do not in fact possess. This paper defends the counterfactual comparative account from these objections.

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)

Is it wrong to create a blind child, for example by in vitro fertilization, if you could create a sighted child instead? Intuitively many people believe it is wrong, but this belief is difficult to justify. When there is a possibility to create and select either ‘blind’ or ‘sighted’ embryos choosing a set of ‘blind’ embryos seems to harm no-one since choosing ‘sighted’ embryos would create a different child altogether. So when the parents choose ‘blind’ embryos, they give some specific (...) individual a life that is the only option for her. Because her life is worth living (as blind peoples’ lives are), the parents have not wronged the child by creating her. This is the reasoning behind the famous non-identity problem. I suggest that the non-identity problem is based on a misunderstanding. I claim that when choosing a ‘blind’ embryo, prospective parents harm ‘their child’, whoever she or he will be. Put another way: parents harm their child in the de dicto sense and that is morally wrong. (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)

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 defends the Harm Principle, commonly attributed to John Stuart Mill, against recent criticism. Some philosophers think that this principle should be rejected, because of severe difficulties with finding an account of harm to plug into it. I examine the criticism and find it unforceful. Finally, I identify a faulty assumption behind this type of criticism, namely that the Harm Principle is plausible only if there is a full-blown, and problem-free, account of harm, which proponents of the principle can (...) refer to. (shrink)

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 cases of animal mimicry, the receiver of the signal learns the truth that he is either dealing with the real thing or with a mimic. Thus, despite being a prototypical example of animal deception, mimicry does not seem to qualify as deception on the traditional definition, since the receiver is not actually misled. We offer a new account of propositional content in sender-receiver games that explains how the receiver is misled by mimicry. We show that previous accounts of deception, (...) and of propositional content, give incorrect results about whether certain signals are deceptive. (shrink)

Harm is one of the central concepts of ethics so it would be good to offer an account of it. Many accounts appeal to a baseline: they say that you harm someone if you leave them worse off than in the baseline case. In this paper, I draw some lessons regarding what counts as an appropriate baseline and explore what these general lessons reveal about the nature of harm. In the process of so doing, I argue that a certain rarely-discussed (...) account of harm -- the worse than nothing account of harm -- does a particularly good job at identifying a baseline. This account says you harm someone if you leave them worse off than if you had done nothing to them. (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)

According to the Counterfactual Comparative Account of harm and benefit, an event is overall harmful for a subject to the extent that this subject would have been better off if it had not occurred. In this paper we present a challenge for the Counterfactual Comparative Account. We argue that if physical processes are chancy in the manner suggested by our best physical theories, then CCA faces a dilemma: If it is developed in line with the standard approach to counterfactuals, then (...) it delivers that the value of any event for a subject is indeterminate to the extreme, ranging from terribly harmful to highly beneficial. This problem can only be avoided by developing CCA in line with theories of counterfactuals that allow us to ignore a-typical scenarios. Doing this generates a different problem: when the actual world is itself a-typical we will sometimes get the result that the counterfactual nonoccurrence of an actual benefit is itself a benefit. An account of overall harm bearing either of these two implications is deficient. Given the general aspiration to account for deprivational harms and the dominance of the Counterfactual Comparative Account in this respect, theorists of harm and benefit face a deadlock. (shrink)

In recent attempts to define ‘harm’, the most promising approach has often been thought to be the counterfactual comparative account of harm. Nevertheless, this account faces serious difficulties. Moreover, it has been argued that ‘harm’ cannot be defined without reference to a substantive theory of well-being, which is itself a fraught issue. This has led to the call for the concept to simply be dropped from the moral lexicon altogether. I reject this call, arguing that the non-comparative approach to defining (...) harm has not been sufficiently explored. I then develop such an account that avoids the difficulties faced by comparative accounts whilst not presupposing a substantive theory of well-being. I conclude that this definition renders a concept of harm that can be meaningfully employed in our moral discourse. (shrink)

When discussing exploitation, we often say things like this, “sweatshop laborers have terrible working conditions and are paid almost nothing, but they are better off with that labor than with no labor.” Similarly, in describing the Non-Identity Problem, Derek Parfit points out: we cannot say that the individuals born in future generations are worse off because of our destructive environmental policies because the particular people living in those future generations wouldn’t even exist if it were not for these destructive policies. (...) How can we explain these cases, exploitation and environmental destruction, as ones of wrongdoing when the victims in both cases are no worse off than they would have otherwise been? This paper investigates the link between these two moral puzzles and ultimately uses one to solve the other: an exploitation solution to the Non-Identity Problem. (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)

What determines the degree to which some event harms a subject? According to the counterfactual comparative account, an event is harmful for a subject to the extent that she would have been overall better off if it had not occurred. Unlike the causation based account, this view nicely accounts for deprivational harms, including the harm of death, and for cases in which events constitute a harm rather than causing it. However, I argue, it ultimately fails, since not every intrinsically bad (...) state that is counterfactually dependent on an event contributes to its degree of harm. So while the causation based account is too restrictive, the counterfactual comparative view is not restrictive enough. In light of this, I suggest an alternative, explanation based account of overall harm, according to which the degree to which some event is harmful for a subject is determined by the degree to which (crudely) the states explained by it are overall more intrinsically bad than intrinsically good for her. (shrink)

This article defends the Harm Principle, commonly attributed to John Stuart Mill, against recent criticism. Some philosophers think that this principle should be rejected, because of severe difficulties with finding an account of harm to plug into it. I examine the criticism and find it unforceful. Finally, I identify a faulty assumption behind this type of criticism, namely that the Harm Principle is plausible only if there is a full-blown, and problem-free, account of harm, which proponents of the principle can (...) refer to. (shrink)

When is a belief justified? There are three families of arguments we typically use to support different accounts of justification: arguments from our intuitive responses to vignettes that involve the concept; arguments from the theoretical role we would like the concept to play in epistemology; and arguments from the practical, moral, and political uses to which we wish to put the concept. I focus particularly on the third sort, and specifically on arguments of this sort offered by Clayton Littlejohn in (...) Justification and the Truth-Connection and Amia Srinivasan in ‘Radical Externalism’ : 395–431, 2018) in favour of externalism. I counter Srinivasan’s argument in two ways: first, I show that the internalist’s concept of justification might figure just as easily in the sorts of structural explanation Srinivasan thinks our political goals require us to give; and I argue that the internalist’s concept is needed for a particular political task, namely, to help us build more effective defences against what I call epistemic weapons. I conclude that we should adopt an Alstonian pluralism about the concept of justification. (shrink)

In this paper, I investigate backward-looking accounts of death's badness. I begin by reviewing deprivationism—the standard, forward-looking account of death's badness. On deprivationism, death is bad for its victims when it deprives them of a good future. This account famously faces two problems—Lucretius’s symmetry problem and the preemption problem. This motivates turning to backward-looking accounts of death's badness on which death is bad for its victim (in a respect) when it involves a decline from a good life. I distinguish three (...) different backward-looking accounts of death's badness in terms of decline, and I argue for the attractiveness of one in particular. I conclude by considering how the backward-looking consideration of decline might factor into our overall account of death's badness. (shrink)

An important objection to the Counterfactual Comparative Account (CCA) of harm is that the account fails to cohere with standard views about the normative significance of harm. In response, some proponents of CCA suggest that the concept of harm should play a more limited role in normative theorising than philosophers might usually think. This paper addresses the most elaborate defence of CCA of this sort, namely that by Neil Feit (2019) Ethical Theory and Moral Practice, 22, 809–823, and argues that (...) it is unsuccessful. (shrink)

The issue of whether biological and psychological properties associated with disability can be harmful, beneficial, or neutral brings up an important philosophical question about how we evaluate disability, and disability’s impact on well-being. The debate is usually characterized as between those who argue disability is intrinsically harmful, and disability rights advocates who argue that disability is just another way of being different, in part, because disability can also provide important benefits. I argue that this debate is a false one, as (...) neither view can capture the more complicated relationship between disability and well-being. I argue that many disabilities are best understood as a kind of pro-tanto extrinsic harm that is characterized in counterfactual terms. This means that our judgments concerning disability and harm must be context-sensitive. (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)

As autonomous systems rapidly become ubiquitous, there is a growing need for a legal and regulatory framework that addresses when and how such a system harms someone. There have been several attempts within the philosophy literature to define harm, but none of them has proven capable of dealing with the many examples that have been presented, leading some to suggest that the notion of harm should be abandoned and “replaced by more well-behaved notions”. As harm is generally something that is (...) caused, most of these definitions have involved causality at some level. Yet surprisingly, none of them makes use of causal models and the definitions of actual causality that they can express. In this paper, which is an expanded version of the conference paper Beckers et al. (Neurips, 2022), we formally define a qualitative notion of harm that uses causal models and is based on a well-known definition of actual causality. The key features of our definition are that it is based on contrastive causation and uses a default utility to which the utility of actual outcomes is compared. We show that our definition is able to handle the examples from the literature, and illustrate its importance for reasoning about situations involving autonomous systems. (shrink)

The concept of “harm” is ubiquitous in moral theorising, and yet remains poorly defined. Bradley suggests that the counterfactual comparative account of harm is the most plausible account currently available, but also argues that it is fatally flawed, since it falters on the omission and pre-emption problems. Hanna attempts to defend the counterfactual comparative account of harm against both problems. In this paper, I argue that Hanna’s defence fails. I also show how his defence highlights the fact that both the (...) omission and the pre-emption problems have the same root cause – the inability of the counterfactual comparative account of harm to allow for our implicit considerations regarding well-being when assessing harm. While its purported neutrality with regard to substantive theories of well-being is one of the reasons that this account is considered to be the most plausible on offer, I will argue that this neutrality is illusory. (shrink)

In “Harmful Choices, the Case of C, and Decision-Making Competence,” Pickering and colleagues advance an argument in favor of externalism, a view in which the competence of a decision maker is judged relative to factors external to their cognition. In advancing this argument, Pickering and colleagues focus on the external factor of harm: In their view, it is the harmfulness of a considered or chosen action that provides evidence against the competence of the decision maker. However, the proper identification of (...) harmful choices and outcomes remains a demanding task, largely because our understanding of what harm is remains deeply incomplete. Despite 50 years of tempestuous debate, the metaphysics of harm remains an unsettled question. The existence of such a debate does not, in and of itself, provide evidence against the externalist position; rather, it is the theories of harm themselves that pose meaningful challenges for the externalist. Our purpose, here, is to illuminate these challenges. (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)