A volume with 14 chapters on various aspects of the relationship between responsibility and healthcare, plus a substantial introduction that offers a comprehensive overview of the relevant debates and how they relate to one another. -/- Questions of responsibility arise at all levels of health care. Most prominent has been the issue of patient responsibility. Some health conditions that risk death or serious harm are partly the result of lifestyle behaviours such as smoking, lack of exercise, or extreme sports. Are (...) patients with such conditions responsible for them? If so, might healthcare providers, be they state-run systems or private entities, be justified in treating such patients differently? And if they are, which forms of differential treatment are justified? Responsibility isn’t just relevant for patients. Even when individuals affect their health through voluntary behaviour, other influences are also at work before, during, and after the patient’s interaction with the health care system. What are the responsibilities of individual clinicians and other medical professionals, when thinking about individual and public health? What about institutions such as governments or national health care services, or society as a whole? This collection brings together work by world-renowned experts in population ethics, distributive justice, philosophy of action, cognitive science, and medical ethics in order to push the debate forward by elucidating our understanding of these questions, their possible answers, and how they are related. (shrink)

Utilitarianism has an apparent pedigree when it comes to animal welfare. It supports the view that animal welfare matters just as much as human welfare. And many utilitarians support and oppose various practices in line with more mainstream concern over animal welfare, such as that we should not kill animals for food or other uses, and that we ought not to torture animals for fun. This relationship has come under tension from many directions. The aim of this article is to (...) add further considerations in support of that tension. I suggest three ways in which utilitarianism comes significantly apart from mainstream concerns with animal welfare. First, utilitarianism opposes animal cruelty only when it offers an inefficient ratio of pleasure to pain; while this may be true of eating animal products, it is not obviously true of other abuses. Second, utilitarianism faces a familiar problem of the inefficacy of individual decisions; I consider a common response to this worry, and offer further concerns. Finally, the common utilitarian argument against animal cruelty ignores various pleasures that humans may get from the superior status that a structure supporting exploitation confers. (shrink)

This introductory chapter offers an overview of the various ways that responsibility may be relevant to health care, in order to situate the chapters in this volume in their broader context. The chapter begins by outlining relevant concepts, and explaining why it is worth considering the role of responsibility in health care. The chapter then turns to various ways in which patients might be held responsible in a health care system, before considering objections to these practices. Finally, the chapter considers (...) the role of responsibility in health care beyond holding patients responsible, by considering the responsibility of medical professionals, and of institutions. (shrink)

Some healthcare systems are said to be grounded in solidarity because healthcare is funded as a form of mutual support. This article argues that health care systems that are grounded in solidarity have the right to penalise some users who are responsible for their poor health. This derives from the fact that solidary systems involve both rights and obligations and, in some cases, those who avoidably incur health burdens violate obligations of solidarity. Penalties warranted include direct patient contribution to costs, (...) and lower priority treatment, but not typically full exclusion from the healthcare system. We also note two important restrictions on this argument. First, failures of solidary obligations can only be assumed under conditions that are conducive to sufficiently autonomous choice, which occur when patients are given ‘Golden Opportunities’ to improve their health. Second, because poor health does not occur in a social vacuum, an insistence on solidarity as part of healthcare is legitimate only if all members of society are held to similar standards of solidarity. We cannot insist upon, and penalise failures of, solidarity only for those who are unwell, and who cannot afford to evade the terms of public health. (shrink)

There is significant controversy over whether patients have a ‘right not to know’ information relevant to their health. Some arguments for limiting such a right appeal to potential burdens on others that a patient’s avoidable ignorance might generate. This paper develops this argument by extending it to cases where refusal of relevant information may generate greater demands on a publicly funded healthcare system. In such cases, patients may have an ‘obligation to know’. However, we cannot infer from the fact that (...) a patient has an obligation to know that she does not also have a right not to know. The right not to know is held against medical professionals at a formal institutional level. We have reason to protect patients’ control over the information that they receive, even if in individual instances patients exercise this control in ways that violate obligations. (shrink)

The idea of using responsibility in the allocation of healthcare resources has been criticized for, among other things, too readily abandoning people who are responsible for being very badly off. One response to this problem is that while responsibility can play a role in resource allocation, it cannot do so if it will leave those who are responsible below a “sufficiency” threshold. This paper considers first whether a view can be both distinctively sufficientarian and allow responsibility to play a role (...) even for those who will be left with very poor health. It then draws several further distinctions that may affect the application of responsibility at this level. We conclude that a more plausible version of the sufficientarian view is to allow a role for responsibility where failure to do so will leave someone else who is not responsible below the sufficiency threshold. However, we suggest that individuals must exhibit “sufficient responsibility” in order for this to apply, involving both a sufficient level of control and an avoidable failure to respond adequately to reasons for action. (shrink)

Throughout the COVID-19 pandemic, shortages of scarce healthcare resources consistently presented significant moral and practical challenges. While the importance of vaccines as a key pharmaceutical intervention to stem pandemic scarcity was widely publicized, a sizable proportion of the population chose not to vaccinate. In response, some have defended the use of vaccination status as a criterion for the allocation of scarce medical resources. In this paper, we critically interpret this burgeoning literature, and describe a framework for thinking about vaccine-sensitive resource (...) allocation using the values of responsibility, reciprocity, and justice. Although our aim here is not to defend a single view of vaccine-sensitive resource allocation, we believe that attending critically with the diversity of arguments in favor (and against) vaccine-sensitivity reveals a number of questions that a vaccine-sensitive approach to allocation should answer in future pandemics. (shrink)

On 26 January 2021, while announcing that the country had reached the mark of 100,000 deaths within 28 days of COVID-19, UK Prime Minister Boris Johnson said that he took “full responsibility for everything that the Government has done” as part of British efforts to tackle the pandemic. The force of this statement was undermined, however, by what followed: -/- What I can tell you is that we truly did everything we could, and continue to do everything that we can, (...) to minimise loss of life and to minimise suffering... -/- Taking these sentiments together, it was hard to avoid the conclusion that the government took responsibility only for doing everything right. Such an admission of responsibility, accommodating no admission of error or wrongdoing, is not really about responsibility at all. Indeed, the UK’s pandemic response has been marked from its earliest days by a shifting of focus from institutional responsibility to personal responsibility for individual UK residents. -/- This paper explores the relationship between these two sites of responsibility—the institutional and the personal—in the context of the sort of pandemic that is ongoing as we write. Section 2 offers some initial definitions and discussions of key terms. Section 3 outlines how these two ideas interact in principle during such emergencies. Section 4 turns to the ‘non-ideal’ implications for personal responsibility of failures of institutional responsibility. While our focus is on the specific context with which we are most familiar, the UK governmental approach, where appropriate we also include examples from other states. (shrink)

Greg Bognar has recently offered a prioritarian justification for ‘fair innings’ distributive principles that would ration access to healthcare on the basis of patients' age. In this article, I agree that Bognar's principle is among the strongest arguments for age-based rationing. However, I argue that this position is incomplete because of the possibility of ‘time-relative' egalitarian principles that could complement the kind of lifetime egalitarianism that Bognar adopts. After outlining Bognar's position, and explaining the attraction of time-relative egalitarianism, I suggest (...) various ways in which these two kinds of principle could interact. Since various options have very different implications for age-based rationing, proponents of such a rationing scheme must take a position on time-relative egalitarianism to complement a lifetime prioritarian view like Bognar's. (shrink)

Healthcare practitioners have access to a range of ethical guidance. However, the normative role of this guidance in ethical decision-making is underexplored. This paper considers two ways that healthcare practitioners could approach ethics guidance. We first outline the idea of deference to ethics guidance, showing how an attitude of deference raises three key problems: moral value; moral understanding; and moral error. Drawing on philosophical literature, we then advocate an alternative framing of ethics guidance as a form of moral testimony by (...) colleagues and suggest that a more promising attitude to ethics guidance is to approach it in the spirit of ‘critical engagement’ rather than deference. (shrink)

This article considers attempts to include the issues of ageing and ill health in a Rawlsian framework. It first considers Norman Daniels’ Prudential Lifespan Account, which reduces intergenerational questions to issues of intrapersonal prudence from behind a Rawslian veil of ignorance. This approach faces several problems of idealisation, including those raised by Hugh Lazenby, because it must assume that everyone will live to the same age, undermining its status as a prudential calculation. I then assess Lazenby's account, which applies Rawls’ (...) general theory of justice more directly to healthcare. Lazenby suggests that we should apply Rawls’ difference principle – which claims that any inequalities in social goods must benefit the worst off – to conclude that we should significantly prioritise treatment of young patients. I argue first that the existence of young terminally ill patients undermines a number of Rawlsian arguments for the difference principle. I then argue that the structure of ageing undermines the Rawlsian decision mechanism of the ‘veil of ignorance’ on which Lazenby relies. I conclude that age and terminal illness present significant problems for any comprehensive Rawlsian account of justice. (shrink)

Some philosophers and segments of the public think age is relevant to healthcare priority-setting. One argument for this is based in equity: “Old” patients have had either more of a relevant good than “young” patients or enough of that good and so have weaker claims to treatment. This article first notes that some discussions of age-based priority that focus in this way on old and young patients exhibit an ambiguity between two claims: that patients classified as old should have a (...) low priority, and that patients classified as young should have high priority. The author next argues, drawing on a problem raised by Christine Overall, that equity cannot justify giving “old” patients low priority, since there is wide variety in the total lifetime experiences of older people, partly influenced by gender, race, class, and disability injustice. Finally, the author suggests that there might be a limited role for age-based prioritization in the context of infant and childhood death, since those who die in childhood are always and uncontroversially among the worst-off. (shrink)

Subjectivists think that our well-being is grounded in our subjective attitudes. Many such views are vulnerable to variations on the ‘paradox of desire’, where theories cannot make determinate judgements about the well-being of agents who take a positive valuing attitude towards their life going badly. However, this paradox does not affect all subjectivist theories; theories grounded on agents’ prudential values can avoid it.This paper suggests a new paradox for subjectivist theories which has a wider scope, and includes such prudential judgement (...) theories. I outline the new paradox and show how two plausible idealisztions (coherence and consideration) will not help. Subjectivists about well-being must either add an additional idealization that can solve the paradox of judgement or explain why such paradoxes do not constitute serious objections to a theory of well-being. (shrink)

John Rawls’s ‘just savings’ principle is among the better-known attempts to outline how we should balance the claims of the present with the claims of the future generations on resources. A central element of Rawls’s approach involves endorsing a sufficientarian approach, where our central obligation is to ensure ‘the conditions needed to establish and to preserve a just basic structure’.1 This engaging paper by Christian Munthe, Davide Fumagalli and Erik Malmqvist (‘the authors’) does not explicitly mention Rawls’s work on this (...) issue.2 Still, there are parallels in their aim to generate a ‘sustainability principle’ for healthcare systems. The authors defend the broadening of our focus to the relations between rounds—particularly, how decisions in one period can affect our choice range in the next, whereas current principles for allocating healthcare resources operate within ‘allocation rounds’. Where Rawls is concerned about future generations, the authors’ concern is with future sets of patients. Our present decisions may generate system ‘dynamics’ which are either positive—where ‘more resources per health need’ become available—or negative—where (otherwise justified) decisions taken now leave us with less bang for our buck in the future. The paper’s important and compelling central claim is that we have an obligation …. (shrink)

Burnout among health professionals is at epidemic proportions. In response, many health institutions have emphasised the importance of self-care, relying particularly on the idea that doctors who are burned out provide worse care for their patients. Although not made explicit, this suggests that doctors might have a responsibility to their patients (and perhaps others) to practice self-care. This chapter explores the potential grounds for such an obligation. We suggest that while there is potential for a limited obligation of self-care, institutional (...) emphasis on this risks instrumentalising doctors' well-being, minimising institutional responsibilities and workers' rights, and being excessively demanding for individuals. (shrink)

Sufficientarians face a problem of arbitrariness: why place a sufficiency threshold at any particular point? One response is to seek universal goods to justify a threshold. However, this faces difficulties (despite sincere efforts) by either being too low, or failing to accommodate individuals with significant cognitive disabilities. Some sufficientarians have appealed to individuals’ subjective evaluations of their lives. I build on this idea, considering another individualized threshold: ‘tolerability’. I respond to some traditional challenges to individualistic approaches to justice: ‘expensive’ tastes, (...) and adaptive preferences. Finally, I end by offering some suggestions about how this relates to policymaking. (shrink)

Response to commentaries on 'The right not to know and the obligation to know'.

I introduce a distinction between health need and medical need, and raise several questions about their interaction. Health needs are needs that relate directly to our health condition. Medical needs are needs which bear some relation to medical institutions or processes. I suggest that the question of whether medical insurance or public care should cover medical needs, health needs, or only needs which fit both categories is a political question that cannot be resolved definitionally. I also argue against an overly (...) strict definition of medical need on the grounds that this presupposes, wrongly, that medical intervention should always be a last resort. (shrink)

Nicholas Agar argues that we should avoid certain ‘radical’ enhancement technologies. One reason for this is that they will alienate us from current sources of value by altering our evaluative outlooks. We should avoid this, even if enhancing will provide us with novel, objectively better sources of value. After noting the parallel between Agar’s views and G. A. Cohen’s work on the ‘conservative bias’, I explore Agar’s suggestion in relation to two kinds of radical enhancement: cognitive and anti-ageing. With regard (...) to both, there are reasons to doubt Agar’s empirical predictions about the severity of the evaluative changes we will undergo. Nonetheless, there is some force to the argument as applied to cognitive enhancement; in particular, radical cognitive enhancement may endanger our current valuable relationships with our loved ones. However, even if we find this a plausible worry for radical cognitive enhancement, it is not plausible for even radical anti-ageing enhancement, because the change Agar predicts will not affect our core motivations in the way that cognitive enhancement threatens to. (shrink)

There is an ongoing increase in the use of mobile health technologies that patients can use to monitor health-related outcomes and behaviours. While the dominant narrative around mHealth focuses on patient empowerment, there is potential for mHealth to fit into a growing push for patients to take personal responsibility for their health. I call the first of these uses ‘medical monitoring’, and the second ‘personal health surveillance’. After outlining two problems which the use of mHealth might seem to enable us (...) to overcome—fairness of burdens and reliance on self-reporting—I note that these problems would only really be solved by unacceptably comprehensive forms of personal health surveillance which applies to all of us at all times. A more plausible model is to use personal health surveillance as a last resort for patients who would otherwise independently qualify for responsibility-based penalties. However, I note that there are still a number of ethical and practical problems that such a policy would need to overcome. The prospects of mHealth enabling a fair, genuinely cost-saving policy of patient responsibility are slim. (shrink)

ABSTRACT:The ethics of high frequency trading are obscure, due in part to the complexity of the practice. This article contributes to the existing literature of ethics in financial markets by examining a recent trend in regulation in high frequency trading, the prohibition of deception. We argue that in the financial markets almost any regulation, other than the most basic, tends to create a moral hazard and increase information asymmetry. Since the market’s job is, at least in part, price discovery, we (...) argue that simplicity of regulation and restraint in regulation are virtues to a greater extent than in other areas of finance. This article proposes criteria for determining which high-frequency trading strategies should be regulated. (shrink)

There is an ongoing debate in medicine about whether patients have a ‘right not to know’ pertinent medical information, such as diagnoses of life-altering diseases. While this debate has employed various ethical concepts, probably the most widely-used by both defenders and detractors of the right is autonomy. Whereas defenders of the right not to know typically employ a ‘liberty’ conception of autonomy, according to which to be autonomous involves doing what one wants to do, opponents of the right not to (...) know often employ a ‘duty’ understanding, viewing autonomy as involving an obligation to be self-governing. The central contribution of this paper is in showing that neither view of autonomy can reasonably be said to support the extreme stances on the right not to know that they are sometimes taken to. That is, neither can a liberty view properly defend a right not to know without limits, nor can a duty view form the basis of an absolute rejection of the right not to know. While there is still theoretical distance between these two approaches, we conclude that the views are considerably closer on this issue than they first appear, opening the way for a possible compromise. (shrink)

A considerable literature has emerged around the idea of using ‘personal responsibility’ as an allocation criterion in healthcare distribution, where a person's being suitably responsible for their health needs may justify additional conditions on receiving healthcare, and perhaps even limiting access entirely, sometimes known as ‘responsibilisation’. This discussion focuses most prominently, but not exclusively, on ‘luck egalitarianism’, the view that deviations from equality are justified only by suitably free choices. A superficially separate issue in distributive justice concerns the two–way relationship (...) between health and other social goods: deficits in health typically undermine one's abilities to secure advantage in other areas, which in turn often have further negative effects on health. This paper outlines the degree to which this latter relationship between health and other social goods exacerbates an existing problem for proponents of responsibilisation (the ‘harshness objection’) in ways that standard responses to this objection cannot address. Placing significant conditions on healthcare access because of a person's prior responsibility risks trapping them in, or worsening, negative cycles where poor health and associated lack of opportunity reinforce one another, making further poor yet ultimately responsible choices more likely. It ends by considering three possible solutions to this problem. (shrink)

John Taurek famously held the view that, when deciding whom to rescue, the numbers don’t count: we should instead give everyone the same chance of surviving. Surprisingly little engagement has taken place between the detailed and rich literature on whether the numbers count in rescue cases, and the practical question of whether certain facts about patients are eligible for consideration in real-world prioritisation, e.g., in emergency triage during a pandemic. I suggest that a position close to Taurek’s maps on to (...) real-world arguments by groups representing disabled individuals. Whereas Taurek is focused on equalising survival chances, some disability rights activists and scholars appear to argue in favour of equalising selection chances. I consider the philosophical promise of this approach by appealing to the idea of “opacity respect”, and suggest a sufficientarian alternative. (shrink)

This paper is about teaching philosophy to high school students through Lincoln-Douglas (LD) debate. LD, also known as “values debate,” includes topics from ethics and political philosophy. Thousands of high school students across the U.S. debate these topics in class, after school, and at weekend tournaments. We argue that LD is a particularly effective tool for teaching philosophy, but also that LD today falls short of its potential. We argue that the problems with LD are not inevitable, and we offer (...) strategic recommendations for improving LD as a tool for teaching philosophy. Ultimately, our aim is to create a dialogue between LD and academic philosophy, with the hope that such dialogue will improve LD’s capacity to teach students how to do philosophy. (shrink)

Health institutions recommend that young infants be exclusively breastfed on demand, and it is widely held that parents who can breastfeed have an obligation to do so. This has been challenged in recent philosophical work, especially by Fiona Woollard. Woollard’s work critically engages with two distinct views of parental obligation that might ground such an obligation—based on maximal benefit and avoidance of significant harm—to reject an obligation to breastfeed. While agreeing with Woollard’s substantive conclusion, this paper (drawing on philosophical discussion (...) of the ‘right to rear’) argues that there are several more moderate views of parental obligation which might also be thought to ground parental obligation. We first show that an obligation to breastfeed might result not from a general obligation to maximally benefit one’s child, but from what we call ‘choice-specific’ obligations to maximise benefit within particular activities. We then develop this idea through two views of parental obligation—the Dual Interest view, and the Best Custodian view—to ground an obligation to exclusively breastfeed on demand, before showing how both these more moderate views fail. Finally, we argue that not only is there no general obligation to breastfeed children, but that it is often morally right not to do so. Since much advice from health institutions on this issue implies that exclusive breastfeeding on demand is the best option for all families, our argument drives the feeding debate forward by showing that this advice often misrepresents parents’ moral obligations in potentially harmful ways. (shrink)

Healthcare systems need to consider not only how to prevent error, but how to respond to errors when they occur. In the United Kingdom’s National Health Service, one strand of this latter response is the ‘No Blame Culture’, which draws attention from individuals and towards systems in the process of understanding an error. Defences of the No Blame Culture typically fail to distinguish between blaming someone and holding them responsible. This article argues for a ‘responsibility culture’, where healthcare professionals are (...) held responsible in cases of foreseeable and avoidable errors. We demonstrate how healthcare professionals can justifiably be held responsible for their errors even though they work in challenging circumstances. We then review the idea of ‘responsibility without blame’, applying this to cases of error in healthcare. Sensitive to the undesirable effects of blaming healthcare professionals and to the moral significance of holding individuals accountable, we argue that a responsibility culture has significant advantages over a No Blame Culture due to its capacity to enhance patient safety and support medical professionals in learning from their mistakes, while also recognising and validating the legitimate sense of responsibility that many medical professionals feel following avoidable error, and motivating medical professionals to report errors. (shrink)

Many people feel that respecting a person’s autonomy is not sufficiently important to obligate us to stay out of their affairs in all cases; but the ground for interference may often turn out to be a hunch that the agent cannot really be competent, or cannot really know what her decision implies; for if she were both of these things, surely she would not make such a foolish decision. This paper suggests a justification of paternalism that does not rely on (...) such appeals. I argue that in cases where an agent will undergo a significant alteration in their evaluative outlook – ‘evaluative shift’ – three central, persuasive objections to paternalism lose their force, and offer a prima facie case for paternalism in some of these cases. I then suggest that we can extend this argument to some cases where evaluative alteration is not predictable, but where the risk and harm are both significant. In such cases, paternalism may be justified. (shrink)

Many assume that theories of distributive justice must obviously take people’s lifetimes, and only their lifetimes, as the relevant period across which we distribute. Although the question of the temporal subject has risen in prominence, it is still relatively underdeveloped, particularly in the sphere of health and healthcare. This paper defends a particular view, “momentary sufficientarianism,” as being an important element of healthcare justice. At the heart of the argument is a commitment to pluralism about justice, where theorizing about just (...) principles demands paying attention to the role particular goods play in our lives. This means that different approaches to the temporal subject—as well as other relevant issues—may be appropriate for different goods, including different goods within healthcare. In particular, the paper discusses two central goods targeted by healthcare: life-saving and pain relief. The view is offered as complementary to, rather than competitive with, lifetime approaches. As such, the paper finishes by considering how a pluralist approach, which engages both with people’s lives as a whole and with their states at particular moments, can reconcile the potentially competing claims in healthcare that emerge from these two perspectives. (shrink)

All of finance is now automated, most notably high frequency trading. This paper examines the ethical implications of this fact. As automation is an interdisciplinary endeavor, we argue that the interfaces between the respective disciplines can lead to conflicting ethical perspectives; we also argue that existing disciplinary standards do not pay enough attention to the ethical problems automation generates. Conflicting perspectives undermine the protection those who rely on trading should have. Ethics in finance can be expanded to include organizational and (...) industry-wide responsibilities to external market participants and society. As a starting point, quality management techniques can provide a foundation for a new cross-disciplinary ethical standard in the age of automation. (shrink)

Hun Chung argues for a theory of distributive justice – ‘prospect utilitarianism’ – that overcomes two central problems purportedly faced by sufficientarianism: giving implausible answers in ‘lifeboat cases’, where we can save the lives of some but not all of a group, and failing to respect the axiom of continuity. Chung claims that prospect utilitarianism overcomes these problems, and receives empirical support from work in economics on prospect theory. This article responds to Chung's criticisms of sufficientarianism, showing that they are (...) misplaced. It then shows that prospect utilitarianism faces independent problems, since it too requires a threshold, which Chung bases on the idea of ‘adequate functioning’. The article shows that there are problems with this as a threshold, and that it is not empirically supported by prospect theory. (shrink)

The use of Quality-Adjusted Life Years (QALYs) in healthcare allocation has been criticized as discriminatory against people with disabilities. This article considers a response to this criticism from Nick Beckstead and Toby Ord. They say that even if QALYs are discriminatory, attempting to avoid discrimination – when coupled with other central principles that an allocation system should favour – sometimes leads to irrationality in the form of cyclic preferences. I suggest that while Beckstead and Ord have identified a problem, it (...) is a misdiagnosis to lay it at the feet of an anti-discrimination principle. The problem in fact comes from a basic tension between respecting reasonable patient preferences and other ways of ranking treatment options. As such, adopting a QALY system does not solve the problem they identify. (shrink)

This article is about the potential justification for deploying some form of affirmative action (AA) in the context of healthcare, and in particular in relation to the pandemic. We call this Affirmative Action in healthcare Resource Allocation (AARA). Specifically, we aim to investigate whether the rationale and justifications for using prioritization policies based on race in education and employment apply in a healthcare setting, and in particular to the COVID-19 pandemic. We concentrate in this article on vaccines and ventilators because (...) these are both highly scarce resources in the pandemic, and there has been a need to develop policies for allocating them. However, as will become clear, the ethical considerations relating to them may diverge. We first set out two rationales for AAs and what they might entail in a healthcare setting. We then consider some disanalogies between AA and AARA, as well as the different implications of AARA for allocating ventilators as opposed to vaccines. Finally, we consider some of the practical ways in which AARA could be implemented, and conclude by responding to some key objections. (shrink)

How should we respond to patients who do not wish to take on the responsibility and burdens of making decisions about their own care? In this paper, we argue that existing models of decision-making in modern healthcare are ill-equipped to cope with such patients and should be supplemented by an “appointed fiduciary” model where decision-making authority is formally transferred to a medical professional. Healthcare decisions are often complex and for patients can come at time of vulnerability. While this does not (...) undermine their capacity, it can be excessively burdensome. Most existing models of decision-making mandate that patients with capacity must retain ultimate responsibility for decisions. An appointed fiduciary model provides a formalized mechanism through which those few patients who wish to defer responsibility can hand over decision-making authority. By providing a formal structure for deferring to an appointed fiduciary, the confusions and risks of the informal transfers that can occur in practice are avoided. Finally, we note how appropriate governance and law can provide safeguards against risks to the welfare of patients and medical professionals. -/- . (shrink)

All of finance is now automated, most notably high frequency trading. This paper examines the ethical implications of this fact. As automation is an interdisciplinary endeavor, we argue that the interfaces between the respective disciplines can lead to conflicting ethical perspectives; we also argue that existing disciplinary standards do not pay enough attention to the ethical problems automation generates. Conflicting perspectives undermine the protection those who rely on trading should have. Ethics in finance can be expanded to include organizational and (...) industry-wide responsibilities to external market participants and society. As a starting point, quality management techniques can provide a foundation for a new cross-disciplinary ethical standard in the age of automation. (shrink)

Abstract:What would Wittgensteinian fiction—not overtly about or influenced by him, but that resonates with his thought—look like? Lydia Davis has avowed, but never explained, her admiration for Ludwig Wittgenstein. Her short and fragmentary fictions are attuned to how grammar and usage reveal our forms of life. Alongside briefer discussion of Adam Ehrlich Sachs and other contemporary American writers, I characterize both Wittgenstein and Davis as uncanny grammarians: though we live in language, we are never fully at home in it. Both (...) press on our ordinary language in an extraordinary way, defamiliarizing the familiar to more explicitly understand it. (shrink)

continent. 2.1 (2012): 40–43. Lance Olsen is a professor of Writing and Literature at the University of Utah, Chair of the FC2 Board of directors, and, most importantly, author or editor of over twenty books of and about innovative literature. He is one of the true champions of prose as a viable contemporary art form. He has just published Architectures of Possibility (written with Trevor Dodge), a book that—as Olsen's works often do—exceeds the usual boundaries of its genre as it (...) explores his interests in narrative theory and pedagogy. The book is a kind of “anti-textbook;” a performative polemic against the stale, conservative and monolithic conception of the literary that so often dominates institutional discourse around creative writing. The following interview takes the occasion of AoP's publication as a chance to speak with Olsen about the book itself as well as to engage with larger, unanswerable, questions about the futures and intersections of literature and education. —Ben Segal INTERVIEW: 1) First, I want to start before the beginning, with the title. I’m really fascinated by the concept it conjures. Can you say something about innovative/experimental/(choose your adjective) literature in relation to both ideas around architecture and possibility? Innovative or experimental are tremendously fraught adjectives, needless to say. But for the purposes of my book, they modify a fiction concerned with the questions: What is fiction? What can it do, and how, and why? Now, of course, what looks “innovative” or “experimental” to one at 17 may not be what looks “innovative” or “experimental” to one at 27 or 57, and what looks “innovative” or “experimental” in 1812 may not be what looks “innovative” or “experimental” in 2012. A certain existential and historical perspectivism is always at work. But I think it’s fair to say that innovative and experimental usually refer to a narrativity that includes a self-reflective awareness of and engagement with theoretical inquiry, concerns, and obsessions, as well as a sense of being in conversation with fiction across space and time. One can't create challenging writing in a vacuum; it has to challenge in relation to something. So contemporary writers interested in the subject are not only in pursuit of the innovative, but are also always-already writing subsequent to it—writing, that is, in its long wake. Architectures of Possibility conceives of creativity as a possibility space, a locale just outside our comfort zones where we can and should take multiple chances in order to imagine in new ways, explore fresh strategies for finding and cultivating ideas, re-view what it is we’re doing and why, better understand what Samuel Beckett meant when he wrote: “Try again. Fail again. Fail better.” It reminds us that there are other ways of narrating our worlds and ourselves than those we have inherited from the entertainment industry, the government, academia, previous writing, and so on. 2) AoP seems to be directed at several audiences (and purposes) simultaneously. What I mean is that it seems at times a polemic in favor of innovative literature, at other times a creative writing textbook, and still other times a guide to the network of publishers, journals, and programs that make up the current world of non-mainstream literary art in the U.S. In my mind, Architectures is a theorized anti-textbook about writing. Most textbooks on the subject (think of Janet Burroway’s Writing Fiction: A Guide to Narrative Craft , taught in most creative-writing classroom across the country) orchestrate how to construct conventional stories. They instruct from a place of power how to generate familiar stories that are repeated so often that many of us begin to take them as the primary model for narrativity, if not unconsciously as a kind of truth. The result, as Brian Kiteley points out in 3 A.M. Epiphany (one of the only other alternative textbooks about innovative writing around, by the way, and a tremendous repository of exercises), is merely competent texts. Architectures problematizes that gesture by outlining what conventional narrativity looks like, urging writers to think about its ideology of form as well as content, and invites them to imagine writing, not as a set of relatively stable conventions, but, rather, as a possibility space where everything can and should be thought, tried, challenged. It thereby rhymes with Roland Barthes’s definition of literature: the question minus the answer—which is to say Architectures poses complications to the act of writing rather than solutions. 3) One of the most notable things about the book is the use of interviews. This is also one of the reasons that I think the book works so well for a variety of audiences—that anyone with even a passing interest in the state and future of literature will have an interest in your conversation with people like Ben Marcus, Samuel Delany, and Lydia Davis. I was hoping you could just talk a little about how you chose these subjects to interview, how you edited the interview material, and which answers you received struck you the most. Experimentalism , like realism , wants to appear in the plural. The idea of gathering more than forty interviews (with the help of my awesome collaborator, Trevor Dodge, himself a fine innovative author) represents an attempt to suggest that: the wide, rich, exciting opportunities inherent in the term. There are interviews with younger writers, elder statesmen in the field, publishers, editors, hypermedia artists, comic book makers, and so on: Joe Wenderoth, Carole Maso, Scott McCloud, Nick Montfort, Kathy Acker, et al. Trevor and I decided to do flash interviews: short, concentrated Q&As, each focusing on a particular troubling of writing. We only lightly edited the results to match the manuscript’s overall style, and every interview arrived as a surprise housing several unexpected insights. Three brief examples: Michael Mejia, when asked about what he dreads when setting about writing: “Dread is an interesting word here. I associate it less with loathing or aversion, I suppose, than with a kind of productive fear. Do I dread a project’s failure? Sure, who doesn’t? Who wants to waste time on something that comes to nothing, or is unreadable? But then, what do these terms mean, and who or what defines a work as a ‘failure,’ as ‘waste,’ as ‘unreadable’? Should a work actually try to interrogate and exceed these conceptual limitations? My tendency is to write into dread in order to reveal to myself, as much as to any reader that may come after, the varied complacencies that make other, mostly more conventional writings, readable. It’s at the frontier between readability (security) and unreadability (terror) that I want to live creatively.” Carole Maso, when asked what she’d like a sentence to accomplish: “I think a sentence can if allowed carry emotional and intellectual states as they flee, as they come and go, an escaping essence difficult to hold in other ways. In this way I think the sentence can work as a phrase of music does, sounding something large and elusive in us. Alternatively it can provide sometimes a stability, an essence, a moment of being. Unlike music the sentence also of course carries language with all its potential for meaning making and memory traces and association with it as well. I probably love the accretion of sentences most—those patterns, that shimmer, that resonance.” Shelley Jackson, when asked what is innovative about the innovative: “The purpose of the innovative is, I think, to wake us up. We are not quite alive, most of the time; we occupy a sort of cartoon version of our lives, its lines made smooth by repetition. Writing can open the seams in that world, reintroduce us to the real lives that we have forgotten. Maybe all good writing is innovative in some sense, in that it shows or tells or makes you feel something you never felt before—something for which you have no cartoon ready.” 4) You talk a little about N. Katherine Hayles’s concept of Media Specific Analysis and propose the supplemental notion of Medium Specific Generation—basically taking Hayles and applying her thought from the perspective of the writer. I’ve been trying to develop somewhat related theoretical frameworks, so I was really excited to come upon this section of the book. I’m wondering if you can talk a little more about this idea and, in general, about the potentials that you see as being opened up by writers engaging with and exploiting different media as literary platforms? “Lulled into somnolence by five hundred years of print,” Hayles urges in her (at least for me) transformative 2004 essay, “Print is Flat, Code is Deep,” “literary analysis should awaken to the importance of media-specific analysis, a mode of critical attention which recognizes that all texts are instantiated and that the nature of the medium in which they are instantiated matters.” She goes on to argue critics should learn to become more attuned to the materiality of the medium under investigation—which is to say a story isn’t a story isn’t a story. Rather, the “same” story remediated through film is intrinsically different from that story remediated through conventionally printed books is intrinsically different from that story remediated through hypermedia. “Materiality,” Hayles goes on, “is reconceptualized as the interplay between a text’s physical characteristics and its signifying strategies, a move that entwines instantiation and signification at the outset.” My point in Architectures is simply to emphasize Media Specific Generation: the idea that when writing you should be cognizant, not only of the thematics of the text you are working on, and, as it were, the internal components of its narrativity (character, language, plot, etc.), but also of the material embodiment those components take, and, perhaps more important, the material embodiment those components can take. The idea that the way texts matter matters isn’t something usually addressed in any significant way in creative-writing classrooms and textbooks. It may almost go without saying such experimentation with typography, layout, and white space has a long tradition—certainly one that tracks back at least as far as Guillaume Apollinaire’s early twentieth-century Calligrammes , Laurence Sterne’s textually ribald eighteenth-century Tristram Shandy , although one could arguably plot a hypothetical trajectory that reaches to ancient Greek romances like Achilles Tatius’ second-century Leucippe and Clitophon . Experiments into atomic materiality and digital immateriality bracket the definition of “book” at the same time they highlight Michael Martone’s prediction of its present future as increasingly viral, collaborative, and ephemeral. Or, as Matthew Battles points out: the future of the “book” has already arrived, and it is “ethereal and networked” rather than “an immutable brick.”While conventional writing and reading practices are conceptualized as private, individual, relatively fixed experiences, many of the new forms indicate that writing and reading—from production through dissemination—are rapidly becoming public, collective, incrementally unfixed experiences. That strikes me as an astonishing set of opportunities for a writer to investigate. 5) Another concept you elaborate in AoP is that of limit texts, basically texts that, once you read them, change what you imagine as the shape/horizon/potential of literature. You provide a fantastic reading list of limit texts at the end of AoP. I was hoping you could talk about a few of them in terms of how they specifically operate as limit texts for you—how they expand your understanding of what literature could be or do. Karl Jaspers coined the word Grenzsituationen (border/limit situations) to describe existential moments accompanied by anxiety in which the human mind is forced to confront the restrictions of its existing forms—moments that make us abandon, fleetingly, the securities of our limitedness and enter new realms of self-consciousness. Death, for example. Limit texts are a variety of disturbance that carries various elements of narrativity to their brink so the reader can never quite imagine them in the same terms again. Once you’ve taken one down from the shelf, you’ll never be able to put it back up again. They won’t leave you alone. They will continue to work on your imagination long after you’ve read them. Simply by being in the world, they ask us to embrace difficulty, freedom, radical skepticism. One of the most important for me is Samuel Beckett’s The Unnamable . Instead of establishing conventional setting and building traditional character, from its first words it unsettles both: “Where now? Who now? When now?” That first trio of question marks broadcasts the thematics of the writing (“novel” may be too strong a word) that will follow: it is all about a voice (or, perhaps, voices, about the grammatical mistake of the first-person pronoun), a consciousness (maybe, again, too strong a word), often genderless, removed from place and chronology and socioeconomic reality, hovering in a state of perpetual aporia. All it knows is what it doesn’t know, and its not-knowing is blackly, sardonically comic. The Unnamable is the embodiment of an unreliable narrator—a subject position that can’t trust itself, let alone be trusted by a reader. It contradicts, takes back, digresses, undoes what it just did, forgets, lies, hallucinates gloriously. The language is abstract, disembodied, devoid of sensory data, grayish rather than painterly in texture. Without knowing this passage is from a novel, a reader might well conclude s/he were reading a patch of (anti-)Cartesian philosophy. It might be helpful to conceive of what Beckett is doing as post-genre writing, then, or perhaps what Raymond Federman referred to as critifiction—a mode that blurs conventional distinctions between theory and narrative. In completely different register, and much more recently, Anne Carson’s Nox blew me away. It takes the form of an elegy for her older brother, whom she didn’t know well and who died unexpectedly while on the run from the law in Europe. The thing itself arrives in a box that simulates a thick book, as well as the brother’s textual coffin. Open it, and inside you discover, not a codex, but an accordioned series of “pages” that folds out into an arrangement that suggests an ancient scroll (Carson is, perhaps illuminatingly, a professor of classics) made up of shards of her brother’s letters, old photographs, tickets, Carson’s observations, Catullus’ poem 101 (the one addressed to the Roman poet’s dead brother, a doubling of Carson’s situation), and extensive dictionary entries on all the words that compose that poem. The aggregate produces a collage about the impossibilities of aggregates, the impossibilities of understanding fully, of capturing absences in language. At times Nox feels less an example of what most readers consider a book than something closer to a three-dimensional work of assemblage art. It’s a beautiful mechanism for contemplating Media Specific Analysis, for urging us all to be more extreme. 6) Finally, I want to talk a little about pedagogy and institutions. I’m less interested in questions like “Are MFA programs good for writers?” than in questions about how your role as teacher informs your understanding of literature and your writing practice. I’m also very curious about your take on how commercially marginal literary art is largely patronized by large state institutions and at the same time often imagines itself as a critical and even possibly revolutionary practice. How have your own positions within universities and university-affiliated organizations shaped your thinking about them and about innovative literature? I can imagine in many ways it might make you even more critical. And (I know, another ‘and’...) how does AoP (especially given its relation to Rebel Yell , your previous text on creative writing) reflect your personal history and experience as a teacher and member of communities that are largely defined by institutions? In the classroom, I try to generate the pedagogical field I would have liked to have inhabited as a student, but didn’t. Roland Barthes has a lovely line about this: “We need to substitute for the magisterial [classroom] space of the past (the word delivered by the master from the pulpit above with the audience below, the flock, the sheep, the herd)—a less upright, less Euclidean space where no one, neither teacher nor students, would ever be in his final place.” Easier said than done, of course, but an important life project for all who think of themselves as educators. My own classroom, my own writing, and Architectures of Possibility itself attempt to create the sort of possibility space where, as I mentioned at the outset of our interview, everything should be thought, tried, challenged; where everything rhymes with Roland Barthes’s definition of literature: the question minus the answer. I’m not sure I could write what I’m writing now without the conversations I have almost daily with my students, the conversations they have with each other, the conversations we all have with the texts we study. Especially in light of the paradigm shift over the last, say, quarter century from academia as intellectual exploration to academia as McDonaldized trade school, the irony isn’t lost on me concerning the discrepancy between the safe harbor innovative authors find there and the cultural critiques those authors launch through their writing and pedagogical work. In 2001, I quit my full professorship at one institution precisely because of my disappointment over what had happened to the learning environment there. I had no intentions of reentering the field. In 2007, however, the University of Utah approached me, and I found myself in an environment much more hospitable to the sort of work I want to do—teaching experimental narrative theory and practice. It isn’t by any means a simple irony. One could easily argue innovative writing and pedagogy represents the trace of the paradigm Barthes suggests, and that trace is tremendously productive in all kinds of ways. Innovative writing has never and will never change the world in any large, macrocosmic way. But we’ve all had our lives changed, one by one, by an encounter with a difficult, rich, resonant piece of prose, poetry, music, art, you name it. We’ve all had our lives changed at the ahistorical, microcosmic moment by a class we’ve taken, a teacher we’ve studied with, to such an extent that we became, quite literally, different people. I just came across a stunning set of sentences from Derrida on the topic: “What is education? The death of the parents.” That’s what we’re all up to in the innovative, be it in written texts or the texts we call our classrooms or the texts we call our politics: trying to disrupt what both can and can’t be disrupted, trying to undo what both can and can’t be undone, continuously. (shrink)

In the last thirty years, work in analytic philosophy of art has flourished, and it has given rise to considerably controversy. Stephen Davies describes and analyzes the definition of art as it has been discussed in Anglo-American philosophy during this period and, in the process, introduces his own perspective on ways in which we should reorient our thinking. Davies conceives of the debate as revealing two basic, conflicting approaches--the functional and the procedural--to the questions of whether art can (...) be defined, and if so, how. As the author sees it, the functionalist believes that an object is a work of art only if it performs a particular function (usually, that of providing a rewarding aesthetic experience). By contrast the proceduralist believes that something is an artwork only if it has been created according to certain rules and procedures. Davies attempts to demonstrate the fruitfulness of viewing the debate in terms of this framework, and he develops new arguments against both points of view--although he is more critical of functional than of procedural definitions. Because it has generated so much of the recent literature, Davies starts his analysis with a discussion of Morris Weitz's germinal paper, "The Role of Theory in Aesthetics." He goes on to examine other important works by Arthur Danto, George Dickie, and Ben Tilghman and develops in his critiques original arguments on such matters of the artificiality of artworks and the relevance of artists' intentions. (shrink)

In 1988, Michael Nyman composed the score for Peter Greenaway’s film Drowning by Numbers (or did something that we would ordinarily think of as composing that score). We can think of Nyman’s compositional activity as a “generative performance” and of the sound structure that Nyman indicated (or of some other abstract object that is appropriately related to that sound structure) as the product generated by that performance (ix).1 According to one view, Nyman’s score for Drowning by the Numbers—the musical work—is (...) the product generated by Nyman’s compositional activity (namely, an abstract object) and, more generally, artworks are identified with the products generated by compositional or other creative activities. Let’s call this view The Product Theory. By contrast, according to another view, Nyman’s score for Drowning by Numbers is the generative performance itself (namely, Nyman’s compositional activity) and, more generally, artworks are identified with generative performances themselves. Following David Davies in Art as Performance, let’s call this view The Performance Theory (80). In that book, Davies argues for The Performance Theory and against The Product Theory. (shrink)

Collected and edited by Noah Levin -/- Table of Contents: -/- UNIT ONE: INTRODUCTION TO CONTEMPORARY ETHICS: TECHNOLOGY, AFFIRMATIVE ACTION, AND IMMIGRATION 1 The “Trolley Problem” and Self-Driving Cars: Your Car’s Moral Settings (Noah Levin) 2 What is Ethics and What Makes Something a Problem for Morality? (David Svolba) 3 Letter from the Birmingham City Jail (Martin Luther King, Jr) 4 A Defense of Affirmative Action (Noah Levin) 5 The Moral Issues of Immigration (B.M. Wooldridge) 6 The Ethics of our (...) Digital Selves (Noah Levin) -/- UNIT TWO: TORTURE, DEATH, AND THE “GREATER GOOD” 7 The Ethics of Torture (Martine Berenpas) 8 What Moral Obligations do we have (or not have) to Impoverished Peoples? (B.M. Wooldridge) 9 Euthanasia, or Mercy Killing (Nathan Nobis) 10 An Argument Against Capital Punishment (Noah Levin) 11 Common Arguments about Abortion (Nathan Nobis & Kristina Grob) 12 Better (Philosophical) Arguments about Abortion (Nathan Nobis & Kristina Grob) -/- UNIT THREE: PERSONS, AUTONOMY, THE ENVIRONMENT, AND RIGHTS 13 Animal Rights (Eduardo Salazar) 14 John Rawls and the “Veil of Ignorance” (Ben Davies) 15 Environmental Ethics: Climate Change (Jonathan Spelman) 16 Rape, Date Rape, and the “Affirmative Consent” Law in California (Noah Levin) 17 The Ethics of Pornography: Deliberating on a Modern Harm (Eduardo Salazar) 18 The Social Contract (Thomas Hobbes) -/- UNIT FOUR: HAPPINESS 19 Is Pleasure all that Matters? Thoughts on the “Experience Machine” (Prabhpal Singh) 20 Utilitarianism (J.S. Mill) 21 Utilitarianism: Pros and Cons (B.M. Wooldridge) 22 Existentialism, Genetic Engineering, and the Meaning of Life: The Fifths (Noah Levin) 23 The Solitude of the Self (Elizabeth Cady Stanton) 24 Game Theory, the Nash Equilibrium, and the Prisoner’s Dilemma (Douglas E. Hill) -/- UNIT FIVE: RELIGION, LAW, AND ABSOLUTE MORALITY 25 The Myth of Gyges and The Crito (Plato) 26 God, Morality, and Religion (Kristin Seemuth Whaley) 27 The Categorical Imperative (Immanuel Kant) 28 The Virtues (Aristotle) 29 Beyond Good and Evil (Friedrich Nietzsche) 30 Other Moral Theories: Subjectivism, Relativism, Emotivism, Intuitionism, etc. (Jan F. Jacko). (shrink)

Subjectivists about welfare face two problems that pull them in opposite directions. The Paradox Problem, outlined by Ben Bradley, is that, for an agent who desires that her life go badly, subjectivist theories are sometimes unable to give a determinate answer about how well her life goes. This problem demands that subjectivists choose a complex mental attitude to ground well-being. The Infant Problem, from Eden Lin, is that many subjective theories end up denying that infants (and some others) have welfare. (...) This problem demands that subjectivists choose a simple attitude to ground well-being. I argue that subjectivists should respond by adopting Disjunctive Subjectivism. Your welfare depends on your judgements that things are intrinsically good or bad for you (c.f. Dorsey), unless you are not capable of such judgements. In that case, it depends on your desires. I then defend DS against objections from Lin, and the potential charge of being ad hoc. (shrink)

Claims concerning processes, claims of the form “xisφing”, have been the subject of renewed interest in recent years in the philosophy of action. However, this interest has frequently limited itself to noting certain formal features such claims have, and has not extended to a discussion of when they are true. This article argues that a claim of the form “xisφing” is true when what is happening withxis such that, if it is not interrupted, a φing will occur. It then applies (...) itself more directly to the case of action, arguing that when “xisφing” describesx's intentional action, it is true iffxis acting from a method she knows to be sufficient to φ, in the sense that if she is not interrupted in carrying out this method, she will φ. I use this criterion to argue that the carbon‐copier example Donald Davidson gives in “Intending” fails to refute Elizabeth Anscombe's claim that an agent who is φing intentionally knows that she is, because the agent in Davidson's example is not intentionally making the copies. (shrink)

Many philosophers and psychologists argue that out everyday ability to predict and explain the actions and mental states of others is grounded in out possession of a primitive 'folk' psychological theory. Recently however, this theory has come under challenge from the simulation alternative. This alternative view says that human beings are able to predict and explain each other's actions by using the resources of their own minds to simulate the psychological aetiology of the actions of the others. This book and (...) the companion volume Folk Psychology: The Theory of Mind Debate together offer a richly woven fabric of philosophical and psychological theory, which promises to yield real insights into the nature of our mental lives. (shrink)

Presents general information about meteorology, weather, and climate and includes more than thirty activities to help study these topics, including making a ...

La menzogna è irrinunciabile per vincere in politica? Davi ci spiega quali sono i meccanismi di persuasione a cui ricorrono taluni politici per farsi eleggere e quali le responsabilità di quegli elettori che scelgono comunque di votare chi sostiene anche ciò che non può essere vero. È indubbio che la comunicazione politica si rifaccia al simbolismo e al linguaggio delle favole; non necessariamente per occultare la realtà, ma più direttamente per esprimere con maggiore efficacia il suo messaggio. Alle celebri favole (...) di 'Biancaneve', 'Cenerentola', 'Il brutto anatroccolo' sono ricorsi infatti uomini politici del calibro di Berlusconi, Prodi, Nixon, Carter, Mitterrand e partiti quali la Democrazia Cristiana; l'hanno fatto per conquistare voti ma anche per attivare ampi meccanismi di consenso che attingessero direttamente dall'inconscio collettivo. Le conseguenze - ammonisce l'autore - possono essere molto serie, come nel caso dell'attuale politica americana che ha portato la manipolazione e l'inganno a essere riconosciuti come tratti identitari della presidenza di George W. Bush. (shrink)

Well-Being and Death addresses philosophical questions about death and the good life: what makes a life go well? Is death bad for the one who dies? How is this possible if we go out of existence when we die? Is it worse to die as an infant or as a young adult? Is it bad for animals and fetuses to die? Can the dead be harmed? Is there any way to make death less bad for us? Ben Bradley defends the (...) following views: pleasure, rather than achievement or the satisfaction of desire, is what makes life go well; death is generally bad for its victim, in virtue of depriving the victim of more of a good life; death is bad for its victim at times after death, in particular at all those times at which the victim would have been living well; death is worse the earlier it occurs, and hence it is worse to die as an infant than as an adult; death is usually bad for animals and fetuses, in just the same way it is bad for adult humans; things that happen after someone has died cannot harm that person; the only sensible way to make death less bad is to live so long that no more good life is possible. (shrink)