Death is something we mourn or fear as the worst thing that could happen―whether the deaths of close ones, the deaths of strangers in reported accidents or tragedies, or our own. And yet, being dead is something that no one can experience and live to describe. This simple truth raises a host of difficult philosophical questions about the negativity surrounding our sense of death, and how and for whom exactly it is harmful. The question of whether death is bad has (...) occupied philosophers for centuries, and the debate emerging in philosophical literature is referred to as the "badness of death." Are deaths primarily negative for the survivors, or does death also affect the deceased? What are the differences between death in fetal life, just after birth, or in adolescence? In order to properly evaluate deaths in global health, we must find answers to these questions. -/- In this volume, leading philosophers, medical doctors, and economists discuss different views on how to evaluate death and its relevance for health policy. This includes theories about the harm of death and its connections to population-level bioethics. For example, one of the standard views in global health is that newborn deaths are among the worst types of death, yet stillbirths are neglected. This raises difficult questions about why birth is so significant, and several of the book's authors challenge this standard view. -/- This is the first volume to connect philosophical discussions on the harm of death with discussions on population health, adjusting the ways in which death is evaluated. Changing these evaluations has consequences for how we prioritize different health programs that affect individuals at different ages, as well as how we understand inequality in health. (shrink)

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

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

Many economic measures are structured to reflect ethical values. I describe three attitudes towards this: maximalism, according to which we should aim to build all relevant values into measures; minimalism, according to which we should aim to keep values out of measures; and an intermediate view. I argue the intermediate view is likely correct, but existing versions are inadequate. In particular, economists have strong reason to structure measures to reflect fixed, as opposed to user-assessable, values. This implies that, despite disagreement (...) about precisely how to do so, economists should standardly adjust QALYs and DALYs to reflect egalitarian values. (shrink)

Summary measures of health, such as the quality-adjusted life year and disability-adjusted life year, have long been known to incorporate a number of value choices. In this paper, though, I show that the value choices in the construction of such measures extend far beyond what is generally recognized. In showing this, I hope both to improve the understanding of those measures by epidemiologists, health economists and policy-makers, and also to contribute to the general debate about the extent to which such (...) measures should be adjusted to reflect ethical values. (shrink)

In their insightful article, ‘The Disvalue of Death in the Global Burden of Disease’, Solberg et al argue that there is a potential incoherence in the way disability-adjusted life years are calculated. Morbidity is measured in years lived with disability in a way quite unlike the way mortality is measured in years of life lost. This potentially renders them incommensurable, like apples and oranges, and makes their aggregate—DALYs—conceptually unsound. The authors say that it is ‘vital’ to address this problem, that (...) ‘[n]eglecting [it] is not an option’, and that ‘one cannot add YLLs and YLDs together in [their] current form’.1 Though one might object to their argument in various ways, let us assume the authors are correct that there is a potential inconsistency here. I want to ask why we should be troubled by that. Now, this question may scarcely seem worth asking. Consistency and coherence are regarded as non-negotiable in so many domains that of course we should demand them in a measure such as the DALY. And this desire for coherence is clearly shared by both the architects of the DALY and their critics.2 3 I think, though, that things are more complicated. In 2012, I wrote an article discussing the epidemiological perspective from which DALYs should be calculated.4 Simplifying greatly, here is the problem: both YLDs and YLLs can be calculated either from prevalence data or from incidence data. The most natural way to calculate YLDs bases them on prevalences, because when we think about morbidity our initial thought is of people who are suffering. The most natural way to calculate YLLs bases them on an incidence measure, because when …. (shrink)

This paper is about the neglected question of what sort of things we are metaphysically speaking. It is different from the mind-body problem and from familiar questions of personal identity. After explaining what the question means and how it differs from others, the paper tries to show how difficult it is to give a satisfying answer.

According to standard comparativist views, death is bad insofar as it deprives someone of goods she would otherwise have had. In The Ethics of Killing, Jeff McMahan argues against such views and in favor of a gradualist account according to which how bad it is to die is a function of both the future goods of which the decedent is deprived and her cognitive development when she dies. Comparativists and gradualists therefore disagree about how bad it is to die at (...) different ages. In this paper I examine two prominent criticisms of gradualism and show that both misconstrue McMahan. I develop a related criticism that seems to show that a gradualist cannot coherently relate morbidity and mortality. This criticism also fails, but has an instructive implication for how policy-makers setting priorities for health care investments should regard choices between life-saving interventions and interventions against non-fatal diseases in the very young. (shrink)

A comprehensive study of the ethics of killing in cases in which the metaphysical or moral status of the individual killed is uncertain or controversial. Among those beings whose status is questionable or marginal in this way are human embryos and fetuses, newborn infants, animals, anencephalic infants, human beings with severe congenital and cognitive impairments, and human beings who have become severely demented or irreversibly comatose. In an effort to understand the moral status of these beings, this book develops and (...) defends distinctive accounts of the nature of personal identity, the evaluation of death, and the wrongness of killing. The central metaphysical claim of the book is that we are neither nonmaterial souls nor human organisms but are instead embodied minds. In ethical theory, one of the central claims is that the morality of killing is not unitary; rather, the principles that determine the morality of killing in marginal cases are different from those that govern the killing of persons who are self‐conscious and rational. Another important theme is that killing in marginal cases should be evaluated in terms of the impact it would have on the victim at the time rather than on the value of the victim's life as a whole. What primarily matters is how killing would affect that which would be rational for the victim to care about at the time of death. By appealing to various foundational claims about identity, death, and the morality of killing, this book yields novel conclusions about such issues as abortion, prenatal injury, infanticide, the killing of animals, the significance of brain death, the termination of life support in cases of persistent vegetative state, the use of anencephalic infants as sources of organs for transplantation, euthanasia, assisted suicide, and advance directives in cases of dementia. In particular, the book defends the moral permissibility of abortion, infanticide, and euthanasia in certain cases and argues that brain death is not the appropriate criterion of death either for a person or a human organism. (shrink)

This is an important book precisely because there is none other quite like it.

Given that a person's death is bad for her,whenis it bad? I defendsubsequentism, the view that things that are bad in the relevant way are bad after they occur. Some have objected to this view on the grounds that it requires us to compare the amount of well-being the victim would have enjoyed, had she not died, with the amount she receives while dead; however, we cannot assign any level of well-being, not even zero, to a dead person. In the (...) population ethics literature, many philosophers have argued along similar lines that bringing someone into existence can neither harm nor benefit her. Working within the comparative framework (on which harms make us worse off), I respond by proposing a good sense in which we can say that dead people, and actual people at alternatives in which they do not exist, have a well-being level of zero. (shrink)

We are often faced with choices that involve the weighing of people's lives against each other, or the weighing of lives against other good things. These are choices both for individuals and for societies. A person who is terminally ill may have to choose between palliative care and more aggressive treatment, which will give her a longer life but at some cost in suffering. We have to choose between the convenience to ourselves of road and air travel, and the lives (...) of the future people who will be killed by the global warming we cause, through violent weather, tropical disease, and heat waves. We also make choices that affect how many lives there will be in the future: as individuals we choose how many children to have, and societies choose tax policies that influence people's choices about having children. These are all problems of weighing lives. How should we weigh lives? Weighing Lives develops a theoretical basis for answering this practical question. It extends the work and methods of Broome's earlier book Weighing Goods to cover the questions of life and death. Difficult problems come up in the process. In particular, Weighing Lives tackles the well-recognized, awkward problems of the ethics of population. It carefully examines the common intuition that adding people to the population is ethically neutral - neither a good nor a bad thing - but eventually concludes this intuition cannot be fitted into a coherent theory of value. In the course of its argument, Weighing Lives examines many of the issues of contemporary moral theory: the nature of consequentialism and teleology; the transitivity, continuity, and vagueness of betterness; the quantitative conception of wellbeing; the notion of a life worth living; the badness of death; and others. This is a work of philosophy, but one of its distinctive features is that it adopts some of the precise methods of economic theory (without introducing complex mathematics). Not only philosophers, but also economists and political theorists concerned with the practical question of valuing life, should find the book's conclusions highly significant to their work. (shrink)

This book elucidates the theoretical structure and scope of interpersonal and intra-personal aggregation--a trade-off between benefits to a group of individuals and losses to another group of individuals--and defends a form of aggregation -- formal aggregation -- that resolves a variety of outstanding problems arising from the conventional understanding of aggregation, including the Number Problem concerning the moral relevance of the number of individuals.

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)

Douglas proposes a new ideal in which values serve an essential function throughout scientific inquiry, but where the role values play is constrained at key points, protecting the integrity and objectivity of science.

This book shows through argument and numerous policy-related examples how understanding moral philosophy can improve economic analysis, how moral philosophy can benefit from economists' analytical tools, and how economic analysis and moral philosophy together can inform public policy. Part I explores the idea of rationality and its connections to ethics, arguing that when they defend their formal model of rationality, most economists implicitly espouse contestable moral principles. Part II addresses the nature and measurement of welfare, utilitarianism and cost-benefit analysis. Part (...) III discusses freedom, rights, equality, and justice - moral notions that are relevant to evaluating policies, but which have played little if any role in conventional welfare economics. Finally, Part IV explores work in social choice theory and game theory that is relevant to moral decision making. Each chapter includes recommended reading and discussion questions. (shrink)

Exploring the role of values in scientific inquiry, Hugh Lacey examines the nature and meaning of values, and looks at challenges to the view, posed by postmodernists, feminists, radical ecologists, Third-World advocates and religious fundamentalists, that science is value free. He also focuses on discussions of 'development', especially in Third World countries. This paperback edition includes a new preface.

When disability-adjusted life years are used to measure the burden of disease on a population in a time interval, they can be calculated in several different ways: from an incidence, pure prevalence, or hybrid perspective. I show that these calculation methods are not equivalent and discuss some of the formal difficulties each method faces. I show that if we don’t discount the value of future health, there is a sense in which the choice of calculation method is a mere question (...) of accounting. Such questions can be important, but they don’t raise deep theoretical concerns. If we do discount, however, choice of calculation method can change the relative burden attributed to different conditions over time. I conclude by recommending that studies involving disability-adjusted life years be explicit in noting what calculation method is being employed and in explaining why that calculation method has been chosen. (shrink)

Although the counterfactual comparative account of harm, according to which someone is harmed when things go worse for her than they otherwise would have, is intuitively plausible, it has recently come under attack. There are five serious objections in the literature: some philosophers argue that the counterfactual account makes it hard to see how we could harm someone in the course of benefitting that person; others argue that Parfit’s non-identity problem is particularly problematic; another objection claims that the account forces (...) us to see many harms where there is just one; a fourth objection is based on the claim that the counterfactual account makes mysterious the distinction between harms and mere failures-to-benefit; and a final problem arises from cases of pre-emption, in which the nearest possible world in which the harmful event does not occur is a world in which some other harmful event occurs. This paper argues that, properly understood, harm essentially involves a counterfactual comparison, and that these comparisons are sensitive to context in the manner typical of counterfactual conditionals, and that, augmented with two plausible distinctions, this account has the resources to provide satisfying responses to each of the objections that have been raised against it. (shrink)