Archives for category: dementia

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Nils Holtug argues for the Value of Existence View which makes ‘the comparative claim that existence can be better (or worse) for a person than non-existence’ (p.370). Derek Parfit and John Broome argue against this view by stating that it is incoherent. Parfit argues that causing someone to exist cannot be better for a person because the alternative would not have been worse. Broome argues that it can never be true that it is better for a person to exist than to not exist because if she had not existed there would not have been a ‘her’ to have been worse off.

The argument set out by Parfit and Broome is called the Metaphysical Argument and it relies upon two premises. The first premise makes the judgement that it is better (or worse) to exist than never to exist and entails that it is worse (or better) to not exist than to exist. The second premise is that it cannot be worse (or better) to not exist. The first claim, Holtug states, is based upon the logic of ‘betterness’ relation, and the second premise is based upon the metaphysical principle called The No Properties of the Non-Existent Principle. This means that an individual cannot have any properties if it does not exist.

This principle can be disputed. Broome’s argument relies upon the point that if a person does not exist then it is impossible for any properties to be attached to her. Holtug contends that the logic of betterness relation that the argument relies upon assumes that in order for existence to be worse than non-existence, non-existence must be better than existence. To explore the logical properties of the betterness relation, Holtug considers the following definition:

1)      y is worse for S than x, if and only of x is better for S than y.

If (1) states that existence if better (or worse) for a person than non-existence, non existence is better (or worse) for her. The latter part seems to violate the No Properties of the Non-Existent Principle. It seems to ascribe to her the property of being worse (or better) off in a possible world in which she does not exist. According to this principle we cannot claim that existence is better for her than non-existence because this implies that non-existence is worse for her than existence. So Holtug reassesses the argument with the proposition:

P: Non-existence is worse for Jeremy than existence.

Can the truth of P be established without ascribing to Jeremy positive properties in a possible world in which he does not exist? Holtug claims that P can be established by appeal to a preference that Jeremy has in an actual world in which he exists. Existence may be preferable for Jeremy because he prefers existence to non-existence. Jeremy’s life includes a surplus of positive value, whereas his non-existence had no value. Holtug insists that this is compatible with The No Properties of the Non-Existent Principle; it is better to have a surplus of values than no value. The Metaphysical Argument is not preserved because the Value of Existence View does not rely upon someone existing for the possibility of them benefiting from existence.

  • Holtug, Nils. “On the value of coming into existence” Journal of Ethics , 5:4 , 2001 , 361-384

Ronald Dworkin points to a distinction between reasons people wish for their lives to go one way or another. One set of reasons he calls experiential preferences and the other set of reasons are critical interests. Experiential preferences are those things that we find enjoyable in life. They also can entail things that are painful or bad experiences but, within limits, these kinds of experiences do not make our whole life worse. Critical interests, Dworkin asserts, are those that people find are essential to their understanding of what constitutes a good life.

Experiential interests are not frivolous and critical interests profound, Dworkin states, it is just that critical interests are important to the aspirations of our lives. In his view, we need to establish the distinction between these two interests in order to understand how people should be treated. It is not difficult to understand why we care about our experiential interests as it is natural to prefer pleasure to pain. But it is more difficult to understand why people should care about their critical interests. Therefore, Dworkin contends that we need an intellectual explanation of how our critical interests connect with the larger beliefs that we have about life.

Critical interests are bound in what Dworkin calls the integrity of our lives; the capacity we have to autonomously structure our lives to contain the right experiences and achievements. Integrity is similar to dignity, which is why we think someone has little self-respect if they have acted perversely for gain or the avoidance of trouble. It is important to understand that one may be mistaken in the decisions one makes for understanding the idea of critical interests. For Dworkin, this is essential to the basic distinction between critical and experiential interests.

In using such a distinction to consider whether death is in the best interests for someone with dementia, Dworkin thinks that we must consider what was important in that person’s life; what was their life narrative. Someone who has dementia may have more to gain through pleasant experience for several years before they die a natural death and to kill oneself through the fear of a lack of experiential interests is probably wrong.  However, Dworkin argues, it is critical interests that matter when we wish to consider how one might die. If people think that they will be living in degrading conditions through being fully dependent then they may wish to choose to die. Therefore Dworkin asserts that these decisions based upon their critical interests before they were afflicted should be taken into account when considering how an advanced dementia patient may not wish to live.

Rebecca Dresser objects to Dworkin’s differentiation between experiential and critical interests on the grounds that it is possible that people do not draw a sharp line between these interests. In the circumstances of dementia, Dresser says, Dworkin fails to consider that critical interests become less important and experiential interests more so, just as they may for people who are brain damaged or intellectually disabled. Dresser states that people who seem happy and contented although they may be suffering from dementia, will experience clear harm from a decision that purports to advance the critical interests that they may no longer care about.

  • Dworkin, Ronald. “Dying and living” in Life’s Dominion: An Argument About Abortion and Euthanasia , Dworkin, Ronald , 1993 , 179-217
  • Dresser, Rebecca. “Dworkin on dementia: Elegant theory, questionable policy” in Bioethics: An anthology , Kuhse, Helga Singer, Peter , 1999 , 312-320