Death’s Shadow Lightened

This chapter by Daniel Rubio defends Epicurus’ famous argument that death cannot harm us because we no longer exist after we die. Focusing on the deprivationist account of the harm of death, Rubio contends that death is not especially harmful in any candidate ways.

The value of longevity

Longevity is valuable. Most of us would agree that it’s bad to die when you could go on living, and death’s badness has to do with the value your life would have if it continued. Most of us would also agree that it’s bad if life expectancy in a country is low, it’s bad if there is high infant mortality and it’s bad if there is a wide mortality gap between different groups in a population. But how can we make such judgments more precise? How should we evaluate the harm of mortality in a population? Although philosophers have written a lot about the harm of death for individuals, very little work has been done on the harm of mortality for populations. In this article, I take the first steps towards developing a theory of the harm of population mortality. Even these first steps, I argue, lead to surprising results.

Saving People from the Harm of Death

Many people believe that death is one of the worst things that can happen to us. At the same time, the incident of death cannot be experienced. This raises philosophical questions about how and to whom death is bad. Is death negative primarily for the survivors, or does death also affect the decedent? And when is the worst time to die? Is it late in fetal life, just after birth, or in adolescence? In order to properly evaluate deaths in global health, we must provide answers to these questions. In this volume, leading philosophers, medical doctors, and health economists discuss different views on how to evaluate deaths and the relevance of such evaluations to health policy. These include state-of-the-art theories about the harm of death and its connections to population-level bioethics. The standard view in global health is that newborn deaths count as the worst deaths, while stillbirths are neglected. This raises a question about why birth is so significant. 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. The results from the book will change the way we evaluate deaths in global health. If we do change how deaths are evaluated, this will have consequences for how we prioritize different health programs that affect individuals at different ages, as well as how we think about inequality in health.

Quantifying the Harm of Death

In economic evaluation of health interventions and in measurements of burden of disease, the harm of death is routinely quantified. Can this make sense? I review approaches to measuring willingness to pay to reduce risks of death, discuss methods used in health economics and burden of disease estimation for measuring the undesirability of death relative to the undesirability of illness, and address context-dependent variation in the harm of death. I conclude that most of the approaches to quantifying the harm of death are in fact quantifications of something else or quantifications based on questionable assumptions. However, there is a relatively straightforward approach consisting in studying how many averted cases of a given health loss people think an averted death is equal to in value and priority merit. Results from such studies can help policymakers set priorities between health programs in accord with population values.

Putting a Number on the Harm of Death

Donors to global health programs and policymakers within national health systems have to make difficult decisions about how to allocate scarce health care resources. Principled ways to make these decisions all make some use of summary measures of health, which provide a common measure of the value (or disvalue) of morbidity and mortality. They thereby allow comparisons between health interventions with different effects on the patterns of death and ill health within a population. The construction of a summary measure of health requires that a number be assigned to the harm of death. But the harm of death is currently a matter of debate: different philosophical theories assign very different values to the harm of death at different ages. This chapter considers how we should assign numbers to the harm of deaths at different ages in the face of uncertainty and disagreement.