Death Wish

Chapter 6 examines Ezekiel Emanuel’s reasons for thinking that after a “complete life” (by around age seventy-five) it can be reasonable (at least for some) to omit easy preventive measures (e.g., flu shots) that would extend life even when such life would not be worse than death. To better understand such a position the chapter makes use of the views of Susan Wolf and Bernard Williams on meaning in life and reasons to go on living, and also considers different ways of judging the worth of activities. It further compares Emanuel’s views with those of Atul Gawande, B. J. Miller, and Douglas MacLean. Finally, it considers whether Emanuel’s arguments succeed and also whether they support the moral permissibility of suicide and assisted suicide.

The Badness of Death and What to Do About It (if Anything)

Chapter 1 discusses the pros and cons of four views about the badness of death on the assumption that it involves one’s ceasing to exist: Deprivationism, Willlhavehadism, Alloverism, and Insultism. It considers how these views bear on such questions as whether death is always bad for the person who dies, whose life to save when not all can be saved, how the distribution of goods and bads in a life matters, and whether it is reasonable to have an asymmetrical attitude toward death and prenatal nonexistence. The chapter also considers what the four views imply about the badness of the extinction of humanity (and all other persons).

Direction and Distribution in Life

Chapter 5 distinguishes qualitative aging from becoming older in years by considering the fictional case of Benjamin Button. It then considers the significance and necessity at a given time of death in lives with different aging trajectories. There follows a discussion of better and worse distributions of goods and bads within lives, both on the assumption that we have and do not have control over the total of goods and bads and the length of life. Finally the chapter considers how the difference between conditional and categorical goods may affect appropriateness of tradeoffs between quantity and quality of life.

Advanced and End-of-Life Care

Chapter 4 considers proposals for advanced and end-of-life care and for helping the general public make decisions about such care. Possible conflicts are identified between the aim of respecting people’s preferences and meeting objective standards of best practices, satisfying family preferences, and meeting requirements of informed consent. The chapter considers in detail questions suggested for conversations about advanced and end of life care. It locates imprecision, nudging, and framing effects in those questions that may interfere with their correctly eliciting people’s preferences. It also suggests that there may be attempts to promote specific values and goals favored by end-of-life care professionals, such as peacefulness and avoiding invasive treatments. The possible connection between the aim of a good life to the end and the use of assisted suicide is also examined.

Death, Dying, and Meaning

Chapter 3 discusses Atul Gawande’s views about the choice between trying to live on by way of medical treatment and trying to retain meaning during one’s dying process through hospice care. It first compares medical and philosophical conceptions of death and dying. It then considers how Gawande’s views relate to Bernard Williams’ distinction between categorical and conditional desires and how they compare with views discussed in Chapter 2 about when it can make sense not to resist the end of one’s life. There is discussion of Gawande’s conception of the dying role, fear, the importance of how things end, and meaning in life. Suggestions are offered about possible meaningful use of suffering and death.

Death and the State

Chapter 8 considers how one should reason about assisted suicide as a matter of public (and legal) policy in the absence of a constitutional right to it by critically examining anti-legalization views such as those of Ezekiel Emanuel. The chapter considers the role of (i) moral rights and wrongings and how they come about as well as (ii) harms and benefits and how to aggregate them. How arguments for the distinctive role of the state in enabling or interfering with behavior bears on these issues is considered by reviewing some arguments about capital punishment. Finally, in the light of empirical data about effects of legalizing physician-assisted suicide and given what else Emanuel believes, the chapter considers whether he should no longer oppose legalization.

Five Easy Arguments for Assisted Suicide and the Objections of Velleman and Gorsuch

This chapter presents five arguments in favor of the moral permissibility of, and even a duty to engage in, physician-assisted suicide both to end suffering and for other reasons in those who are and are not terminally ill. It considers objections to these sorts of arguments presented by David Velleman from a Kantian perspective and by Neil Gorsuch (now associate justice of the U.S. Supreme Court) who argues against intentionally causing death. The chapter considers how to identify intention, the significance of it for moral and legal permissibility, and the role of the Doctrine of Double Effect in arguments about assisted suicide. It also deals with the difference between assisted suicide for the good of some enabling versus causing harm to others.

The Purpose of My Death

Chapter 2 discusses Shelly Kagan’s views about (i) when ending or not ending one’s life does or does not make sense, and (ii) how to reach a decision about this issue. It considers whether his views about the worth of living on are consistent with his views about when it makes no sense to end one’s life. The chapter also examines whether the way in which Kagan adds up the negative and positive aspects of life to decide whether to live on gives sufficient weight to context-dependent values and to the reasonableness of not going through great suffering for the sake of an even greater good to oneself.