Ethics, Medicine and Public Health (2016) 2, 481-489 Available online at ScienceDirect www.sciencedirect.com DOSSIER ''PERSONHOOD: INTIMITY AND OTHERNESS'' / Thoughts Animals, advance directives, and prudence: Should we let the cheerfully demented die? Animaux, directives anticipées et prudence : devrions-nous laisser mourir les « déments heureux » ? D.G. Limbaugh (Ph.D Candidate) Department of Philosophy, University at Buffalo, 135 Park Hall, Buffalo, NY 14260, USA Received 2 July 2016; accepted 6 October 2016 Available online 21 November 2016 KEYWORDS Animalism; Advance directives; Personal identity; Prudence; Dementia Summary This paper argues that the animalist-–someone who believes we are no more than human organisms-–should not be highly confident that advance directives are properly applied to patients who are cheerful and yet severely demented. Pretend that I have suffered from severe dementia for some time. Though I am cheerful and well off considering the circumstances, I live with minimal psychological continuity. Currently I am sitting in a chair gazing out a window. Question: is the individual sitting in the chair actually me? My memories, hopes, fears, interests, and ability to project myself into the future are gone. Am I also gone? Now let's imagine that the individual in the chair has been diagnosed with pneumonia. I signed an advance directive refusing treatment in such a scenario. Has the individual in the chair signed an advance directive? The answer to this question depends on what you think I am and what it takes for such a thing to persist. The animalist, who tells us we are nothing more than human organisms, says that I persist if the organism persists. I survive as long as the organism survives, and that survival has nothing to do with psychology (memories, beliefs, etc.), only with biology. So, me-last-night is identical to me-this-morning if the organism is the same as it was last night. This will be true if the organism survived (remained alive) through the night. Now, I-–as the signee-–sign an advance directive in the interest of consenting in advance in case there is a time when I-–as the patient-–cannot speak for myself in terms of medical treatment. I assume that the consent in this case is binding only if I am in fact speaking for myself in the future and not someone else. That is, I must be both the signee and the patient for the advance directive to be binding. The advocate of animalism contends that her view gives the obvious answer. That the patient and signee are identical. There is no clinical case where one would be remotely tempted to apply an advance directive where the signee and patient do not share E-mail address: dglimbau@buffalo.edu http://dx.doi.org/10.1016/j.jemep.2016.10.006 2352-5525/© 2016 Elsevier Masson SAS. All rights reserved. 482 D.G. Limbaugh a life. If the signee and patient share a life, then they are the same organism, and according to animalism the signee has survived and is thus identical to the patient. So, if animalism is true, then in the case of severe dementia or Alzheimer's, the organism continues to persist, which means I continue to persist. Were this problem merely theoretical, then perhaps the above argument would be satisfying, assuming the truth of animalism. However, in practice, we need more than the assumed truth of animalism. To overcome this problem of identity, we need enough justification in animalism to warrant a lethal omission of action towards a cheerful patient who cannot express her own wishes. That is, animalism is only helpful in telling you when to honor an advance directive in so much as you are confident enough in its truth to allow for the consequences of a mistake. I assume that when it comes to the risk of allowing the wrong individual to die, we should have a high level of confidence in the success of our actions before proceeding, ceteris paribus. I argue that we should not have a high level of confidence that we persist according to animalism, and thus, we should not apply lethal advance directives to the cheerfully demented. My argument is that animalism is undermined by its attempts to overcome objections. For instance, the animalist must be able to principally exclude the brain, as opposed to the animal, as what is the thinker. There is consensus among animalist that the best way to avoid the brain as the thinker is to adopt a sparse ontology denying the existence of brains, hands, tables, and chairs. However, the adoption of such an ontology reduces the justificatory force of commonsense, which is key in arguing for animalism and that we persist as long as our animal is biologically alive. This is also a loss of justification that I am the signee and the patient, that the advance directive applies to the individual in the chair, and that the directive is sufficient to let that individual die. © 2016 Elsevier Masson SAS. All rights reserved. MOTS CLÉS Animalistes ; Directives anticipées ; Identité personnelle ; Prudence ; Démence Résumé Cet article soutient que les animalistes-–ceux qui croient que nous ne sommes que des animaux-–ne devraient pas être hautement confiants que les directives anticipées sont proprement applicables aux patients qui sont heureux bien qu'atteints de démence sévère. Imaginez que j'aie souffert de démence sévère depuis un certain moment. Bien que je sois heureux et à l'aise vu les circonstances, je ne vis qu'avec une continuité psychologique minimale. En ce moment, je suis assis sur une chaise à regarder dehors. Question: est-ce que l'individu assis sur cette chaise est vraiment moi ? Mes souvenirs, espoirs, craintes, intérêts et mon habileté à me projeter dans le futur ont disparue. Ai-je également disparu ? Imaginons que l'individu sur la chaise ait été diagnostiqué pneumonique. J'ai signé une directive anticipée voulant que je ne reçoive pas de traitement dans un tel scénario. Est-ce que l'individu assis sur la chaise a signé une directive anticipée ? La réponse à cette question dépend de ce que je suis et des conditions nécessaires à la persistance. L'animaliste, qui nous assure que nous ne sommes rien d'autre que des organismes humains, affirme que nous survivons si notre organisme persiste dans l'existence. Je survis aussi longtemps que mon organisme survit et ma survivance n'a rien à voir avec ma psyché (mes souvenirs, me croyances, etc.) ; elle ne dépend que de ma biologie. Par conséquent, « moi-hier-soir » est identique à « moi-ce-matin » si et seulement si l'organisme est le même ce matin qu'hier. Cela ne sera vrai que si l'organisme est resté en vie durant la nuit. Seulement, je-–le signataire-–signe une directive afin de consentir à l'avance à un certain traitement dans le cas où je-–le patient-–ne pourrait pas parler en mon propre nom en ce qui a trait aux affaires médicales. Je présume que le consentement dans ce cas n'est contraignant que si je parle en mon nom dans le futur et non au nom de quelqu'un d'autre. C'est-à-dire que je dois être aussi bien le signataire que le patient pour que la directive anticipée soit contraignante. Le partisan de l'animalisme prétend que sa thèse nous fournit une réponse immédiate. Le patient et le signataire seraient identiques. Il n'y a aucun cas clinique où l'on serait tenté d'appliquer une directive anticipée alors que le signataire et le patient ne partagent pas la même vie. Or si le signataire et le patient partagent la même vie, ils constituent un seul et même organisme et donc, selon la thèse animaliste, le signataire aurait survécu et serait identique au patient. Conséquemment, si l'animalisme est vrai, dans le cas où je suis atteint de démence sévère ou d'Alzheimer, mon organisme continue à persister dans l'existence, ce qui veut dire que je survis. Si le problème n'avait été que théorique et en supposant que la thèse animaliste est correcte, il est possible que l'argument précédent nous eût satisfaits. Néanmoins, dans la pratique, nous avons besoin de plus que de supposer Animalism and advance directives 483 que l'animalisme soit vrai. Pour résoudre le problème de l'identité dans un cas particulier, nous avons besoin d'une justification assez solide en l'animalisme pour légitimer l'omission des soins nécessaires à maintenir en vie le patient heureux. Autrement dit, l'animalisme n'est utile, lorsqu'il dicte en quelles circonstances honorer les directives anticipées, que si nous sommes assez confiants dans sa vérité pour tolérer les conséquences d'une erreur. Je présume que, lorsqu'il y a une possibilité de laisser mourir le mauvais individu, nous devrions, avant de procéder, avoir le plus haut degré de confiance dans le succès de notre action, ceteris paribus. Je maintiens que nous n'avons pas de raisons suffisantes d'être pleinement confiants en la vérité de l'animalisme, et donc nous ne devrions pas suivre les directives anticipées au cas du dément heureux. Mon raisonnement est que l'animalisme est miné par ses tentatives de répondre à des objections. Par exemple, l'animaliste doit être en mesure d'exclure, par des principes, que le cerveau plutôt que l'animal soit le penseur. Il y a un consensus au sein des animalistes que le meilleur moyen d'éviter cette proposition est d'adopter une ontologie parcimonieuse qui nie l'existence des cerveaux, des mains, des tables et des chaises. En revanche, l'adoption d'une telle ontologie réduit la force justificatrice du sens commun, lequel est un élément clef dans les arguments en faveur de l'animalisme et de la thèse selon laquelle nous persistons tant et aussi longtemps que l'animal persiste biologiquement. L'adoption d'une telle ontologie se fait aussi au détriment de la force justificatrice de la thèse que je suis le signataire et le patient, de la thèse que la directive anticipée s'applique à l'individu dans le chaise ; enfin, de la thèse que la directive est suffisante pour nous permettre de laisser mourir l'individu atteint de démence. © 2016 Elsevier Masson SAS. Tous droits réservés. T P d c i h e m u l i g b t w t t I o a w m s a o s h i e beliefs, desires, temperament, personality, memories, etc. have nothing to do with my continued existence. I go where the organism goes. I survive as long as the organism sur-Introduction This paper argues that if one is an animalist-–a holder of the view that we are human animals (further explained below)-–then she should rethink the applicability of advance directives. That is, if one holds the view that we are identical to human organisms-–the position of, to name a few, Peter van Inwagen [1], Eric Olson [2], Trenton Merricks [3], and David Hershenov [4], then lethal advance directives to ''not treat'' as applied to the cheerfully severally demented (e.g., some Alzheimer's patients) are suspect. Here is the problem. If the patient is severely demented, then the animalist should lack a high level of confidence that the signee of an advance directive is (is identical to) the patient the directive might be applied to at a later time. I assume that in the case of lethal advance directives, we want to be highly confident that we let the right patient die. Thus, the animalist should not apply lethal advance directives to the severely demented. In what follows, I will briefly explain why a highconfidence in the identity of the patient is important in applying lethal advance directives. I will then lay out the main argument for why such confidence is not had on animalism. Section three will develop this argument by demonstrating how responding to objections should cause animalists to lose confidence in their view. This loss is a result of their adopting a sparse ontology called 'biological minimalism'-–the claim that the world only contains animals and partless fundamental particles sometimes called 'simples' or 'elementary particles' (e.g., quarks). The final two sections will pull together the dialectic and explain why, on animalism, we should not be highly confident that the individual that signs an advance directive is identical to the severally demented patient to which it will be applied. vhe argument retend that some time ago I was diagnosed with severe ementia. A disease that progressively eliminates the psyhological life of an individual [5]. Years later, there is an ndividual that I resemble and with whom I might share a istory sitting in a chair. The individual is well off considring the circumstances, but lives only from moment to oment with minimal psychological continuity. The individal appears to be me. But is it? Did I survive the devastating oss of psychological continuity? My memories, hopes, fears, nterests, and ability to project myself into the future are one. Am I also gone? More so, the individual in the chair has een diagnosed with pneumonia. Given the mild nature of he infection, the pneumonia is currently treatable, though ill eventually be fatal. The individual's cheerful state and he vast monetary resources that pay the medical costs point o not allowing him to die. However, prior to any dementia, signed an advance directive refusing treatment in the case f such a scenario. Did the individual in the chair sign it? The nswer to this question depends on what you think I am and hat it takes for such a thing to persist. So, what does it take for me to persist from moment to oment, month to month, year to year, etc.? Why am I the ame thing now that I was when I went to sleep last night nd woke up this morning? This is the persistence question f personal identity. The animalist answer to this question says that I perist if the animal I am persists. I am nothing more than a uman animal, an organism, that thing that biology tells us s alive (in the biological sense) that sits in my chair whenver I sit in my chair. On this view the continuation of myives, and that survival has nothing to do with psychology 4 o t o s i w o [ i s p a o i a s m a b t y y W c Y Q s 3 a o a t d a t n d t t w d p t w I c s d a a a d d i c c ( d a f d t h t n t T A p E t c o i b i a e n o p t s t b a t w T p T p m p e I a i n 84 r anything other than biology. So, I-last-night is identical o I-this-morning if, and only if, the organism is the same rganism as it was last night, which is true if the organism urvived (remained alive) through the night. Now, I-–as the signee-–sign an advance directive in the nterest of consenting in advance in case there is a time hen I-–as the patient-–cannot speak for myself in terms f medical treatment. Though not everyone would agree 6], I assume that the consent in this case is binding only f I am in fact speaking for myself in the future and not omeone else. That is, I must be both the signee and the atient for the advance directive to be binding. The signee nd the patient must be identical. Imagine that by some bit f philosophical magic you, in a similarly demented state, nstantaneously replaced me in the hospital bed. Would my dvance directive apply to you just because you were my patiotemporal descendent? I think not. Not any more than y advance directive would apply to a patient who became ssociated with my medical records due to a clerical error. So, what happens if we are unsure of the relationship etween the signee and the patient when an advance direcive is lethal? Say, you are 60% confident (40% uncertain) in our belief that the signee and the patient are identical. Do ou let the cheerfully demented patient die of pneumonia? hat about a 75% confidence that the individuals are idential? To help, imagine that Quinn is a patient under your care. ou are 100% confident that Quinn-the-signee is identical to uinn-the-patient. However, because of the mishandling of ome records you can only be 75% sure that Quinn is in bed 47 and not in bed 348. Patients in both beds are as similar s they can be. Both are cheerfully demented and will die f pneumonia if not treated. However, one of them has an dvance directive to not treat in this circumstance, while he other one does not. Do you let the patient in bed 347 ie while there is a 25% chance she is the wrong patient? I assume that many would agree that such odds render lethal advance directive non-applicable. I also assume hat such individuals should have a similar opinion in the on-identity case. That is, unwilling to apply an advance irective when they are only 75% confident (25% uncertain) hat the signee and the patient are identical. What percentage of confidence is enough to risk letting he wrong patient die? Rather than answer that question I ill refer to such level of certainty as a 'high level of confience'. We must have a high level of confidence that the atient is identical to the signee of the advance directive hat is allowing her to die. Here are other beliefs that I hold ith a high level of certainty: that I exist, my name, that am currently typing on a keyboard, where I grew up as a hild, etc. Importantly, noting that I could be wrong about ome of these beliefs does not take away from my confience in them, for I have little or no reason to believe they re wrong. In light of the above, here is the main argument: (1) the pplication of a lethal advance directive requires a justifibly high level of confidence that the signee of an advance irective is identical to the patient to whom the advance irective is applied; (2) if we are animalists and the patient s severely demented, then we should not have a high level of onfidence that the signee of an advance directive is idential to the patient to whom the advance directive is applied; 3) therefore, if we are animalists and the patient is severely t h a D.G. Limbaugh emented, then a lethal advance directive should not be pplied. The argument is valid and premise (1) is being assumed or the sake of argument. That leaves premise (2) in need of efense and elucidation. To defend premise (2) I will need o do two things. First, defend that animalists should not be ighly confident in their view. Second, I will need to show hat, if animalism is false, then the animalists' likely alterative accounts leave them less than highly confident that he signee and the patient are identical. he cost of animalism nimalism is a materialist view of personal identity (i.e., no art of us is immaterial) in which we are merely animals. ach of us is identical to a human animal (homo sapien) in he same trivial sense that anything is necessarily idential to itself. If this is correct, then I am not merely a brain r some collection of thoughts. I am not something like an mmaterial soul, which is intimately related to my animal, ut entirely separate from it. I am literally a human organsm, a biological object. I survive as long as and only as long s my animal survives because we are the same. I could ntirely lose my ability to think, but as long as this does ot entail a biological death, I have survived. To be any sort f thinker on animalism is like being a teenager. It is just a hase. It is marked by the having of certain properties at a ime. For instance, if I am enrolled in school, then I am a tudent. Likewise, if I have mental properties, then I am a hinker. If I lose my mental properties I cease to be a thinker ut I do not cease to be an animal. The animal is what I m. Being a thinker is just a phase. In fact, if animalism is rue, then I plausibly started life as a non-thinker, a zygote, ithout a brain or an ability to maintain mental activity. he upshot of animalism is that in principle I can lose any roperty not necessary for biological life and survive. Eric Olson is the primary defender of animalism, and the hinking Animal Argument below is his go-to defense of the osition [7]: Consider a situation where you are alone in a room sitting in a chair and thinking. . . A1. There exists a human animal sitting in your chair. A2. If there exists a human animal sitting in your chair, then that animal is thinking. A3. If there is a thinking human animal sitting in your chair, then that human animal is you. A4. Therefore, you are a thinking human animal [8]. The argument is straightforward and cashes in on the aterialist conception of mental properties as more or less hysical parts of my brain. For most animalists, mental proprties are certain neurological states that play the right role. f such neurological states belong to the animal, then, if I m truly alone in the room, and there is an animal thinking n my chair, then I am that human animal. This argument is ot unassailable, but is unchallenged in its ability to bring he animalist account of identity on par with other more istorically accepted accounts [7]. Here is the problem. Objections to animalism push nimalists to adopt beliefs about the world that deny C s t o t c t t o h o t w t b m fi i l o v a w t w p ' a m b g a m a o m e n o t o p n Animalism and advance directives commonsense. By 'commonsense' I mean whatever it is that justifies platitudes, propositions that are so prolific and obvious that they need not be supported by argument. For example, I need no argument to support the belief, ''The sun will rise tomorrow.'' It is commonsense. This does not mean it could not be false, but it does mean that it can be accepted without argument. However, as a general rule, if enough beliefs from a particular source are found to be mistaken, then we should no longer trust that source. Likewise, if we deny too many commonsense beliefs, then a belief's being commonsense ceases to be a good reason to believe it is true. Finally, if for some reason the term 'commonsense' troubles you, then replace it with whatever you take to justify platitudes and the substance of my argument will remain unchanged. Premise (A1) of the Thinking Animal Argument is prima facie justified by commonsense. The same commonsense that tells us that tables and chairs exist. However, the animalist in defense of her position denies the existence of all ordinary objects such as, tables, chairs, lampposts, coffee, livers, brains, etc. The only exceptions are animals like starfish, quail, dogs, cats, pandas, you, me, etc. Such a systematic denial of commonsense belief is good reason to strongly doubt other related beliefs. Thus, if we can no longer trust our commonsense about ordinary objects, then we should also doubt our commonsense about the existence of animals. After all, animals are just ordinary objects. In the words of Dean Zimmerman, ''The premise [A1] is warranted by its platitudinous or commonsensical status; but Olson's arguments lead him to conclusions that undermine the family of platitudes to which it belongs.'' [9, p. 23]. So, why must animalists deny the existence of ordinary objects? Well, because the cost of acceptance of ordinary objects is greater than the cost of denial. If human animals have parts with too much potential for thought, then the thinking animal argument can be exploited in such a way that it makes animalism absurd. This exploitation comes in two forms: (i) the rival-candidate objection; (ii) the problem of too many thinkers. The rival-candidate objection considers other options than the human animal for what might be thinking in the chair in Olson's argument. The objection alters the thinking animal argument's conclusion that I am a human animal by replacing 'animal' with other nouns like 'brain'. This exploits the form of the argument arguing for rivalcandidates as the thinker instead of the animal. If I am alone in a room sitting in a chair and thinking, then I am whatever is in my chair and thinking [7]. For example, B1. There exists a brain attached to an animal in your chair. B2. If there exists a brain attached to an animal in your chair, then that brain attached to an animal is thinking. B3. If there is a thinking brain attached to an animal in your chair, then that brain attached to an animal is you. B4. Therefore, you are a thinking brain attached to an animal [8].Olson disagrees with (B1) believing that the human animal is what's thinking in his chair; the subject of his thoughts. However, what if instead of the human animal a brain is thinking instead and is the subject of my thoughts? t t i b 485 ertainly, if I am anything, then I am the subject of my concious thoughts, but which subject? If there is some object hat is thinking instead of the human animal, then the form f the thinking animal argument can be leveraged to show hat I am that object, instead of the human animal. Importantly, for the rival-candidate objection to be sucessful, one and only one candidate must come out as hinking instead of the animal. For instance, if one believes hat the animal's brain is the thinker, and the proper subject f the argument, then she must also deny that the animal's ead or the animal itself is a thinker. She must hold that nly the brain is thinking. Otherwise, the third premise, ''If here is a thinking x sitting in your chair, then that x is you,'' ould be false. If we assume that I am the thinking brain but hat the animal is also a thinker, then there would always e at least two thinkers in my chair. Thus, if a thinker is in y chair, then that thinker may or may not be me. Furthermore, if more than one candidate can be identied as the thinker, then the problem of too many thinkers s invoked. That is, there would be more than one thinker iterally thinking your thoughts. In this case any more than ne thinker is too many. However, if the animal is thinking in irtue of its brain, then how do we understand 'in virtue' in way that does not entail that brain is also thinking? Or, if e do assume that the brain is thinking, then is there a way o do this and deny the animal thought? If not, then there ill be at least two thinkers, which is one too many. Olson uts this problem well: Consider your head. Your head isn't you: it is smaller than you are. Yet, it has a brain and is hooked up to a nervous system and sense organs just like yours. It interacts with a surrounding community of thinkers and speakers, has an appropriate evolutionary history, and so on. It would presumably be able to think if the rest of you were cut away. Should not that make it rational, intelligent, and self-conscious even now [10, p. 190]? Any part of my body that includes the brain could replace 'head'' in the above quote and yield the same result. The rea from my hips to my head is part of my body, so is y body minus my pinky. Both of these parts include my rain, and thus would both seem to be ''rational, intellient, and self-conscious even now.'' [10, p. 190]. So, there re as many thinkers as there are parts of me that include y brain; that is, there are too many thinkers. Some have avoided too many thinkers by denying that the nimal or any part of the animal other than the thinking-part f the brain is a thinker. This is the position of the embodied ind account. Jeff McMahan and Derek Parfit have hypothsized that we are the conscious parts of the brain, those eurological states that produce conscious self-awareness, r at least would be able to with the proper support (e.g., he organism's normal life processes or medical intervention f some variety) [6,11]. We are not animals, we are those arts of animal's brain that have a capacity for consciousess. Unfortunately, it is not at all clear that this does anything o avoid the problem of too many thinkers. Perhaps having a hinking brain is not enough for the animal to be a thinker in ts own right. And, this does avoid any part larger than the rain from being an extra thinker thinking my thoughts. But, 4 i c t s c c o m o e m c p b E m a S i f o ' a l p B r o h p a t e o w t a i c a o b t o o I a s b e p a w n n i t h t e t a r e c s i V s a c c t a b k e s p d p c m o n w C o c t e f w w t E e 86 f this region of the brain that could support consciousness ould have parts sufficient to be thinkers on their own, then he problem animalists have with brains is still present with maller-than-the-whole portions of the embodied mind. Consider the embodied mind Joan-Eunice Smith. She is omposed of a complex assortment of brain tissue with a apacity for consciousness. Joan-Eunice has two large parts f her brain called 'Joan' and 'Eunice'. These parts together ake up all of Joan-Eunice Smith and mostly overlap each ther with the exception of a few cells. As such, each has nough potential for conscious to be an embodied mind very uch like Joan-Eunice. Question: are Joan and Eunice both urrently embodied minds? They each have the relevant otential for consciousness, so what reason do we have to elieve that they are not each embodied minds like Joanunice Smith? Should we believe that being parts of a larger ind overrules what would otherwise be sufficient for being thinker? Rather it seems that these parts of Joan-Eunice mith are (reusing Olson's quote from above), ''rational, ntelligent, and self-conscious even now'' [10, p. 190]. David Hershenov has further developed this problem or embodied mind account as inspired by medical cases f overlapping cerebra [12]. What the literature calls cephalothoracopagus' [13]. Imagine two individuals born ttached at the brain. Together their brains compose a arge abnormally shaped collection of neurons with a shared ortion in the middle. This is analogous to Highway 64 and road Street, which occupy the same physical stretch of a oad for a time before they eventually diverged at the edge f town. Now, Hershenov asks us to imagine what would appen if a natural disaster wiped out the non-overlapping ortions of Highway 64 and Broad Street. It seems that, lthough they now entirely overlap, there are still two disinct roads. With this in mind Hershenov says: Assuming that brains can be reduced in size like roads, then if roads can come to completely overlap, brain-size persons should be able to as well. It would be arbitrary to insist that one person survives and not the other. But it is unappealing to claim that a new person fuses into existence for this isn't a case of two objects merging their matter and forming a larger entity. Rather, this just involves someone losing parts of their anatomy that we would uncontroversialy deem the shrinking of a person in the absence of overlap. So, it seems that even McMahan and Parfit would have to admit that two thinkers can come to have their thoughts generated by exactly the same neurology [13, p. 207]. If Hershenov is right, then if Joan-Eunice were to lose nough cells as to be paired down to just the Joan part r just the Eunice part, then Joan, Eunice and Joan-Eunice ould all three occupy the same physical space. To deny his is to deny that I could survive getting smaller by losing handful of cells in my brain; presumably even as an emboded mind I would regularly gain and lose parts. Like the ase of the roads, we lack a principled reason to deny that ll three, Joan-Eunice, Joan, and Eunice survived and now ccupy the exact same physical space due to what appears to e a normal loss of parts. If I am an embodied mind rather han an animal, I still might be sharing my thoughts with ther thinkers. Thus, the embodied mind account does not H d M t D.G. Limbaugh ffer an easy solution to the problem of too many thinkers. n fact, any view that allows the thinker to have parts that re on their own sufficient for consciousness will have these ame problems [13]. The animalist has a solution. One that has been adopted y at least one embodied mind theorist as well [14]. It is legant but costly; it is to deny the existence of brains and arts of brains-–to deny that rival-candidates exist. This is metaphysical solution in which one adopts an ontology here undetached parts (brains, parts of brains, etc.) do ot exist. If one principally makes this denial it is hard to ot also deny the existence of most everyday objects-–thus, f you are an animalist, then you might escape these objecions by revising your ontology of objects, but then you must ave also denied that there are any everyday objects other han animals. This is called 'biological minimalism'. It affirms the existnce of only animals and simples. Chairs do not exist; rather here are only simple particles arranged in the shape of chair. Adopting this view aids the animalist in handling ival-candidate and too many thinker type objections by liminating any part of me large enough to be a rivalandidate thinker. Biological minimalism arises from reflections on the pecial composition question: under what circumstances s some object composed by other objects as its parts? an Inwagen's proposed answer to that question is that ome object has parts only and always when the parts re caught-up-in-the-life of the object [1]. Roughly, to be aught-up-in-a-life is to be engaged in those activities that onstitute an organism's biological life. Accordingly, somehing has parts only if that thing is an organism and the parts re caught-up-in-the-life of the thing. Everything else must e entirely simple (i.e., entirely lacking of parts). Brains, idneys, lampshades, books, and watches, have parts if they xist, but are not organisms. Thus, biological minimalism ays they do not exist but are mere arrangements of simles. So, it goes for all other complex non-organisms; they o not exist. Fundamental particles (the most basic unit of a hysical theory) on the other hand might be simple. In which ase they could exist and not be organisms. So, if biological inimalism is true then the world is filled with simples, the rganisms whose lives in which they might be caught up, and othing else. Biological minimalism gets the animalist what she ants by sacrificing commonsense about ordinary objects. ommonsense about ordinary objects is what justifies ur belief that animals exist. Thus, by undermining ommonsense about ordinary objects, our justification for he belief that animals exist is decreased. If animals do not xist, then biological minimalism and animalism are both alse. So, as it stands, if biological minimalism is true, then e should be less confident in the truth of animalism, than hen we began; and if biological minimalism is false, then he animalist is left with troubling objections to her view. ither way, the animalist has suffered a loss of confidence. One might hope that the animalist would justify the xistence of animals some way other than as a platitude. owever, the literature suggests otherwise. The most well eveloped defenses of animalism by van Inwagen, Olson, and erricks all, after adopting biological minimalism, justify he existence of animals with something like a commonsense l t m r j n e n e a r m w r n j a A t h m s p i o a ' b a w W N w o w i a h a t e s t a t i p f H T h c c most of my life) are false. I believed in chairs, rocks, andAnimalism and advance directives inference. Van Inwagen argues that we know that animals exist because you and I exist, the nature of thought requires us to be composite material beings, and animals make the most sense as candidates for such composites [1, p. 122]. Olson, says little more than, composition is plausible, and if there is composition, then animals are composites: ''The particles that make up a live cat are unified if any particles are'' [15, p. 114-115]. Merricks, appeals to the fact that animals perform most of the everyday activities that we also perform. When I get out of bed, so does an animal; when I wind my watch, so does the animal. So, if we exist, then we are probably organisms. We exist; thus, so do animals [3, p. 114-115]. The point is not to say that there is something illicit about this style of inference. There is not. Everyone begins with what they take to be plausible assumptions; initial assumptions should seem true (even Descartes assumed, ''I think''). Each of these philosophers recognize that philosophical questions are rarely settled by devastating arguments that render the opponent's position incoherent. Rather, questions are answered by considering puzzling cases (e.g., Debtor's Paradox, Ship of Theseus, Body-minus, Problem of the Many, etc.), counting the cost of theories, working with arguments, and finding balance [16]. The point is that the justification for animals in these instances is a product of commonsense about objects and composition. This justification is no longer as strong after denying that most ordinary objects exist. For these arguments to work, it has to be commonsensical for organisms to exist. But, after we adopt an ontology that tells us that there are no tables, chairs, brains, fingers, lemonade, or cupcakes, but rather just particles arranged as such, our reasons for believing that organisms exist, and are not themselves just clouds of particles, is reduced. What drives commonsense as an arbiter of belief is that there is a cost to assuming false what is easy to believe, hard to deny, and possibly widespread. Some beliefs are innocent until proven guilty. For instance, my having hands, that there is an external world, that I am identical to the person I was 20 years ago, etc. are all commonsense. It is rational to have such beliefs until they are undermined or defeated, and that is because denying them comes at the price of rendering the world very different than what some of our most strongly held commonsense beliefs tell us. However, if it can be shown that the price of denying a strongly held commonsense belief is acceptable or has already been paid through the reasonable adoption of some unintuitive theory, then commonsense is no longer as strong a source of justification. This creates two issues for the animalist: (i) if you have accepted a sparse ontology, then you have already paid the price of denying commonsense about ordinary objects, including animals; (ii) the loss of commonsense as justification for the existence of animals makes it harder to accept animals as what I am over and above a psychological account, which can do without animals or composite objects. What is commonly called 'neo-Lockeanism' is concerned with connections between psychological states (i.e., memories, desires, personality, etc.). You are your psychology; you are a chain of psychological states-–no animals required. As t d 487 ong as the chain is sufficiently unbroken, then you continue o exist [6,17]. The first issue has already been explained above. In sumary, the price of denying commonsense, is a function of endering nearly all beliefs about ordinary objects false; my ustification for believing in chairs and tables was platitudious. I saw them every day and had no reason to doubt their xistence. This is also largely why I believed in animals, so ow I need more to justify belief in their existence. The second issue is that after lowering justification in the xistence animals, the rival-candidate objection can once gain be raised. A chain of psychological states being the ival-candidate. Initially it seemed that on biological minialism, any candidate for what I am other than the animal ould be sufficiently counter intuitive as to not be a true ival-candidate. However, as demonstrated above animals o longer have a privileged place as the commonsenseustified option for what I am, and thus, the ''there is an nimal'' portion of premise (A1) of the Thinking Animal rgument needs more than platitude-status to be taken as rue. The psychological account now looks more attractive. We ave already admitted that we are struggling to keep anials in our ontology. To wit, eliminating animals can be een as a feature and not a cost of a view. The fact that sychological-persons could explain what we are without dentifying us with animals is a problem for the animalist. After all, what reason do we have that animals, or any ther composite thing, exists? The reason given was that, ''I m a composite object!'' and something like the thought, 'If it were the case that animals did not exist, then it would e unclear what I am.'' Consider Olson and his remarks bout non-animalist options for what we are, ''For those ho enjoy metaphysics, these are all fascinating proposals. hatever their merits, though, they certainly are strange. o one but a philosopher could have thought of them. And it ould take quite a bit of philosophy to get anyone to believe ne of them. Compared with these claims, the idea that e are animals looks downright sensible'' [10, p. 200]. It s agreeable that, if it is prima facie true that ''I think'' nd that animals exist, then the Thinking Animal Argument as purchase. However, after the animalist faces objections nd adopts biological minimalism, it is no longer prima facie rue that animals exist. At this point, one cannot posit the xistence of animals without evidence, and that I exist and eem to be a composite is not as convincing as it was prior o taking a hard look at biological minimalism. I gather the animalist must now first raise arguments gainst the psychological criterion before even assuming he existence of animals. Prior to adopting biological minmalism, one could have objected to the suggestion of sychological-persons citing organisms as a better candidate or what is in my chair and thinking: ''It makes more sense!'' owever, now there are no tables, chairs, heaps, or ships of heseus; there are also no brains, or livers, you do not have ands and apple trees do not have apples. The qualitative ount on biological minimalism is minimal, and most (prinipally held) beliefs about everyday objects (that I have hadables, because I see them every day; they were hard to eny, and now merely seeing ''animals'' all around me does 4 n t A A f s t o w t e l m a c e s d I t a t d t t b o i s c c s p a i l p i l t e a o c e p t t t t t a m a r m o t i a t i i d v i t e s t p c t d c r h c I l p l w I r m p i w m e t I h i r s a F i p e t t 88 ot help me decide what is sitting in my chair, especially if here are other (perhaps) serviceable options. loss of confidence s I sit here, I find myself believing that there is a mug of cofee sitting on my desk. However, if I am an animalist, then I hould not believe this. This is relevant because it extends to he existence of animals as well. They are after all ordinary bjects, with their existence justified by commonsense, or hatever it is that justifies platitudes. If I am an animalist, hen I must believe that animals exist. Thus, if I have a lowred confidence in the existence of animals, then I have a owered confidence in my belief that animalism is true. This is no great loss to the animalist, per se. It hardly akes for a convincing argument against the position. After ll, metaphysics is a speculative enterprise. However, the onsiderations of the previous section aim to highlight xactly the cost of being an animalist, and to what extent I hould be confident in its truth. This is important because, in so much as I am not confient in animalism, I should not be confident in those beliefs justify based on the truth of animalism. One such belief is hat, I survive as long as my organism, the organism that I m, survives. This in turn has the consequence of justifying he belief that, I can survive a transition into a severally emented state via organismic continuity. Thus, if I believe hat animalism is true, then I have reason to believe that he signee of my advance directive and the patient it would e applied to are identical. So, I contend that with a loss f confidence in animalism, I suffer a loss of confidence n the signee and the patient's being identical, in cases of evere dementia. Mind you, it may very well be just a loss of onfidence. I might still believe they are identical, but my ertainty is not what it was prior to defending animalism. Let us take stock of how the discussion up to this point upports the second premise from the main argument. The remise states: (2) If we are animalists and the patient is severely demented, then we should not have a high level of confidence that the signee of an advance directive is identical to the patient to whom the advance directive is applied. To defend this claim I needed to show two things: (i) the nimalist should not be highly confident in their view; (ii) f animalism is false, then the animalist's likely alternatives eave her less than highly confident that the signee and the atient are identical. I have argued for the former by showng the justificatory cost of adopting a sparse ontology. The atter will be argued below. What about alternatives to animalism? I will consider the wo that I take to make up the bulk of the bioethics litrature: the psychological account and the embodied mind ccount [6]. If neither of these accounts grant a high level f confidence in the identity of the patient, then we can onclude that for a significant number of animalists, by lowring confidence in animalism, we raise uncertainty that the atient is identical to the signee. Here is why. We are assuming that if animalism is false, hen we lose justification for the belief that the signee and he patient are identical. However, if the likely alternatives l S a i D.G. Limbaugh o animalism also supply high-confidence justification for he belief that the signee and the patient are identical, hen the falsity of animalism would not necessarily entail net loss of justification. Rather the justification from anialism might merely be exchanged for the justification of nother view. So, if by reducing confidence in animalism we aise confidence in another view, then we have to check and ake sure that we are not just replacing the justification f animalism with the justification of some other view-–in his case, that of the psychological account or the emboded mind account. So, what is needed is for the relevant lternative accounts to supply less than high-confidence jusification for the belief that the signee and the patient are dentical, and thus for there to be a net loss of justification n the case that such an account replaces animalism. A full iscussion of this issue would also include the constitution iew, hylomorphism, soul theory, and all of those views' varous iterations. I assume that no matter how well argued for hese positions may be, the psychological account and the mbodied mind account are popular enough as to yield a ignificant conclusion without considering other views. Alright, the psychological account requires that for idenity to obtain between the signee and the patient they be sychologically connected to one another. Necessary for psyhological connectedness is the having of veridical memories hat were caused in a normal way. If I continue from day to ay, then I must have memories that stretch into the past onnecting me in a sense to my past selves. These memoies must be about events that actually occurred and cannot ave been planted by an evil scientist or otherwise fabriated [16]. Importantly, the connection cannot have gaps. f there is a gap, say a time when an individual permanently ost all memories due to a head injury, then identity is not reserved over the gap. Memories are among the psychoogical features that are destroyed as dementia progresses, hich gradually destroys psychological capacities generally. n the case of severe dementia not only might a patient not emember signing an advance directive, they may have no emories from earlier in the day. Thus, according to the sychological account, such a patient might not just be nondentical to the signee, but non-identical to the individual ho was sitting in their chair hours before [6]. The problem of identity is also found on the embodied ind account. Rather than relying on psychological connectdness, this account tracks identity by the continuing of hose parts of the brain with a capacity for consciousness. nitially McMahan seems to deny any problem of identity on is account, ''According to the embodied mind account of dentity. . . there are no cases in which progressive dementia esults in a different individual, much less a different peron.'' However, he continues, ''perhaps it would be more ccurate to say that there is no new or different individual. or what remains may not in any robust sense be the same ndividual but merely a fragment of that individual. . . It is ossible to see this process as the gradual fading from existnce of the individual himself'' [6, p. 494]. McMahan seems o consider his account a solution to the problem of idenity and advance directives, but then suggests that what is eft of the individual might be vague and come in degrees. o I ask, to what degree must I exist as the patient for the dvance directive I signed to still be binding? If it is entirely ndeterminate whether I still exist, then is an advance [ [ [ [ [ [ [16] Cannon MR, editor. Material constitution: a reader. Lanham: Rowman & Littlefield; 1997.Animalism and advance directives directive sufficient to allow the patient to die? Without answering these questions, we can conclude that we should, at least, not be highly confident that the signee and the patient are identical, which is what is required for premise (2). To conclude, when allowing someone to die, we should be highly confident that we are letting the right individual die. In the case of advance directives, that individual is the one who signed the lethal advance directive. Animalists, when dealing with the severely demented, should not be highly confident; if animalism is false, then relevant alternative accounts should render us less than highly confident in the identity of the signee and the patient. It follows that the extent to which we should not be highly confident in animalism, is, at least, the extent to which we should not be highly confident in the identity of the signee and the patient. As has been argued, no one should be highly confident in animalism. Disclosure of interest The author declares that he has no competing interest. References[1] Van Inwagen P. Material beings. Ithaca: Cornell University Press; 1991. [2] Olson ET. The human animal: personal identity without psychology. Oxford: Oxford University Press; 1997. [ 489 [3] Merricks T. Objects and persons. Oxford: Clarendon Press; 2001. [4] Hershenov D. ''Do dead bodies pose a problem for biological approaches to personal identity?''. Mind 2005;114(453):31-59. [5] Firlik AD. ''A piece of my mind. Margo's logo''. JAMA 1991;265(2):201. [6] McMahan J. The ethics of killing: problems at the margins of life. New York: Oxford University Press; 2002. [7] Olson ET. What are we? A study in personal ontology. New York: Oxford University Press; 2007. [8] Olson ET. ''An argument for animalism''. In: Martin R, Barnes J, editors. Personal identity. Oxford: Blackwell; 2003. p. 318-34. [9] Zimmerman D. ''Problems for animalism''. Abstracta, Special 2007;1:23-31. 10] Olson ET. ''Thinking animals and the reference of 'I'''. Philos Top 2002;30(1):189-207. 11] Parfit D. We are not human beings. Philosophy 2012;87(01):5-28. 12] Hershenov D. Who doesn't have a problem of too many thinkers? Am Philos Q 2013;50(2):203. 13] Biswas A, Chia D, Wong Y. ''Three-dimensional sonographic diagnosis of Cephalothoracopagus Janiceps twins at 13 weeks''. Ultrasound Obstet Gynecol 2001;18(3):289-90. 14] Dowland SC. ''Embodied mind sparsism''. Philos Stud 2016;173(7):1853-72. 15] Olson ET. ''Replies''. Abstracta, Special 2008;1:32-42.17] Parfit D. Reasons and persons. Oxford: Oxford University Press; 1984.