Dementia patients in the moderate-late stage of the disease can, and often do, express different preferences than they did at the onset of their condition. The received view in the philosophical literature argues that advance directives which prioritize the patient’s preferences at onset ought to be given decisive moral weight in medical decision-making. Clinical practice, on the other hand, favors giving moral weight to the preferences expressed by dementia patients after onset. The purpose of this article is to show that (...) the received view in the philosophical literature is inadequate and is out of touch with real clinical practice. I argue that having dementia is a cognitive transformative experience and that preference changes which result from this are legitimate and ought to be given moral weight in medical decision-making. This argument ought to encourage us to reduce our confidence in the moral weight of advance directives for dementia patients. (shrink)

Most philosophers writing about personal identity in recent years claim that what it takes for us to persist through time is a matter of psychology. In this groundbreaking new book, Eric Olson argues that such approaches face daunting problems, and he defends in their place a radically non-psychological account of personal identity. He defines human beings as biological organisms, and claims that no psychological relation is either sufficient or necessary for an organism to persist. Olson rejects several famous thought-experiments dealing (...) with personal identity. He argues, instead, that one could survive the destruction of all of one's psychological contents and capabilities as long as the human organism remains alive--as long as its vital functions, such as breathing, circulation, and metabolism, continue. (shrink)

Children’s preferences about medical treatment—like the preferences of other patients—hold moral weight in decision-making that is independent of considerations of autonomy or best interests. In light of this understanding of the moral value of patient preferences, the American Academy of Pediatrics could strengthen the ethical foundation for its formal guidance on pediatric assent.

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)

Why does the problem of free will seem so intractable? I surmise that in large measure it does so because the free will debate, at least in its modern form, is conducted in terms of a mistaken approach to causality in general. At the heart of this approach is the assumption that all causation is fundamentally event causation. Of course, it is well-known that some philosophers of action want to invoke in addition an irreducible notion of agent causation, applicable only (...) in the sphere of intelligent agency. But such a view is generally dismissed as incompatible with the naturalism that has now become orthodoxy amongst mainstream analytical philosophers of mind. What I want to argue is that substances, not events, are the primary relata of causal relations and that agent causation should properly be conceived of as a species of substance causation. I shall try to show that by thus reconceiving the nature of causation and of agency, the problem of free will can be made more tractable. I shall also argue for a contention that may seem even less plausible at first sight, namely, that such a view of agency is perfectly compatible with a volitionist theory of action. (shrink)

Why does the problem of free will seem so intractable? I surmise that in large measure it does so because the free will debate, at least in its modern form, is conducted in terms of a mistaken approach to causality in general. At the heart of this approach is the assumption that all causation is fundamentally event causation. Of course, it is well-known that some philosophers of action want to invoke in addition an irreducible notion of agent causation, applicable only (...) in the sphere of intelligent agency. But such a view is generally dismissed as incompatible with the naturalism that has now become orthodoxy amongst mainstream analytical philosophers of mind. What I want to argue is that substances, not events, are the primary relata of causal relations and that agent causation should properly be conceived of as a species of substance causation. I shall try to show that by thus reconceiving the nature of causation and of agency, the problem of free will can be made more tractable. I shall also argue for a contention that may seem even less plausible at first sight, namely, that such a view of agency is perfectly compatible with a volitionist theory of action. (shrink)

In this paper I will provide a hylomorphic critique of Jeff McMahan’s “An Alternative to Brain Death.” I will evaluate three puzzles—the dicephalus, the braintransplant, and the split-brain phenomenon—proposed by McMahan which allow him to deny that a human being is identical to an organism. I will contend thatMcMahan’s solution entails counterintuitive consequences that pose problems to organ transplant cases. A Thomistic hylomorphic metaphysics not only avoids these unwelcome consequences and provides solutions to the three puzzles but in doing so (...) allows for an alternative definition of death. Since McMahan has constructed his definition of death around his own metaphysics, alternative metaphysics, in this case a hylomorphic metaphysics, allow for an alternative definition of death. (shrink)

In this paper I will provide a hylomorphic critique of Jeff McMahan’s “An Alternative to Brain Death.” I will evaluate three puzzles—the dicephalus, the braintransplant, and the split-brain phenomenon—proposed by McMahan which allow him to deny that a human being is identical to an organism. I will contend thatMcMahan’s solution entails counterintuitive consequences that pose problems to organ transplant cases. A Thomistic hylomorphic metaphysics not only avoids these unwelcome consequences and provides solutions to the three puzzles but in doing so (...) allows for an alternative definition of death. Since McMahan has constructed his definition of death around his own metaphysics, alternative metaphysics, in this case a hylomorphic metaphysics, allow for an alternative definition of death. (shrink)

The Human Animal is an extended defense of what its author calls the Biological Approach to personal identity: that you and I are human animals, and that the identity conditions under which we endure are those which apply to us as biological organisms. The somewhat surprising corollary of this view is that no sort of psychological continuity is either necessary or sufficient for a human animal—and thus for us—to persist through time. In challenging the hegemony of Psychological Approaches to personal (...) identity, Olson offers a number of inventive and original arguments which are certain to evoke discussion and debate. (shrink)

When patients have progressive and incurable dementia, should their advance directives always be followed? Contra Dworkin, Dresser argues that when patients remain able to enjoy and participate in their lives, directives to hasten death should sometimes be disregarded.

Although epistemic values have become widely accepted as part of scientific reasoning, non-epistemic values have been largely relegated to the "external" parts of science (the selection of hypotheses, restrictions on methodologies, and the use of scientific technologies). I argue that because of inductive risk, or the risk of error, non-epistemic values are required in science wherever non-epistemic consequences of error should be considered. I use examples from dioxin studies to illustrate how non-epistemic consequences of error can and should be considered (...) in the internal stages of science: choice of methodology, characterization of data, and interpretation of results. (shrink)

How should we make choices when we know so little about our futures? L. A. Paul argues that we must view life decisions as choices to make discoveries about the nature of experience. Her account of transformative experience holds that part of the value of living authentically is to experience our lives and preferences in whatever ways they evolve.

A high level of confidence in the identity of individuals is required to let them die as ordered by an advance directive. Thus, if we are animalists, then we should lack the confidence required to apply lethal advance directives to the cheerfully demented, or so I argue. In short, there is consensus among animalists that the best way to avoid serious objections to their account is to adopt an ontology that denies the existence of brains, hands, tables, chairs, iced-tea, and (...) lemonade. The adoption of such an ontology reduces the justificatory force of commonsense, which is key in arguing that we are animals and that we persist as long as we are biologically alive. With this loss of justification comes the loss of a high level of confidence that Quinn-pre-dementia’s lethal advanced directive applies to Quinn-post-dementia, via identity. If we do not have a high level of confidence that Quinn-pre-dementia’s advanced directive applies to Quinn-post- dementia, then it is not enough (on its own) to let Quinn-post-dementia die. (shrink)

Animalists accuse the advocates of psychological approaches of identity of having to suffer a Problem of Too Many Thinkers. Eric Olson, for instance, is an animalist who maintains that if the person is spatially coincident but numerically distinct from the animal, then provided that the person can use its brain to think, so too can the physically indistinguishable animal. However, not all defenders of psychological views of identity assume the spatial coincidence of the person and the animal. Jeff McMahan and (...) lately Derek Parfit claim we are roughly brain-size, composed of just those parts of the human animal that directly produce thought. They claim to avoid the Problem of Too Many Thinkers because it is the brain-sized person who truly thinks, while the animal thinks only in a derivative sense in virtue of having a thinking proper part. Waiting in the wings are some dualists who claim that all materialist accounts fail to avoid the Problem of Too Many Thinkers. One such dualist, Dean Zimmerman, insists that wherever there is an ordinary material thing like a brain, there is also a mass with distinct persistence conditions and thus the threat of two material thinkers. Zimmerman contends that only positing an immaterial thinker can avoid the problem. (shrink)

My comments have two parts. I begin by laying out the argument that seems to me to be at the core of Olson’s thinking about human persons; and I suggest a problem with his reasons for accepting one of its premises. The premise 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. Then I’ll raise a question about how Olson should construe the vagueness that (...) would seem to infect the boundaries of human animals. (shrink)