Morality, Mortality (Vol. 1) - Death and Whom to Save from It
Kamm (F.M.)
This Page provides (where held) the Abstract of the above Book and those of all the Papers contained in it.
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BOOK ABSTRACT:

OUP Abstract

  1. Morality, Mortality as a whole deals with certain aspects of ethical theory and with moral problems that arise primarily in contexts involving life-and-death decisions. The importance of the theoretical issues is not limited to their relevance to these decisions; however, they are, rather, issues at the heart of basic moral and political theory.
  2. This first volume comprises three parts.
    • Part I, Death: From Bad to Worse, has with four chapters, and an appendix, discussing death and why it is bad for the person who dies.
    • Part II, Saving Lives: General Issues, has six chapters, and explores a cluster of moral problems that arise in saving lives. The general question raised is whether we should always, in aiding life, act so as to save the greater number of lives or to produce the greatest amount of good.
    • Part III, Scarce Resources: Theoretical Issues, Specific Recommendations, and Organ Transplants1, has five chapters, and deals with the problem of the acquisition and distribution of organs for transplantation2. It allows us to apply the theoretical discussion of saving lives and relevant/irrelevant utilities presented in the previous parts. However, the discussion can be understood independently of the first two parts, and the conceptual issues and procedures on which it focuses are relevant to dealing with any scarce resource, including money and time, which are needed to use other plentiful resources.
  3. Although the book contains much theoretical and methodological argument, it is firmly grounded in practical ethical issues, and is illustrated throughout by examples.



"Kamm (F.M.) - Morality, Mortality (Vol. 1) - Preface & Introduction"

Source: Kamm - Morality, Mortality (Vol. 1) - Death and Whom to Save from It


OUP Abstract
    Starts with an outline of the book, and then discusses the philosophical approach taken in it. Three methods used by philosophers to approach problems are considered: the first is a theory whose correctness is immediately apparent to the philosopher concerned, and whose implications for any particular cases will be accepted, even if they lead to uncomfortable results; in the second case, the philosopher starts with a theory, but one to which commitment is not so great, and whose implications for particular cases may be examined, and if they conflict, lead to alterations in the theory; and the third starts with responses to cases (practical or theoretical) with just enough detail for philosophical purposes, rather than total or tentative commitment to a theory. The method used in this book is closer to the third than any other, and is outlined.



"Kamm (F.M.) - Why Is Death Bad?"

Source: Kamm - Morality, Mortality (Vol. 1) - Death and Whom to Save from It, Chapter 1


OUP Abstract
  1. Examines the question of why death is bad: is it bad for the person who dies, and, if so, why?
  2. The question of what the scientific criteria should be for the person who dies is dealt with later in the book.
  3. The discussion is based on an assumption that death is painless, not untimely, and involves no afterlife1 or return to life, only posthumous non-existence; it also assumes that the concern is with why death is bad for the person who dies rather than any people who remain alive, and that even if everyone died at once, something worse has happened to each person than would have happened if that person and everyone else had lived instead.
  4. The approach taken to the question by Epicurus (How can death be bad for anyone at all?) and Thomas Nagel's response to this (his ‘Deprivation Account’) are examined, and then various criticisms of Nagel's approach are presented and discussed.
  5. Additional objections to Nagel's approach are considered in the next chapter.



"Kamm (F.M.) - The Asymmetry Problem: Death and Prenatal Nonexistence"

Source: Kamm - Morality, Mortality (Vol. 1) - Death and Whom to Save from It, Chapter 2


OUP Abstract
    Examines further the question of why death is bad, but also discusses whether death is worse than prenatal non-existence: the asymmetry thesis. This is Lucretius's question: if we are not much disturbed about our non-existence before our creation, why are we so disturbed about our non-existence after death. The answers given to the asymmetry problem by Thomas Nagel, Bernard Williams, and Derek Parfit are discussed. Objections to Nagel's and Williams's approach are briefly mentioned, but a fuller consideration is given to Parfit's approach (that we seem to care less about what we have already suffered than what we will suffer), with discussion of both objections and defences to these. The final section of the chapter shows how Parfit's insight can be used to modify Nagel's view about why death is bad in a way that helps to explain why death at least seems worse than prenatal non-existence; this is designated the Nagel/Parfit proposal — that death is bad because it prevents additional goods of life, and from the perspective within life, it seems worse than prenatal non-existence because we do not care as much about past as future goods.



"Kamm (F.M.) - Accounting for Asymmetry?"

Source: Kamm - Morality, Mortality (Vol. 1) - Death and Whom to Save from It, Chapter 3


OUP Abstract
    Offers a final proposal on the two questions of the question of why death is bad, and whether it is worse than prenatal non-existence (the asymmetry thesis); it is concerned with whether there are properties observable from a view outside life, rather from within it, that help explain why death is worse than prenatal non-existence, and if so, whether these properties must make non-existence-in-the-future different from non-existence-in-the-past in ways other than just that it is in the future. The chapter is also concerned with what more we can say about the fact, or beliefs about the fact, that something exists in the future that will help illuminate the explanatory role of this fact. Many of the factors that may explain why death is really worse depend on asymmetries related to time: the (supposed) fact that causation has a direction (forward), so that the past affects the future, but the future does not affect the past; the (supposed) fact that there is a direction in time, from past to future; and the fact that there is a before and after in the passage of time. However, some of these features may not be objective at all, rather, they may be features of the subjective view of those who are observing another's life from the outside, and if this were so, the asymmetrical features dependent on the asymmetries related to time and causation might explain the asymmetrical attitude, but they might not justify it. The chapter comes to focus on three factors: the Insult Factor, that death happens to a person who has already existed and undoes him; the Future Deprivation Factor, that death deprives the person who dies of significant future goods (the Thomas Nagel/Derek Parfit point); and the Extinction Factor, that death means the possibility of anything significant for the person in the future is over.



"Kamm (F.M.) - Appropriate Attitudes Towards Nonexistence"

Source: Kamm - Morality, Mortality (Vol. 1) - Death and Whom to Save from It, Chapter 4


OUP Abstract
    Considers how one should deal with death, given what makes it bad, and worse than prenatal non-existence. An evaluation is made of the three main types of factors discussed in Ch. 4 that play a part in our asymmetrical attitude toward death and prenatal non-existence: the Insult Factor, that death happens to a person who has already existed and undoes him; the Extinction Factor, that death means the possibility of anything significant for the person in the future is over; and the Deprivation Factor, that death deprives the person who dies of significant future goods (the Thomas Nagel/Derek Parfit point). Part of the discussion on the Insult Factor involves looking at the shape of events at the edges of life, as well as within it: incline and decline. This matter is considered further in a brief appendix following this chapter.



"Kamm (F.M.) - Inclines and Declines"

Source: Kamm - Morality, Mortality (Vol. 1) - Death and Whom to Save from It, Appendix to Chapter 4


OUP Abstract
    Part of the discussion on the Insult Factor involves looking at the shape of events at the edges of life, as well as within it: incline and decline. This matter is considered further in a brief appendix following this chapter.



"Kamm (F.M.) - Is it Worse If More Die: Agent Relative or Non-Relative Views?"

Source: Kamm - Morality, Mortality (Vol. 1) - Death and Whom to Save from It, Chapter 5


OUP Abstract
    Considers arguments for the following radical claim: the fact that we could save a greater number of lives is not a reason to save some people rather than others when we cannot save everyone. Against this view, an argument is presented that claims to prove that it is worse if more die than if fewer do, but then a counterargument is given that considerations of justice and fairness might stand in the way of preventing this worse state of affairs, requiring us to give to a group with the greater number of people and to a group with the smaller number equal chances to be saved. This means there would be a conflict between considerations of the right (e.g. justice, fairness), and considerations of the good (e.g. maximizing lives saved). The arguments offered are based around the claims of John Taurek on conflict situations in which some can be helped and some cannot: his brand of consequentialism, which involves an evaluation of outcomes relative to an individual's interests combined with an agent-neutral theory of permission to act. The aspects addressed all centre around the aggregation argument — aggregation vs non-aggregation.



"Kamm (F.M.) - Is It Right To Save the Greater Number?"

Source: Kamm - Morality, Mortality (Vol. 1) - Death and Whom to Save from It, Chapter 6


OUP Abstract
    In the situation that we have to choose between the numbers of lives saved (is it right to save the greater number?), Ch. 6 argues against the existence of the conflict between considerations of the right (e.g. justice, fairness) and considerations of the good (e.g. maximizing lives saved). This is the aggregation argument put forward in Ch. 5. The argument is presented in two ways: the modest way is to show that considerations of the right do not demand equal chances; the strong way is to show that considerations of the right require us to count numbers of lives in order to save the greater number and to engage in substitution of lives that are equivalents from a certain perspective. In discussing the modest approach, consideration is given to what makes a policy unfair and the significance of the distinction between direct and indirect need for aid.



"Kamm (F.M.) - Ideal Procedure, Nonideal Alternatives, and Proportional Chances"

Source: Kamm - Morality, Mortality (Vol. 1) - Death and Whom to Save from It, Chapter 7


OUP Abstract
    Examines two alternatives to the ‘majority rule’ situation described in the Ch. 7, i.e. that numbers count in any consideration of saving lives. It looks at two procedures that, other than straightforwardly saving the greater number of lives, still consider the number of people that can be saved. The first is what the author calls the ‘Ideal Procedure’ for non-Taurek situations, in which some compromise between conflicting groups is possible; this can only be used when there is some chance of saving everyone. The other procedure is an alternative way to give numbers weight: distribution by proportional chances. Finally, the difference that present vs future need may make is considered.



"Kamm (F.M.) - Are There Irrelevant Utilities"

Source: Kamm - Morality, Mortality (Vol. 1) - Death and Whom to Save from It, Chapter 8


OUP Abstract
    Examines cases in which the choice faced is not between different numbers of lives but between equal numbers of lives when saving one group but not the other would be accompanied by some additional lesser good; the aim is to investigate whether and under what conditions substitution of equivalents and aggregation are incorrect and, accordingly, under what conditions additional utilities (goods) should be irrelevant to the choice made. Distinctions are made between direct and indirect need for aid and between extra utilities that would come to persons whose lives are at stake and those whose lives are not at stake; distinctions are also made between different types of irrelevance — one type based on different spheres of interest and considerations of fairness, and the other on relative insignificance of effect. Five principles for the second type of irrelevance, describing which extra utilities should be relevant and why (the Principle of Irrelevant Utility), are examined in this chapter and the following two (Chs 9 and 10); cases are dealt with in which not only each person has a right to have his life preserved, but also in which we merely take an interest in each person's special interest in his own survival; these three chapters also re-examine the justification for counting numbers of lives. In connection with defending the Principle of Irrelevant Utility, the concept of ‘Sobjectivity’ is introduced, and a detailed description given of how subjective and objective, personal and impersonal, and partial and impartial perspectives interrelate when decisions are being made as to which extra utilities to count and which not to count. Ch. 8 looks at one possible justification for the Principle of Irrelevant Utility: that concerned with the particular combination of the objective and subjective that is to do with how we view the interests of those involved, here designated Sobjectivity; it makes the point that we should not always make the move to substituting equivalents, since that move is not necessarily appropriate in those cases where, in helping one side, we can do all the good that we would do if we helped the other, as well as additional good.



"Kamm (F.M.) - Sobjectivity: The Anatomy of the Subjective and Objective in Moral Judgment"

Source: Kamm - Morality, Mortality (Vol. 1) - Death and Whom to Save from It, Chapter 9


OUP Abstract
    Looks at a two more approaches to justifying the Principle of Irrelevant Utility advanced in Ch. 8 with respect to the question of saving different groups of lives. Once again, it involves combining objective and subjective views. Here the combinations are designated ‘Sobjectivism’ and ‘Sobjectivism’. Sobjectivism differs from Sobjectivism (which was presented in Ch. 8), in that it pits the various subjective points of view against each other differently, taking into account each person's moral responsibility, rather than only his interests or desires. Sobjectivism provides an alternative principled distinction between losses of lives in order to distinguish relevant from irrelevant utilities: that certain utilities would be irrelevant in a life-saving choice situation if they would receive no proportional weight on their own, no matter how many individuals were involved.



"Kamm (F.M.) - Sobjectivity: Aggregation and Scales of Equivalents and Cost"

Source: Kamm - Morality, Mortality (Vol. 1) - Death and Whom to Save from It, Chapter 10


OUP Abstract
    Continues the exploration of ‘Sobjectivity’ addressed in Ch. 8 and 9 as applied to justifying the Principle of Irrelevant Utility with respect to the question of saving different groups of lives, and advances two more combinations of objective and subjective views, here designated ‘Sobjectivism’ and ‘Sobjectivism’. Sobjectivism is a move in the direction of aggregating significantly lesser losses of life, and distinguishes costs from equivalents; Sobjectivism (presented in Ch. 8) in combination with Sobjectivism is viewed as most accurately representing commonsense morality (rather than Sobjectivity (Ch. 8) or Sobjectivism (Ch. 9)). In the fifth type of Sobjectivity, Sobjectivism, everything of concern to individuals is always allowed to be aggregated on the scale of equivalents, no matter how small — the approach is just straightforwardly utilitarian in aggregating everything. Overall, the chapter contrasts the permissibility of aggregating certain extra utilities as costs that inhibit the saving of lives with the impermissibility of aggregating these extra utilities as equivalents to and so substitutable for lives. The results obtained on irrelevant utilities are applied to the paradox of group beneficence, and the distinction between extra utility that is distributed over many people whose lives are not at stake and extra utility that is concentrated on the person whose life is at stake is considered further; in conclusion, a brief comparison is made between Sobjectivity and contractualist moral reasoning.



"Kamm (F.M.) - Acquisition of Organs"

Source: Kamm - Morality, Mortality (Vol. 1) - Death and Whom to Save from It, Chapter 11


OUP Abstract
    Deals with the problem of the acquisition and distribution of organs for transplantation1 and allows the application of the foregoing theoretical discussion of saving lives and relevant/irrelevant utilities. As an aid to dealing with categories that are of current concern to the medical community, Ch. 11 starts with a summary of the recommendations of the US Task Force on Organ Transplantation2 on acquisition and distribution of organs, and discusses and criticizes the total-brain-death criterion for death. The next section of the chapter discusses the role of informed consent of the original organ owner and his family in relation to the State in the task of acquiring organs, as well as the moral possibility of sale, trading, and taking of organs. The last section of the chapter considers the morality of more controversial proposals for acquiring organs: ‘donation’ from foetuses, donation from live donors where there is significant risk to the donor, and (the most radical) killing some persons for the sake of acquiring organs for others.



"Kamm (F.M.) - Distribution of Resources: Need and Outcome"

Source: Kamm - Morality, Mortality (Vol. 1) - Death and Whom to Save from It, Chapter 12


OUP Abstract
    Begins the discussion of organ distribution for transplantation1 presented in the last four chapters of Part III of the book by analysing factors that may be relevant in three situations: true scarcity of resources, temporary scarcity of resources, and uncertainty as to the type of scarcity. The first two sections of the chapter consider the different concepts of need and urgency and their relation to each other: what makes one person needier than another and why is greater need a factor that should give one person a stronger claim to resources? Arguments are presented for and against the view that the younger are needier than the older, and proposals offered concerning a possible diminishing marginal utility of life and diminishing marginal value of life, fairness, and the relation between helping the worst off and equality. The last section of the chapter starts by examining the concept of outcome with an eye to deciding what effects of a transplant2 and differential effects between potential recipients are morally relevant and irrelevant. It then considers the relation between the factors of need and outcome, and presents several rationales for procedures that give outcome more weight relative to need — moving away from the maximin approach (that of aiding the much worse off before the better off).



"Kamm (F.M.) - Distribution of Resources: Urgency and Outcome"

Source: Kamm - Morality, Mortality (Vol. 1) - Death and Whom to Save from It, Chapter 13


OUP Abstract
    Continues the discussion of organ distribution for transplantation1 presented in the last four chapters of Part III of the book. Discusses the relative weight that should be assigned to urgency and outcome when need is constant, although the discussion also bears on the relation of need to outcome. Various hypothetical cases are presented that involve varying outcomes in absolute numbers of years, and these are discussed in the contexts of a determining organ distribution by a maximin approach (the approach of aiding the much worse off before the better off) that is modified so that consideration is given to outcome. Aspects addressed include unavoidable inequality, chances, lending organs, and various alternatives to the modified maximin approach — Dan Brock's proposal of chances proportional to outcome, multiplying outcomes, and outcome as sole determinant. The last section of the chapter looks at the justification for moving from the maximin approach to the modified maximin approach and then even further toward an approach that shows an even greater concern for outcome.



"Kamm (F.M.) - Distribution of Resources: Outcome, Waiting Time, and Money"

Source: Kamm - Morality, Mortality (Vol. 1) - Death and Whom to Save from It, Chapter 14


OUP Abstract
    Continues the discussion of organ distribution for transplantation1 presented in the last four chapters of Part III of the book. Considers whether and why, when need and urgency are held constant, greater (better) outcome should be given weight in making decisions. An examination is made of various theories in more detail, including that of contractualist moral reasoning as proposed by Thomas Scanlon. Aspects addressed include the substitution of equivalents, counting numbers vs concentrated benefit, worse vs better outcomes, the weight to be given to death, equal rights, and social utility in relation to outcome, and the role of the doctor in relation to consideration of outcome and social policy. Discussions of how much weight to give to waiting time, the role of ability to pay in distribution decisions, and problems in deriving the government's duty to pay complete the chapter.



"Kamm (F.M.) - Procedures for Distribution"

Source: Kamm - Morality, Mortality (Vol. 1) - Death and Whom to Save from It, Chapter 15


OUP Abstract
    Brings to a close the discussion of organ distribution for transplantation1 presented in the last four chapters of Part III of the book. Presents the argument against using procedures in determining the distribution of resources, and then goes on to give a critical examination of two possible procedures for determining the distribution of organs: that of John Kilner, and that of T. Starzl (this is a points system for determining kidney distribution in which no one factor has lexical priority over another that is used in a major transplant2 centre); some modifications are suggested to the Starzl procedure. Next, an alternative distribution procedure is described for application in conditions where resources are scarce. The final section of the chapter moves on from discussing the situation where the decision to be made is which of two (or more) people should receive one organ, to the choice of situation where the choice is whether to assign multiple organs to one person or each of those multiple organs to other people.



Text Colour Conventions (see disclaimer)
  1. Blue: Text by me; © Theo Todman, 2018
  2. Mauve: Text by correspondent(s) or other author(s); © the author(s)



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