ISSN 1393-614X Minerva
- An Internet Journal of Philosophy Vol. 11 2007
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|
What is a
Premature Death? Brooke Alan Trisel |
Abstract
The one who dies is deprived of goods that this person would have enjoyed if he or she had continued living, according to the popular “deprivation account of harm.” The person who dies “prematurely” is generally thought to suffer the most harm from death. However, the concept of a premature death is unclear, as will be shown. I will evaluate various definitions of a premature death and will argue that the existing definitions are too ambiguous and unreliable to serve as the basis for estimating the degree of harm from death.
According to the
“deprivation account of harm,” the most popular account of how we can be harmed
by death, the person who dies may suffer harm by being deprived of goods that
this person would likely have enjoyed if he or she had continued living.
Proponents of this view continue to work on overcoming the following challenges
to their belief. First, because the dead no longer exist, it is not clear who
is the subject of the alleged harm. It
is also not clear when death is harmful to the person who dies.[1]
Deprivation theorists often
use examples of individuals who died “prematurely” as support for their belief.
For example, Thomas Nagel (1979, p. 9) writes: “The death of Keats at 24 [25][2] is generally regarded as tragic;
that of Tolstoy at 82 is not. Although they will both be dead for ever, Keats’
death deprived him of many years of life which were allowed to Tolstoy; so in a
clear sense Keats’ loss was greater. . . .” To give another example, Steven
Luper (1993, p. 272) writes: “The idea that a premature death is a misfortune for
its victim seems rather obvious. I believe that it has been responsible for
most of the anxiety which people (such as I) have felt about dying. . . .”
Although deprivation
theorists use the concept of premature death in their arguments, they often do
not indicate what they mean by a premature death. What is a premature death?
The term “premature death” suggests that the person died before
something, but before what? In response, one might reply that if someone dies
prematurely that this means that the person died before the person should have
died. However, it is not clear, as will be discussed later, whether this is a
non-moral statement or whether it simply reflects one’s desire for the person
to have lived longer. The notion of a premature death is ambiguous, as will be
shown, and requires clarification.
Nagel argues that we can
be harmed by death despite the age at which we die; even a person who lived to
the age of 806 could be so harmed. If death can be harmful regardless of the
age at which we die, then one might question whether there is a need to clarify
the concept of a premature death. Although some
deprivation theorists believe that everyone, no matter the age at which they
die, can be harmed by death, other deprivation theorists dispute Nagel’s
account and suggest that death can be harmful only to those who die
prematurely.[3] Therefore, it is important to obtain
a better understanding of the concept of a premature death.
Deprivation theorists can
be seen as making two claims. First, they claim that death may be harmful to
the one who dies. Second, they claim that the degree of harmfulness varies
among those who die; one person may suffer little or no harm from death whereas
another person may suffer great harm. Why should we be concerned with the
question of how much harm occurs? Why not just focus on the question of whether
death is harmful to the one who dies?
If the members of a jury
hear a victim of a crime declare that she was harmed, the jurors want to know,
not just whether harm occurred, but how much the victim was harmed. Did
the harm result in the victim being deprived of only a day’s worth of lost
wages or was the harm so severe that the victim was deprived of the ability
ever to work again? Similarly, when it is claimed that a person was harmed by
death, it is important to know, not just whether harm occurred, but the
severity of the harm.
Deprivation theorists
could be correct that those who die may suffer harm, but incorrect regarding
how much harm is occurring. This harm, if it is occurring, might be great or
negligible. To convince us that the harm
from death is significant enough that it warrants our attention, deprivation
theorists must have a reliable and objective method for determining the degree
of harm. Does such a method exist? What are the methods used to measure the
amount of harm? Are these methods reliable indicators of the degree of harm?
The principal aim of this paper is to evaluate the methods utilized to judge
the amount of harm from death. I will argue that the existing methods are
ambiguous and unreliable and need more work if they are to do the job of
measuring the degree of harm.
1.
The Relations Between Deprivation, Prematurity, and Harm
Joel Feinberg (1993, p.
187) argues: “The degree of harmfulness of a person’s premature death thus
depends on how premature it is, given the interests that defined his own
particular good.” Feinberg’s statement shows
that the degree of harm is thought to be positively correlated with the degree
of prematurity. In other words, as the level of prematurity or deprivation
increases, there is a corresponding increase in the level of harm that is
suffered by the one who dies. A person who dies at age 80 is generally thought
to suffer little or no harm from death, whereas a person who dies at age 18 is
thought to have suffered great harm.
Deprivation theorists
believe that death may be harmful to those who die because it deprives them of goods
that they would have enjoyed if they had not died when they did. For example, suppose
that a person has a strong desire to write a best-selling novel and then is
killed at the age of 30 before he had the opportunity to complete the novel.
His death will prevent him from ever enjoying the satisfaction of achieving his
goal. Even if he had lived to the age of 120, he might never have achieved the
goal of writing a best-selling novel. Therefore, deprivation theorists, in
estimating how much harm occurs, typically only count goods that one would or
might have enjoyed if one had continued living.[4]
If a person who has done
everything that he wanted to do in life dies at age 45, one could argue that
the deprivation of years of life did not result in the deprivation of any
goods. Because the deprivation of time does not always result in harm,
deprivation theorists are more concerned with determining how many goods were
lost to death than simply measuring how much time was lost to death. However,
measuring lost goods or missed opportunities can be very difficult.
What is a good, how do we
know that the person who died likely would have enjoyed that good, and how do
we place a numeric value on goods to determine the amount and value of goods
lost to death? These questions illustrate some of the difficulties one faces in
attempting to measure the amount and value of goods lost to death.
People have attempted to
measure the amount of harm from death indirectly and directly. The indirect
measures focus on measuring the amount of time lost to death, whereas the
direct measures focus on measuring the amount and value of goods lost to death.
Because deprivation theorists are primarily concerned with lost goods, they
tend to use the direct measures of harm, which are more abstract and difficult
to quantify than the indirect measures. In contrast, laymen and epidemiologists
tend to use the indirect measures of harm.
II.
Indirect Measures of Harm
To have the opportunity
to enjoy the goods associated with living, one must live for a certain amount of
time. If a person lived for only a minute, there would be no enjoyment of
goods. There is a correlation between the amount of goods that can be enjoyed
in one’s life and the length of one’s life, but how strong is this correlation?
If there were a perfect correlation between the length of one’s life and the
amount of goods that can be enjoyed in one’s life, such that each additional
year of life would yield an additional 100 units of goods, then one could
indirectly measure goods lost to death in terms of time lost to death. For
example, if the person who died was deprived of five years of life, we would
then know that this person was deprived of 500 units of goods.
The indirect measures of
harm that will be considered below are based on the assumption that there is a
fairly strong correlation between the length of one’s life and the amount and
value of goods that can be enjoyed in one’s life. Is this a correct assumption?
If well-being in one’s life is not additive,[5] or if one may value goods enjoyed later
in life more than goods enjoyed earlier in one’s life, then the amount of time
lost to death may not be an accurate indication of the value of the goods lost
to death. This would pose a problem for the indirect measures of harm.
To judge whether, and to
what extent, someone died prematurely, laymen often subtract the age at which
the person died from the average life expectancy. For example, if a person died at age 30 and
the average life expectancy was 75, then the difference between these two
figures — 45 years of life — is thought to be the amount of time lost to
death.
Knowing the average life
expectancy is useful information for economists. However, using the average
life expectancy as a method for determining whether an individual died
prematurely is arbitrary and problematic. A common misconception of the average
life expectancy is that it is a measure of how long an individual can expect to
live.[6] The average “life expectancy at
birth” measure, which is the most frequently reported life expectancy measure,
does not represent how long any one individual can expect to live. Rather, it
represents the average number of years of life that a hypothetical cohort of
people can expect to live from the time of birth.[7]
For example, the hypothetical cohort of males born in 2002 in the
Many people assume that
all males born in 2002 can expect to live until the age of 74 and, if one of them does not, then they
conclude that he died prematurely. Because, however, the life expectancy figure
represents the average number of years that the hypothetical cohort can
expect to live, statisticians who calculate the figure recognize that some
males will live until or longer than 74 years and millions of males will have
shorter life spans than 74 years.
Using the average life
expectancy as a way of judging whether an individual died prematurely is a
crude and inexact method of judging prematurity. It is uncertain why many
people use the average life expectancy as a method for judging whether an
individual died prematurely. It may be the result of misunderstanding what the
measure represents, it may be because the number is readily available, or it
may reflect how long they want to live, or perhaps it is all these
reasons. In adopting the average life
expectancy as the way of judging prematurity, one may be implicitly making a
normative statement about how long a person should have lived, as will be
discussed in more detail later.
The World Health
Organization (WHO) defines a premature death as a death that occurs before the
age of 50. (World Health Report 1998, p. 1) The WHO indicates that the age of
50 reflects the global average life expectancy in 1948. (World Health Report
1998, p. v) This definition exemplifies the arbitrariness of some of the
definitions of premature death.
To measure the burden of
disease in a society, epidemiologists calculate how many years of life were
lost to premature death. This is calculated by subtracting the various ages at
which individuals in a population died from the average life expectancy or an
arbitrarily chosen number such as the age of 65. This measure is called “years
of potential life lost” (YPLL).[9]
One problem with this measure, as epidemiologists have recognized, is
that it fails to take into account that someone might have died of a different
disease from the one that killed the person. For example, if someone dies of
heart disease at age 45, it cannot be assumed that this person was deprived of
20 years of life because this person might have developed cancer or another disease
and died before age 65. Because of the preceding problem of “competing risks,”
as it is called, and other limitations with the YPLL measure, epidemiologists
are attempting to develop better population-based measures of prematurity.[10]
To determine, in a
precise way, whether someone died prematurely, it would be necessary to have a
person-specific measure of prematurity, as opposed to a population-based
measure such as the YPLL measure. If Keats had not contracted tuberculosis, we
assume that he had the potential to live much longer than he did and that he
had not reached his potential life expectancy. As noted, this notion of a
potential life expectancy has been used by epidemiologists. It has also been
implicitly used by some philosophers, as will be discussed later.
The notion of a potential
life expectancy is appealing, but it is not as clear as it might at first seem.
What is a potential life expectancy? A maximum or potential life expectancy can
be thought of as a limit. If one reaches one’s potential life expectancy, then
there is nothing further that could be done to prolong one’s life. For example,
suppose that a person is dying of kidney failure. Through dialysis, other
medical treatments, and good nutrition, this person’s life may be prolonged by
many years. However, there will be a point at which nothing further could be
done to prolong this person’s life. When the person reaches that limit, he will
be at his potential life expectancy.
The results obtained
using the person-specific, potential life expectancy measure may differ from
the results obtained by subtracting the age at which a person died from the
average life expectancy. Suppose, for
example, that a healthy person died in a car accident at age 80, but he could
have lived until the age of 100 if he had not been in the car that day. This
person’s death would not have been premature based on the average life
expectancy calculation, but was premature by 20 years based on the potential
life expectancy measure. The reverse is also true in that deaths that are
typically thought of as “premature” may not be premature under the potential
life expectancy measure, as discussed below.
It is rare for someone
born with infantile Tay-Sachs disease[11] (an inherited disease of the central
nervous system) to live beyond the age of five. If a child with Tay-Sachs
disease dies at age five, then the death of this child would likely not have
been premature based on the potential life expectancy measure. Thus, the
results obtained using the potential life expectancy measure may seem
counterintuitive.
An advantage of the
person-specific, potential life expectancy measure over the population-based
measures of prematurity is that it would be a more accurate way of judging the
amount of time that a person lost to death.
However, in determining one’s potential life expectancy we are faced
with the problem of competing risks, as noted earlier. If Keats had not died of
tuberculosis, he might have died two years later from pneumonia or he could
have died in an accident at age 45. There currently is no way of knowing a
person’s potential life expectancy, which limits the usefulness of this
measure.
III.
Direct Measures of Harm
Gisela Striker (1988) has
defined premature death, not in terms of how much time was lost to death, but
in terms of whether one’s life was “complete” before one died. If one died before one’s life was complete,
then one died prematurely, she argues. Striker uses the following analogy to
suggest that people are concerned, not with how long they will live, but about
whether they will be able to complete all of the stages of their lives.
The eighteen year old who wants to continue living is
like someone who has watched the first act of an opera and is justifiably
annoyed if the performance breaks off at this point. He is angry, not because
he had thought he was going to spend three hours instead of only one, but
because he wanted to see the entire opera, not just a part of it. (Striker
1988, p. 325)
Stephen Rosenbaum, who
has defended[12] Epicurus’ argument that death is
nothing to us, calls into question Striker’s notion of a premature death. He
convincingly argues that the idea of completeness is obscure. (Rosenbaum 1990,
pp. 32-35) Our lives, in contrast to
operas, are not well structured with standard elements and so the task of
specifying what constitutes a complete life is dubious, he argues. If our lives did have standard elements, then
it would be possible to convert Striker’s definition of a premature death into
a measure for calculating the degree of harm from death. For example, if there
were 100 standard elements to a life, and a person had completed only 60 of
these elements before she died, we could then say that the degree of
incompleteness of her life was 40 percent. But, as Rosenbaum argues, the task
of identifying standard elements appears to be dubious.
Physicians define a
“premature birth” as a birth that occurs before 37 weeks of gestation.[13] Thus, birth prematurity is defined
in terms of time, perhaps because it is the simplest method for tracking the
progress of a pregnancy. However, a premature birth could also be defined in
terms of completeness because a fetus must pass through certain developmental
stages before it can survive outside the mother’s uterus.
As the above example of a
premature birth demonstrates, to define prematurity in terms of completeness,
it is necessary to have a clearly conceived notion of the endpoint and of the
progression toward the endpoint. Both of these conditions are absent regarding
a human life. Viewing this issue from a biological perspective, one might argue
that reproduction is an essential stage in the life of a human being and,
therefore, define a premature death as a death that occurs before one
reproduces. This would be an objective measure of prematurity. But what about
people who are unable to have children or who choose not to have children?
According to this definition, all of their deaths will be premature, even if
they do not die until they are 100 years old.
This biologically based
definition of premature death implies that there is nothing more to life than
experiencing childhood and perpetuating the species and that one’s life is
“complete” once one ceases reproducing. In response, one might argue that the
task of parenting does not end at reproduction; a parent or adult is also
necessary for child rearing. However, questions then arise about how long a
parent is needed to nurture a child and whether it takes two parents or just
one to do this task. In effect, the definition of prematurity becomes
value-laden.
If a person dies, and he
had goals in the years leading up to his death, but achieving these goals left
him unfulfilled or miserable, then it seems implausible that he was harmed by
death. For this reason, Steven Luper defines a premature death as a death that
prevents its “victims from fulfilling fulfilling desires.” (Luper-Foy
1993, 271-272) Could Luper’s definition be converted into a measure of harm? As
a first step toward determining whether this would be feasible, work would need
to be done to identify under what conditions a desire is fulfilling versus
unfulfilling.
Fred Feldman (1991)
claims that death harms us eternally — a claim that some have disputed.[14] In his essay, Feldman outlines an interesting
method for calculating the degree of harm. He assumes that there are possible
worlds and then asks us to compare the value of a state of affairs to a person
in a world in which he dies at t to
the nearest possible world in which he does not die at t. He gives the
following example to illustrate how his method is used. Feldman asks us to
imagine that he is taking an airplane trip to
Feldman’s method is a
direct measure of harm insofar as it attempts to measure whether the person
would have been better off if he had not died at t. The focus is on
measuring quality of life as opposed to quantity of life. However, the method also implicitly relies on
the notion of a potential life expectancy discussed under the indirect measures
of harm. For example, regarding the possible world in which he does not die in
the airplane crash, he writes: “Suppose I there do live to enjoy many happy
years of retirement.” (Feldman 1991, 216)
Jeff McMahan (1988) had
earlier proposed and ultimately rejected an account similar to Feldman’s. In his paper, McMahan reflected on an example
where a young officer, if he had not been shot and killed by Ivan, would have
been killed a few seconds later by a bullet from Boris. Regarding the example,
if the officer had been killed a few seconds later by a different bullet, then
his death from the earlier bullet deprived him of only a few seconds of life.
In his reply to McMahan, Feldman seems to want us to imagine that in the
nearest possible world that the officer “is wounded, but recovers and goes on
to live a long and happy life.” (Feldman 1991, 226) Of course, if we imagine
this, we will then conclude that the officer’s death from Ivan’s bullet was
very harmful.
As noted earlier,
epidemiologists are seeking to improve the “years of potential life lost”
measure because it fails to take into account competing risks. It is unclear
whether the method proposed by Feldman accounts for competing risks. For
example, if a 35-year-old dies of cancer, but would have died at the age of 36
from a ruptured aneurysm in his brain if he had not earlier died of cancer,
what would his potential life expectancy be with Feldman’s method? If we
imagine that this person lives a long and happy life in the possible world in
which he does not die at t from cancer, we would then greatly overstate
the amount of harm that this person suffered from his death at age 35.
It is also unclear
whether the method proposed by Feldman properly accounts for individuals born with
genetic diseases who have a short life expectancy. As mentioned, it is rare for
children with Tay-Sachs disease to live beyond the age of five. Suppose that a
child with Tay-Sachs disease dies at the age of three in an airplane crash.
With Feldman’s method, are we to imagine that the child lives a long and happy
life in the possible world in which he does not die at age three or should we,
as I believe, imagine that the child lives until the age of five?
If we presume that the
child with Tay-Sachs disease would have lived a long life if he had not died in
the airplane crash, we will misjudge how much this child was harmed by his
death at age three. In the future, treatments may be available to prolong the
lives of children born with Tay-Sachs disease. If so, then children born at
that time may have a potential life expectancy that is much longer than
five years.
IV.
A Thought Experiment About Premature Death
What
conditions would need to be present for a world to have no premature deaths? If
we were immortal or, in other words, if there were no deaths, then there would
be no premature deaths. Immortality is the most obvious scenario in which there
would be no premature deaths. Are there any scenarios in which there would be
deaths in a world, but no premature deaths?
Suppose
that there was a world in which everyone dies on his or her 50th
birthday. For the sake of brevity, this world will be called “Lifespan 50.” On
Lifespan 50, a person born in 1980 would live until the year 2030 and someone
born in 2000 would live until the year 2050.
No one could die sooner or later than the age of 50. For example, no one
could die at age 40 or live until age 70. Would this scenario in which everyone
has a fixed lifespan of 50 years be an example of a world in which there are
deaths, but no premature deaths?
If one were
to define a premature death as a death in which one dies before one’s potential
life expectancy, then this world in which no one dies before their potential
life expectancy would be a world without premature deaths. However, if one were
to adopt Striker’s definition of a premature death as a death that occurs
before one’s life is complete, then Lifespan 50 would not be a world without
premature deaths. For example, if a person is in a vegetative state from the
age of 15 to 45 and then recovers some functional capabilities, when this
person dies at age 50 his death would be premature, Striker would likely argue.
Although he lived to his potential life expectancy of 50 years, his life was
incomplete and so his death was premature.
The
question of whether there would be premature deaths in a world in which
everyone has a lifespan of 50 years was discussed above. Below I consider a
different question. Would the people on Lifespan 50 consider their upcoming
deaths to be premature? Some people may be fully satisfied with living 50 years
of life. Others, however, might wonder what it would be like to live beyond
their 50th birthday. They might think how much better life would be
if they could live until the age of 60 or 70.
There could
be a discrepancy between whether they consider their upcoming deaths premature
and whether their deaths would actually be premature. According to the
potential life expectancy definition of a premature death, their deaths would
not be premature because they live until their potential life expectancy. But
if, for example, a person became a grandmother at age 49, and she intensely
desired to interact with her grandchildren, she may consider her upcoming death
to be premature.
One way
that Lifespan 50 differs from the world in which we live is that everyone in
this imaginary world knows when they will die, assuming that they remember when
they were born. If one knew the date at which one would die, one could avoid
beginning projects late in one’s life so that these projects would not go
uncompleted because of death. However, as shown by the example above where the
grandmother wants to interact with her grandchildren, death may prevent us from
realizing some of our desires even if we knew the exact date on which we will
die.
In this
thought experiment, suppose that a life-prolonging substance is created that
would allow people to live until age 60, but that there is only enough of this
substance for half the population. The other half of the population will live
until age 50. Will the people who will not receive the substance die
prematurely at the age of 50?
Before
addressing this question, it will be useful to reflect on the psychological
reactions of the people who will not be receiving the substance. As argued,
before the life-prolonging substance became available, some people on Lifespan
50 would likely have been satisfied with living 50 years. If they were not
selected to receive the life-prolonging substance, would they still be
satisfied with 50 years of life, or would they, as I suspect, think that they
will be dying prematurely at the age of 50?
They will
live just as long (50 years) as they would have lived before the substance
became available, but they would likely no longer think of themselves as having
lived a full life. What would lead them to think that they are dying
prematurely? As will be explained, I believe that the answer can be traced to
rising expectations and to the desire for fairness. First, the availability of the
life-prolonging substance would change their expectation about how long a
person can live. They become aware that it is physically possible for a person
to live until age 60. Second, previously everyone lived the same amount of
time. However, because they will not be receiving the life-prolonging
substance, they will not live as long as the people who will be receiving the
substance, which raises issues about fairness. They had been satisfied with 50
years of life, but now that they know that half the population will live until
the age of 60 they think that they are entitled to live until that age.
Issues
around fairness can introduce bias into judgements about whether, and to what
extent, someone died prematurely. At the beginning of this section, we
reflected on the question of whether there would be premature deaths in a world
in which everyone had a lifespan of 50 years. An example of a person who was in
a vegetative state from the age of 15 to 45 was considered and it was concluded
that this person would die prematurely at age 50 based on Striker’s definition
of a premature death. What if a person on Lifespan 50 did nothing but play
video games from the age of 15 to 45 and then decided, as the date of his death
approached, that he should do more with his life? Because he started so late in
life, he will not enjoy nearly as many goods as other people who began enjoying
the goods of life at a younger age. When he dies at the age of 50, will his
death be premature?
Because
this individual had the opportunity to enjoy various goods in life, but chose
to spend his life playing video games, I suspect that some people would argue
that his death at age 50 was not premature. In contrast, the person in the
vegetative state from age 15 to 45 did not choose to live in such a state. The
person who was in the vegetative state and the former video game player enjoyed
similar amounts of goods in their lives, but judgements may differ about
whether these individuals died prematurely. If so, what does this say about
these judgements? I believe that it shows that considerations of fairness often
underlie, and can bias, judgements about the degree to which someone was harmed
by death.
If, for
example, a child with Tay-Sachs disease dies in an airplane crash at age three,
and it is assumed that this child would have lived a long and happy life if
this child had not died in the crash, then this assumption may reflect an
underlying desire for there to be equal amounts of well-being, or at least
equal life spans, among all individuals. Are there objective grounds for taking
fairness into account regarding judgements of prematurity? If it could be
demonstrated that we are entitled to live to a certain age, this would
provide an objective basis for taking fairness into account regarding
judgements of prematurity. For example, if one were entitled to live until age
65, and then is born with Tay-Sachs disease and dies at age five, then a great
injustice would have occurred. This person would have been deprived of 60 years
of life that she was entitled to live. The death would be premature because the
person had an entitlement to live until the age of 65 and this person’s right
to live until that age was violated when she died at the age of five.
Are we
entitled to live to a certain age? If so, what is the source of that
entitlement? Nature is impersonal and has given us no assurances regarding how
long we will live. Unless we are entitled to live to a certain age, which
appears doubtful, there is no basis for including considerations of fairness in
judgements about whether, and to what extent, someone was harmed by death.
What does
it mean when someone claims that a person died “too soon” or “should have lived
longer”? The person might be making a non-moral claim about the death. For
example, if the person was young and appeared to be in good health, they may be
claiming that the conditions did not seem sufficient to have caused this person
to die when he did. On the other hand, the word “should” in the claim “he
should have lived longer” may simply reflect their desire for the person to
have lived longer. Without probing the thoughts of the person who made the
claim, we would not know whether the claim is non-moral or normative.
As Hume
(1992, p. 469) is well known for pointing out, people have a tendency to go
beyond making statements about the way something “is” to making statements
about the way something “ought” to be. This leap from “is” to “ought”
frequently seems to occur when people learn that someone died at a young age.
Instead of simply concluding that the person died at a young age or had a
shorter than average lifespan, they claim that the person died “too soon,”
implying that this person ought to have lived longer than he or she did live.
If someone
declares that a person’s height is below average, then this individual is
making a descriptive statement. However, if this person goes on to declare that
this individual is “too short,” then this person may be making a normative
statement about how tall this individual ought to be. In the same way, when
someone declares that a person’s death was “too soon,” “premature,” “untimely,”
or “before his time,” this person may be making a normative statement about how
long this person should have lived.
As argued,
the judgements that people make about whether, and how much, someone was harmed
by death can be biased by the desire for fairness. These judgements can also be
influenced by our feelings toward the person who died. For example, Adolph Hitler’s
lifespan was shorter than average, but no one would claim that he died
prematurely.
V.
The Ambiguity of Measures of Harm
Above we considered what
effect the availability of the life-prolonging substance would have on whether
the people on Lifespan 50 consider their upcoming deaths to be premature. Due
to issues of fairness, those who did not receive the life-prolonging substance
would likely think that their deaths will be premature, but is there an
objective basis for their conclusions? In other words, when they die at age 50,
will they have in fact died prematurely?
Let us first reflect on
this question using Striker’s definition of a premature death. As argued, it is
unclear what are the elements of a “complete” life. For the sake of argument, suppose
that there are 100 standard elements to a life and that some of the people who
will not be receiving the life-prolonging substance had completed all of the
elements. They observed all of the opera, to use Striker’s analogy. In not
receiving the additional ten years of life, the only thing they missed was the
unexpected encore. In that case, their deaths at age 50 were not premature. But
is this ten additional years of life simply supplemental, like an unexpected
encore, or did the experiences that may occur during those ten years somehow
become additional elements of what makes a life complete?
Because of the ambiguity
of the notion of “completeness,” it is not clear whether the individuals who
will die at age 50 will have died prematurely. What if we use the potential
life expectancy definition of a premature death? Can we then tell whether the
deaths of those individuals who did not receive the life-prolonging substance
will be premature?
In the introduction to this
thought experiment, it was stipulated that the potential life expectancy of
everyone in this imaginary world was 50 years. Based on this stipulation, it
was concluded that there would be no premature deaths on Lifespan 50 based on
the potential life expectancy definition of a premature death. However, with
the creation of the life-prolonging substance, things have become more
complicated. What is the potential life expectancy of those individuals who
will not be receiving the life-prolonging substance? Is it 50 years or is it 60
years? Before addressing this question, it is necessary to obtain a better
understanding of the concept of a potential life expectancy.
Through genetic
engineering and anti-aging drugs, future generations may have the potential to
live longer than we do. Even if everyone
born in the year 2100 would have the potential to live until age 177, it would
not be true that anyone currently alive has a potential life expectancy of 177
years. Thus, for the notion of a potential life expectancy to make sense, it
must take into account the context or, in other words, the conditions that were
in effect at the time the person was alive. To give another example, if there
were an undiscovered substance deep in the
With this clarification,
let us return to the question: What is the potential life expectancy of those
individuals on Lifespan 50 who did not receive the life-prolonging substance?
If these individuals were given the substance, they would live until age 60.
However, they are not given the substance. The question becomes whether we
should take into account that these individuals did not have access to the
substance in judging their potential life expectancy. If we omit this fact from
our analysis, it would be concluded that they had a potential life expectancy
of 60 years and were deprived of 10 years of life when they died at age 50.
Whether they had access
to the substance should be considered in determining their potential life expectancy.
If they did not have access to the life-prolonging substance, then their
potential life expectancy was 50 years and so they did not die prematurely.
Similarly, suppose that there are two 50-year-old men with advanced colon
cancer on Earth and that there is a proven drug on the market for prolonging
the lives of individuals with this type of cancer. If one person has the
ability to pay for this expensive medicine and the other does not, it would be
reasonable to conclude that the person who does not have access to the drug has
a shorter potential life expectancy than the other person.
A distinction should be
made between retrospective and prospective judgements about prematurity. One
can ask “Was the person’s death premature?” If the person is still alive, one
might also ask “When he dies, will his death have been premature?” In the
thought experiment, both types of questions were asked.
In our daily lives,
retrospective judgements about prematurity are probably much more common than
are prospective judgements. This is fortunate because prospective judgements
are much more difficult to make than retrospective judgements. Based on the
potential life expectancy definition of a premature death, it was concluded
that there were no premature deaths on Lifespan 50, even after the
life-prolonging substance became available. This, however, ignores other
factors that may have affected the potential life expectancy of the individuals
in this imaginary world. For example, if a massive asteroid was on a course to
collide with their planet shortly after the life-prolonging substance had been
created, then, assuming that all life would be wiped out, the potential life
expectancy of those who received the life-prolonging substance would not have
been 60 years.
With retrospective
judgements about whether someone died prematurely, there are still many factors
that need to be considered in determining how long the person who died could
have lived, but because the death has already occurred and we are still alive to
discuss it, this rules out scenarios, such as asteroid impact, that could have
occurred, but did not occur.
VI.
Conclusion
Direct and indirect
measures of harm have been evaluated. The definition of a premature death that
is based on the concept of a complete life is too ambiguous to serve as the
basis for estimating the degree of harm that may be suffered by people when
they die. The notion of a potential life expectancy was also found to be
ambiguous. For this notion to be more useful in estimating the amount of time a
person lost to death, as argued, one would need to take into account the
conditions, including competing risks, that would have influenced or determined
how long she would have lived if she had not died when she did. We may misjudge
the amount of time that this person lost to death if the conditions under which
the person lived are disregarded and it is assumed that the person would have
lived until age 65 or another arbitrarily chosen age.
Deprivation theorists
might concede that there are problems with the existing measures of harm, but
then argue that it is unimportant to know how much harm is suffered. However, as I argue at the outset, it is not
enough to know that harm occurs. It is also important to know the degree of
harm.
Luper (2006, p. 11)
notes: “[P]roponents of the harm theses still have work to do, for their view
is not secure unless it is clear that we can be the subject who incurs
harms associated with absent goods, and unless there is a clear time
when the harms are received.” If these
challenges can be overcome, the next challenge will be to determine how much
harm is occurring. As argued here, the concept of a premature death is
ambiguous and can be value laden and therefore requires refinement if it is to
serve as the basis for estimating the degree of harm.
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NOTES
[1] A collection of essays discussing these questions can be found in Fischer
(1993). For a recent attempt to state when death is a misfortune, see Bradley
(2004).
[2] John
Keats died at the age of 25 from tuberculosis.
[3] See, for
example, McMahan (1988).
[4] For
further discussion, see Luper (2006).
[5] Velleman
(1991) argues this point.
[6] For further
discussion of this misconception, see Strauss (2003).
[7] For
further discussion, see Arias (2004).
[8] Arias
(2004, 3). In 2002, average life expectancy at birth in the
[9] For
further discussion, see Lee (1997).
[10] See, for
example, Lee (1997, 1456).
[11] For more
information on this disease, see Gravel (1995).
[12] See
Rosenbaum (1986).
[13] See, for
example, The World Health Report (1998, 68).
[14] For
discussion of why Feldman’s claim that death harms us eternally has been
disputed, see Luper (2006, 12).
Copyright
© 2007 Minerva
All
rights are reserved, but fair and good faith use with full attribution may be
made of this work for educational or scholarly purposes.
Brooke Alan Trisel has published articles on human extinction, judging the value of life, futility, and temporality. He works as a Senior
Program Analyst in the state of Ohio.
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