“Death cannot harm the patient: Comparativism and the biased world problem”

Abstract

Premature discussions of patients’ rights or duties to death must be put aside to focus first on whether death injures the patient who dies. Comparativism argues that dying does have impact on this individual, then it may alter our arguments on duties or rights to die, as well as on how and whether we should make end of life decisions for others. If Comparativism is correct, then there are large ramifications for ethics, medicine, and public health. Unfortunately for Comparativism, its incorporation of intuitions and possible worlds gives it the same undermining biased world problem encountered by Moore's isolation test for intrinsic value. Imagining/referring to a possible world whilst in this one merely creates the illusion that a decedent's death can benefit or injure her. When we select possible worlds or fill in their missing states of affairs, we can often impose our own biases into the thought experiment. Thinking about fictions is useful in figuring out what we should do and be, as well as evaluating what others did and were, but medical practice and policy affecting end of life issues in bioethics should always be based on reality and not subjective partiality.