Thursday, August 11, 2016

Benefitting a Person - Part 4 - Reviving a Person from a Coma

For the past few posts I have been looking at some objections that Dr. Chris Heathwood at the University of Colorado - Boulder - sent to me regarding a "desire satisfaction" (or desire fulfillment) theory of well-being.

I had presented the idea that desire fulfillment theory should not be understood as wanting as much desire fulfillment as possible. Instead, it should be understood as seeking the fulfillment of the most and strongest of one's desires.

This understanding handles an objection that Derek Parfit raised - that you can benefit a person by giving them a strong desire for a readily available drug. The addiction only counts as a benefit if having the addiction would contribute to the fulfillment of the agent's other desires. If this criterion is not met, then the agent has no reason to seek the addiction.

In the previous two posts I handled the question of whether giving a child an ability to read counts as giving the child a benefit (given that the child has no current desire to read), and whether giving the child a desire to read counts as a benefit.

Among Dr. Heathwood's objections, also included the following:

A more extreme case is that of a person in a coma. Let’s stipulate that this person has no desires (since he is in a coma). Does your theory imply that we would not benefit him if we were to cause him to have desires, which he will satisfy, as we cause him to wake from his coma — that this would be no more benefit to him than to let him remain in the coma? But that doesn’t seem right.

I would like to answer this question with a question: Do we have an obligation to bring as many people into the world as possible so long as each person has a desire that can be fulfilled?

The question of whether we benefit the person in a coma by reviving him such that the desires he acquires upon regaining consciousness can be fulfilled is relevantly similar to the question of whether or not to bring a conceptus to term as a person with desires that can be fulfilled - or whether to create the conceptus to begin with.

The view that Derek Parfit is arguing against has that implication. If, what we are after is as much desire fulfillment as possible, then a reason must exist to create beings that have desires that can be fulfilled. However, the view that I am defending here does not have this implication.

I have typically considered the “man in a coma” case as follows: Assume that a virus comes into existence that, when it infects a person, stops all brain function. While the patient is infected with the virus, the patient has no beliefs or desires – not even the ability to feel pain or pleasure. However, if doctors keep the body functioning, then the virus will run its course in about nine months and the patient will regain consciousness with no adverse side effects. She can then continue to live out the rest of her life.

If I were to say that it is impossible to benefit the person in the coma, since no activity could fulfill a current desire, then I would also have to say that it is impossible to harm the person in a coma. This not only applies to the question of whether one does harm by turning off the machines that keep him alive. It also applies to the question of whether it would do harm to perform medical experiments on the body, or to use it as a prop in a movie or to have sex with it. These implications seem problematic.

The case derives from an argument that Judith Jarvis Thompson made in "A Defense of Abortion" (Philosophy & Public Affairs, Vol. 1, no. 1 (Fall 1971)). There, she postulated a skilled violin player in a coma being attached to another person as a form of life support for several months until he recovers. She asked us to consider whether a person who was kidnapped and connected to the violinist to keep him alive had an obligation to remain attached to the violinist.

In addressing this question, I first want to note that we would certainly have reasons – grounded on existing desires – to set up a set of institutions that would protect and preserve the body while the virus ran its course. We would have reason to see to it that the bank accounts of patients are protected, that the health of the body is preserved, and that the body not be used in ways that the patients, given their actual desires, did not or would not consent to. To the degree that it is possible, we would have reason to cause people generally to have strong aversions to mistreating the bodies of these patients and to respond with revulsion at the thought of these patients coming to harm. We would also have reason to cause people generally to want to revive the patients - or to feel an obligation to do so - when it became possible to safely do so.

However, none of this generates a reason to create an individual with desires that can be fulfilled from matter that has no desires.

Assume that we had a magic wand that can give desires to a rock – say, a desire bask in the sun – which it can easily fulfill. The question is whether there is a reason to use this wand and create as many sun-basking rocks as possible. We can assume that if we create such a rock that it would have a reason to bask in the sun. However, this does not translate into a reason to bring the rock into existence. If a reason for bringing such a rock into existence exists – then it exists in the desires of the person wielding the wand. It is not built into the fabric of the universe.

Similarly, there is no reason written into the fabric of the universe itself to combine sperm and egg into a being with desires that are fulfilled. The person created will have reasons to do certain things - and have reasons to have us treat it in certain ways (though it may not have the capacity to effectively act on those reasons). However, if a reason for bringing that being into the world exists, then it exists in the desires of others.

Returning to our person in a coma, the reasons that exist for protecting the person in a coma, for making certain that it is revived from the coma when this can be done safely, and that it emerge from the coma with its abilities to fulfill its desires intact come from the desires of people within the community. These desires give them reason to establish these institutions and to promote attitudes that would protect and preserve the body while the virus runs its course.

The main objection that I have to the idea that there is a reason to turn a collection of material having no desires into a being with desires that can be fulfilled is simply the fact that there is no evidence for the existence of such an entity. Using arguments of a type that run a range from Occam’s Razor to J.L. Mackie’s "Argument from Queerness" (Ethics: Inventing Right and Wrong, Penguin Press, 1977) there appears no reason to suggest that such a thing – such a reason – exists.

Furthermore, as with the case of the toddler, we can ask about the situation where a person is revived from the coma in a state where its desires are being thwarted. In this case, we can imagine a person waking in extreme pain. If he wakes up to be a person who has no reason to thank us for bringing him out of the coma, then he is a person for whom we did no favors – provided him with no benefit – by bringing him out of the coma.

Where there is benefit or harm to be found, it is found in the fulfillment or thwarting of the agent's desires.

As with the case of the toddler, we have two ways of describing this situation.

(a) We could say that the activity at time T (the act of reviving the person in a coma) provides a benefit at time T contingent upon its being put to use at a later time T + n to bring about the fulfillment of future desires. If no future desire fulfillment takes place, then the claim of "benefit" is revoked.

(b) Or we could say that the activity at time T does not provide the person with a benefit at time T; instead, the benefit comes at time T + n when the effects of that activity are put to use in the actual fulfillment of desires.

Of these two, (b) is technically more accurate. I find it odd to say that a benefit appears and is then lost – in fact, never existed – if not used.

However, in a community where an activity is almost certain to provide a benefit, option (a) is close enough to the truth for matters of public and social policy. It is useful, in this case, for establishing and maintaining the institutions and for promoting attitudes within the community that will protect individuals while they are in a coma. We can portray the case where a patient would wake up in extreme pain as exceptions to the rule, rather than more accurately understand them as examples of a more complex rule.

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