We are very pleased to now begin our announced Ethics discussion of Jennifer Hawkins' piece, “Well-Being, Time, and Dementia." Here is Valerie Tiberius' critical précis to kick off the discussion, posted below the fold. Thanks in advance to everyone who participates, and we're looking forward to it being a great discussion!
Comments on Jennifer Hawkins’ “Well-Being, Time, and Dementia” for PeaSoup/Ethics Collaboration
April 29, 2014
This is a terrific paper, and I am completely convinced of Hawkins’ main conclusion that it is not good for Rupina to die. Rupina is Hawkins’ opening character (see p. 508 for the full description). Earlier in her life Rupina wrote an advance directive stipulating that she should not receive treatment for any potential fatal condition should she contract Alzheimer’s dementia. When we are introduced to her she is in the middle stage of Alzheimer’s, but (unlike some Alzheimer’s patients) she is happy most of the time and seems to be enjoying her life. Hawkins argues, against Ronald Dworkin and Jeff McMahan, that if Rupina were to develop pneumonia, it would be best (prudentially) for her to receive life-saving antibiotics. Hawkins is careful to distinguish her conclusion about Rupina’s prudential good – her well-being – from many other conclusions one might wish to draw about the case (such as what we ought to do, all things considered); Hawkins’ goal is to illuminate the nature of well-being through this example.
The argument for the main conclusion about Rupina consists in three separate arguments against three reasons for taking past desires (such as were expressed in Rupina’s advance directive) to be relevant to a person’s well-being. The last section of the paper (VII, starting on p. 540) provides a helpful summary. Here I’ll focus on the third of the three reasons, “the life-object approach”, since this is the one that most interests Hawkins. The idea here (articulated in different ways by Dworkin and McMahan) is that there are holistic properties of lives that add value to a life that cannot be reduced to the value of individual parts of the life. Examples of such properties include thematic unity and narrative structure. For Dworkin, according to Hawkins, temporally local goods "are almost never as important for us as is fashioning our lives into good lives, viewed holistically. As self-creators, Dworkin thinks that we strive to give our lives meaning and structure, and this can, in certain cases, lead us to try and impose a particular shape or form on our lives. Rupina’s attempt (while competent) to ensure that her final phase of life is not a demented phase can be views as such a move—as an attempt to ensure that her life as a whole will not be marred by the presence, at the end, of an element so thematically at odds with the rest” (520).
Hawkins articulates a similar argument inspired by McMahan, but I won’t elaborate that more complex argument here.
Hawkins' argument against the life-object approach depends on two premises: (1) that all prudential value is value at a time and (2) the nonalienness principle (NA), which says that for something to count as good for a person it must be the case that if that thing enters her experience, it does so in a positive way (the precise formulation is on p. 527). Hawkins defends NA by appeal to intuitions and by arguing that almost all theories of well-being accept it. So, the argument goes, because Rupina will not register the decision to withhold life-saving antibiotics in any positive way, and because there is no competing timeless prudential value of a life with a certain shape or ending that is independent of what she now values (i.e., a value that does not obtain at any specific time), withholding the medicine is bad for Rupina. On Hawkins way of think about well-being “our good must change as we change because it must, in some sense, fit with our current capacities for positive response” (539). I think this is exactly right. Since that makes for a boring commentary, however, I’ll raise some questions about the non-alienness principle in what follows.
Hawkins rightly points out that some people will be suspicious of her nonalienness principle because of intuitions about cases in which something is good for you now despite the fact that you will not respond positively to it, because you will develop in such a way that you will eventually respond positively enough to it that your life would be worse without it. She gives the example of a person who thinks dancing is dumb, but who would love dancing were she to develop a taste for it. Here is Hawkins’ verdict about the case: “while dancing is a good choice for me now, it is not good for me right now. It will only be good for me once I start to respond positively to it in the appropriate way…” (528). Similarly, the benefit of broccoli for children who hate broccoli: broccoli is a good choice for children, but it is not (intrinsically) good for them until they start to like it. There are two important distinctions here: the familiar distinction between intrinsic and instrumental goods, and the less familiar distinction between a good choice and a ‘good for’. A good choice may be a good choice because of its relationship to intrinsic value, or because it is the choice of something that will be instrumental to an intrinsic value. The nonalienness principle is a claim about intrinsic goods only (527).
We can see from the examples, that NA has some implications for what to say about the way in which improvement, development or growth are good for people. Something that will make you into a person who enjoys a better whole life (call these self-developing actions, or SDAs), but to which you do not respond positively now is instrumentally good for you, not intrinsically good for you. Note that in talking about a better “whole life” here, I do not mean to be disagreeing with Hawkins’ first premise. There is an unproblematic sense of a good whole life, according to which a better whole life is one with more prudentially good segments or moments. (Hawkins discusses the unproblematic sense of a “whole life” as a collection of events that occur over time on p. 519; I am just adding that a better whole life is one in which there are more events that are good for the person. This is the sense of a good or better whole life that I intend in the rest of my comments).
At first reading, I thought this seemed like not quite the right thing to say about development, particularly when it comes to children. To my ear, it is strange to say that activities such as reading, sharing toys and trying different foods are merely instrumentally good for children who do not respond positively to these activities at first, that these are good choices, but not intrinsically good for them. But then I thought about the case of children whose prospects are tragically cut short, cases in which it is not true that these developing activities are instrumental to creating intrinsically valuable positive engagement with these activities later in life (because there will be no later). In such cases it does seem like the disliked (not positively responded to) self-developing activities are not good for these children. It does seem plausible to say that for a child who will not live past the age of 8, learning to play the violin is not good for her if she does not respond positively to it.
So, perhaps it is right to say that disliked developmental activities are only instrumentally good for children. After all, as Hawkins points out, instrumental goods can be very good indeed. The trouble with this, however, is that for SDAs to be instrumentally good for children, it has to be the case that developing into a person who will be able to have a better whole life (a life with more segments that contain higher well-being) is intrinsically good for them and, according to NA, this means that the children have to be such that they would respond positively to being such a person or having such a life. But it’s not clear that young children can comprehend the idea of a whole life well enough to respond to it in any way at all (certainly infants cannot). This does seem to be a problem since NA is formulated so that it is how the person would respond at the current moment that counts. That is, it’s not the case that a life with the greatest number of well-being segments is good for a person at T1 if she would respond positively to that life at the end of it or when she’s older; rather, this good whole life is only good for her at T1 if she would respond positively to it at T1.
Of course, the case of children presents special problems for theories of well-being with subjectivist leanings, so let’s think about how it is with adults. As Hawkins very wisely emphasizes, adults are also developing – or at least changing – and this is plausibly relevant to our good just as it is relevant to the well-being of children. Adults buy self-help books, go to therapy, meditate, and so on to try to change themselves into people who will respond positively to things to which we do not now respond positively. I might engage in rigorous retraining to overcome my heroin addiction, or obsessive love of power, because without these desires I will have more good moments of time over the whole course of my life. What can Hawkins say about the value of these activities compatibly with NA?
There are some SDAs that NA can countenance as intrinsically good for a person. The easiest case is one in which I actually enjoy (say) meditating now and it is also true that it will make me into a kind of person who has more prudentially valuable moments overall. Further, we can respond positively to actions under different descriptions, and there might be cases in which an activity is viewed positively under the description of a self-developing activity (e.g., “the thing I’m doing to be less anxious in the long term”). That is, there are cases in which we do not respond positively to some features of the activity we do to make ourselves prudentially better off in the future, but we respond positively to other features, or to the activity under certain descriptions. It seems to me that NA can countenance such activities as intrinsically good for us even though there’s a sense in which we do not respond positively to them now. Finally, as in the case of children, the instrumental value of SDAs is pretty darn important.
Is this enough? I’m not sure, for reasons similar to those I raised in the case of children. Unlike very young children, most adults are capable of understanding and responding positively to the idea of a better whole life; the problem is that they might not do so. I’m worried about cases in which a person does not respond positively to a better whole life (that is, a life with more good segments than she would have if she didn’t change) because she is severely depressed, suicidal, self-loathing, cynical, pessimistic or otherwise disordered. In such cases the fact that X is a means to a life that contains more moments that are good for her will not make X instrumentally good for the person since the end to which X is a means is not something she responds positively to. Hawkins briefly considers cases in which a person is temporarily unable to appreciate things that are intuitively good (529-30) and she bites the bullet (admitting that the intuitive goods are not good for the person until she regains her ability to respond positively to them). I don’t find this terribly plausible in the particularly case of the good of a life that contains many good-for segments. It does seem to me that the facts about a person’s whole life (just seen as the sum total of good moments) can make it the case that some things are good for her despite a lack of positive response now to a whole life with more good moments, or to a changed version of herself who is able to live such a life.
Concerns about the value of SDAs have led to what I think is an odd implication of NA: that the intrinsic value of a life with more good-for segments depends on a person’s responding positively to a whole life like this. If anything is intrinsically valuable for a person, a life with the most good-for segments seems like an excellent candidate. Maybe the right thing to say is that NA applies only to segments of a life and that a whole life with more good moments in it is good for a person independently of her positive response to it. Of course, according to NA, we must respond positively to the individual moments that make up the good life, but this doesn’t mean we’ll response positively to actions that will lead us to a life with more such moments in total. In other words, one might say that a life in which we get the most “good-for stuff” (whatever that is) is good for us, however we feel about it. (This may amount to saying that there is one timeless good: the good of a life in which you have the most good-for moments). Abandoning NA for whole lives does provide a solution to the problem of self-development and the related problem of disordered agents, because it will ensure that actions that create a person who will get more well-being overall will be instrumentally good for that person. Notice that this admission of a limitation on NA would not change the verdict about Rupina, because given Rupina’s current positive responses, she is now accumulating more good-for moments by staying alive. It’s not true about Rupina that a life with a higher total of good-for moments would be one in which she dies of pneumonia now.