{"id":241,"date":"2010-02-01T14:34:04","date_gmt":"2010-02-01T13:34:04","guid":{"rendered":"https:\/\/blogs.bmj.com\/medical-ethics\/?p=241"},"modified":"2010-02-01T14:34:04","modified_gmt":"2010-02-01T13:34:04","slug":"killing-letting-die-and-epistemology","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/medical-ethics\/2010\/02\/01\/killing-letting-die-and-epistemology\/","title":{"rendered":"Killing, Letting Die, and Epistemology"},"content":{"rendered":"

David Shoemaker has an interesting post on PEASoup about the epistemology of advance directives<\/a>.\u00a0 Starting from a fairly standard thought-experiment about an older, dementing person who wants to accept treatment that her younger, pre-demented person had refused, he adds to the standard metaphysical arguments a claim that<\/p>\n

the real puzzle for ADs isn\u2019t metaphysical, it\u2019s epistemic.\u00a0 And barring physicians\u2019 having the requisite degree of knowledge, a \u201cbetter safe than sorry\u201d mentality rules the day.<\/p><\/blockquote>\n

His exposition of the thought leads him to make a “modest proposal”:<\/p>\n

advance directives should be restricted only to patients and physicians who are expected to have a continuing relationship through the time of the circumstances specified in the AD.\u00a0 […]\u00a0 Thus, there could be an implicit (or explicit) \u201cout\u201d clause in the contract: if the patient finds herself in the specified circumstances with another physician at the helm, the contract may be overridden at the judgment of the physician.\u00a0 This will restrict the range of viable AD\u2019s rather severely, but it seems that it\u2019s the only way to ease the epistemic burden produced by the current system.<\/p><\/blockquote>\n

It’s a provokative thought, and I recommend the post.\u00a0 But it also reminded me of another post on the same site, ostensibly on a different topic.\u00a0 Here, Ralph Wedgwood considered “Scheffler’s Paradox”<\/a>, which relates to the manner in which deontologists are more likely to flinch at the thought of killing one innocent person to save five other persons than they are at the thought of killing one bear to save five other bears.\u00a0 His way out of the problem is intriguing.<\/p>\n

When no persons are involved, if you take the \u201cinterventionist\u201d option of killing one bear to save five, you both actively do<\/em> and intend<\/em> harm to one bear; but you also both actively do and intend good<\/em> to the five other bears. So it seems that in the case involving bears, the reason for<\/em> the interventionist option and the reason against<\/em> it are in the end fairly evenly balanced.<\/p><\/blockquote>\n

What is different in the case involving persons? The pattern of doing vs<\/em>. allowing and intending vs<\/em>. foreseeing is just the same as in the case involving bears. So I propose that the relevant difference is that when persons are involved, the values<\/em> of the relevant consequences<\/em> are different, on the grounds that these consequences involve relationships<\/em> between persons.<\/p><\/blockquote>\n

That is, there is a “special range of values and disvalues exemplified by relationships between persons” that makes the difference.\u00a0 Now, I’m not wholly sold on the idea that this’d satisfy all deontologists – at least some would protest that the nature of the relationships between agents is neither here nor there, and we should take a grim pride in having done the right thing and treat rightness as its own reward.\u00a0 On the other hand, I’m not sure that those dour deontologists are correct, so their point might be moot.<\/p>\n

What’s interesting, though, is the manner in which, in both these blog posts, it’s an appeal to the nature of the relationships between agents that carries a lot of the weight.\u00a0 There’s something attractive about this view, and it’s a theme that’s been made by various Aristotelians, Humeans, virtue theorists and care ethicists for a long time.\u00a0 But if there is something to this, it’s a threat to universalism – and, as Shoemaker all but points out, it might mean that there will be some people who satisfy all the metaphysical and moral requirements for their AD to be considered valid, but whose directive would still not be enforceable because of some prima facie<\/em> contingent fact about the physician: if, for example, the doctor at time t<\/em> retired due to a sudden and unforeseen illness and had been replaced by time t+1<\/em>, those eventualities might drive a coach and horses through the AD.\u00a0 And, while that’d be consistent with the precautionary approach that does seem to obtain in respect of at least some ADs, it’s also problematic from the point of view of justice: if\u00a0a person is entitled to refuse treatment, that entitlement doesn’t seem to have anything to do with the identity of those who would or would not be treating.<\/p>\n

But, then again, ditching an “ethic of justice” is precisely what at least some care ethicists want; they don’t see that as a problem for their approach, but as a virtue.<\/p>\n

\u00a0<\/p>\n","protected":false},"excerpt":{"rendered":"

David Shoemaker has an interesting post on PEASoup about the epistemology of advance directives.\u00a0 Starting from a fairly standard thought-experiment about an older, dementing person who wants to accept treatment that her younger, pre-demented person had refused, he adds to the standard metaphysical arguments a claim that the real puzzle for ADs isn\u2019t metaphysical, it\u2019s […]<\/p>\n

Read More…<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1240,591,328],"tags":[],"class_list":["post-241","post","type-post","status-publish","format-standard","hentry","category-blogosphere","category-life-and-death","category-philosophy"],"yoast_head":"\nKilling, Letting Die, and Epistemology - Journal of Medical Ethics blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/medical-ethics\/2010\/02\/01\/killing-letting-die-and-epistemology\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Killing, Letting Die, and Epistemology - Journal of Medical Ethics blog\" \/>\n<meta property=\"og:description\" content=\"David Shoemaker has an interesting post on PEASoup about the epistemology of advance directives.\u00a0 Starting from a fairly standard thought-experiment about an older, dementing person who wants to accept treatment that her younger, pre-demented person had refused, he adds to the standard metaphysical arguments a claim that the real puzzle for ADs isn\u2019t metaphysical, it\u2019s [...]Read More...\" \/>\n<meta property=\"og:url\" content=\"https:\/\/blogs.bmj.com\/medical-ethics\/2010\/02\/01\/killing-letting-die-and-epistemology\/\" \/>\n<meta property=\"og:site_name\" content=\"Journal of Medical Ethics blog\" \/>\n<meta property=\"article:published_time\" content=\"2010-02-01T13:34:04+00:00\" \/>\n<meta name=\"author\" content=\"BMJ\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"BMJ\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"4 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2010\\\/02\\\/01\\\/killing-letting-die-and-epistemology\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2010\\\/02\\\/01\\\/killing-letting-die-and-epistemology\\\/\"},\"author\":{\"name\":\"BMJ\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/#\\\/schema\\\/person\\\/ba3da426ed20e8f1d933ca367d8216fe\"},\"headline\":\"Killing, Letting Die, and Epistemology\",\"datePublished\":\"2010-02-01T13:34:04+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2010\\\/02\\\/01\\\/killing-letting-die-and-epistemology\\\/\"},\"wordCount\":749,\"commentCount\":6,\"publisher\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/#organization\"},\"articleSection\":[\"Blogosphere\",\"Life and Death\",\"Philosophy\"],\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"CommentAction\",\"name\":\"Comment\",\"target\":[\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2010\\\/02\\\/01\\\/killing-letting-die-and-epistemology\\\/#respond\"]}]},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2010\\\/02\\\/01\\\/killing-letting-die-and-epistemology\\\/\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2010\\\/02\\\/01\\\/killing-letting-die-and-epistemology\\\/\",\"name\":\"Killing, Letting Die, and Epistemology - Journal of Medical Ethics blog\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/#website\"},\"datePublished\":\"2010-02-01T13:34:04+00:00\",\"breadcrumb\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2010\\\/02\\\/01\\\/killing-letting-die-and-epistemology\\\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2010\\\/02\\\/01\\\/killing-letting-die-and-epistemology\\\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/2010\\\/02\\\/01\\\/killing-letting-die-and-epistemology\\\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Killing, Letting Die, and Epistemology\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/#website\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/\",\"name\":\"Journal of Medical Ethics blog\",\"description\":\"A blog to discuss the ethics of medicine in its many guises and formats.\",\"publisher\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/#organization\"},\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-US\"},{\"@type\":\"Organization\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/#organization\",\"name\":\"Journal of Medical Ethics blog\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/\",\"logo\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/#\\\/schema\\\/logo\\\/image\\\/\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/files\\\/2026\\\/04\\\/jme-logo.png\",\"contentUrl\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/files\\\/2026\\\/04\\\/jme-logo.png\",\"width\":200,\"height\":50,\"caption\":\"Journal of Medical Ethics blog\"},\"image\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/#\\\/schema\\\/logo\\\/image\\\/\"}},{\"@type\":\"Person\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/#\\\/schema\\\/person\\\/ba3da426ed20e8f1d933ca367d8216fe\",\"name\":\"BMJ\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/b4d8f39281bcae118348a1c027347b8e53b82d42520e774a8b50dd9a6ac6c01d?s=96&d=mm&r=g\",\"url\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/b4d8f39281bcae118348a1c027347b8e53b82d42520e774a8b50dd9a6ac6c01d?s=96&d=mm&r=g\",\"contentUrl\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/b4d8f39281bcae118348a1c027347b8e53b82d42520e774a8b50dd9a6ac6c01d?s=96&d=mm&r=g\",\"caption\":\"BMJ\"},\"sameAs\":[\"https:\\\/\\\/blogs.bmj.com\\\/\"],\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/medical-ethics\\\/author\\\/admin\\\/\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Killing, Letting Die, and Epistemology - Journal of Medical Ethics blog","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/blogs.bmj.com\/medical-ethics\/2010\/02\/01\/killing-letting-die-and-epistemology\/","og_locale":"en_US","og_type":"article","og_title":"Killing, Letting Die, and Epistemology - Journal of Medical Ethics blog","og_description":"David Shoemaker has an interesting post on PEASoup about the epistemology of advance directives.\u00a0 Starting from a fairly standard thought-experiment about an older, dementing person who wants to accept treatment that her younger, pre-demented person had refused, he adds to the standard metaphysical arguments a claim that the real puzzle for ADs isn\u2019t metaphysical, it\u2019s [...]Read More...","og_url":"https:\/\/blogs.bmj.com\/medical-ethics\/2010\/02\/01\/killing-letting-die-and-epistemology\/","og_site_name":"Journal of Medical Ethics blog","article_published_time":"2010-02-01T13:34:04+00:00","author":"BMJ","twitter_card":"summary_large_image","twitter_misc":{"Written by":"BMJ","Est. reading time":"4 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"Article","@id":"https:\/\/blogs.bmj.com\/medical-ethics\/2010\/02\/01\/killing-letting-die-and-epistemology\/#article","isPartOf":{"@id":"https:\/\/blogs.bmj.com\/medical-ethics\/2010\/02\/01\/killing-letting-die-and-epistemology\/"},"author":{"name":"BMJ","@id":"https:\/\/blogs.bmj.com\/medical-ethics\/#\/schema\/person\/ba3da426ed20e8f1d933ca367d8216fe"},"headline":"Killing, Letting Die, and Epistemology","datePublished":"2010-02-01T13:34:04+00:00","mainEntityOfPage":{"@id":"https:\/\/blogs.bmj.com\/medical-ethics\/2010\/02\/01\/killing-letting-die-and-epistemology\/"},"wordCount":749,"commentCount":6,"publisher":{"@id":"https:\/\/blogs.bmj.com\/medical-ethics\/#organization"},"articleSection":["Blogosphere","Life and Death","Philosophy"],"inLanguage":"en-US","potentialAction":[{"@type":"CommentAction","name":"Comment","target":["https:\/\/blogs.bmj.com\/medical-ethics\/2010\/02\/01\/killing-letting-die-and-epistemology\/#respond"]}]},{"@type":"WebPage","@id":"https:\/\/blogs.bmj.com\/medical-ethics\/2010\/02\/01\/killing-letting-die-and-epistemology\/","url":"https:\/\/blogs.bmj.com\/medical-ethics\/2010\/02\/01\/killing-letting-die-and-epistemology\/","name":"Killing, Letting Die, and Epistemology - Journal of Medical Ethics blog","isPartOf":{"@id":"https:\/\/blogs.bmj.com\/medical-ethics\/#website"},"datePublished":"2010-02-01T13:34:04+00:00","breadcrumb":{"@id":"https:\/\/blogs.bmj.com\/medical-ethics\/2010\/02\/01\/killing-letting-die-and-epistemology\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/blogs.bmj.com\/medical-ethics\/2010\/02\/01\/killing-letting-die-and-epistemology\/"]}]},{"@type":"BreadcrumbList","@id":"https:\/\/blogs.bmj.com\/medical-ethics\/2010\/02\/01\/killing-letting-die-and-epistemology\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/blogs.bmj.com\/medical-ethics\/"},{"@type":"ListItem","position":2,"name":"Killing, Letting Die, and Epistemology"}]},{"@type":"WebSite","@id":"https:\/\/blogs.bmj.com\/medical-ethics\/#website","url":"https:\/\/blogs.bmj.com\/medical-ethics\/","name":"Journal of Medical Ethics blog","description":"A blog to discuss the ethics of medicine in its many guises and formats.","publisher":{"@id":"https:\/\/blogs.bmj.com\/medical-ethics\/#organization"},"potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/blogs.bmj.com\/medical-ethics\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"en-US"},{"@type":"Organization","@id":"https:\/\/blogs.bmj.com\/medical-ethics\/#organization","name":"Journal of Medical Ethics blog","url":"https:\/\/blogs.bmj.com\/medical-ethics\/","logo":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/blogs.bmj.com\/medical-ethics\/#\/schema\/logo\/image\/","url":"https:\/\/blogs.bmj.com\/medical-ethics\/files\/2026\/04\/jme-logo.png","contentUrl":"https:\/\/blogs.bmj.com\/medical-ethics\/files\/2026\/04\/jme-logo.png","width":200,"height":50,"caption":"Journal of Medical Ethics blog"},"image":{"@id":"https:\/\/blogs.bmj.com\/medical-ethics\/#\/schema\/logo\/image\/"}},{"@type":"Person","@id":"https:\/\/blogs.bmj.com\/medical-ethics\/#\/schema\/person\/ba3da426ed20e8f1d933ca367d8216fe","name":"BMJ","image":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/secure.gravatar.com\/avatar\/b4d8f39281bcae118348a1c027347b8e53b82d42520e774a8b50dd9a6ac6c01d?s=96&d=mm&r=g","url":"https:\/\/secure.gravatar.com\/avatar\/b4d8f39281bcae118348a1c027347b8e53b82d42520e774a8b50dd9a6ac6c01d?s=96&d=mm&r=g","contentUrl":"https:\/\/secure.gravatar.com\/avatar\/b4d8f39281bcae118348a1c027347b8e53b82d42520e774a8b50dd9a6ac6c01d?s=96&d=mm&r=g","caption":"BMJ"},"sameAs":["https:\/\/blogs.bmj.com\/"],"url":"https:\/\/blogs.bmj.com\/medical-ethics\/author\/admin\/"}]}},"_links":{"self":[{"href":"https:\/\/blogs.bmj.com\/medical-ethics\/wp-json\/wp\/v2\/posts\/241","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.bmj.com\/medical-ethics\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.bmj.com\/medical-ethics\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.bmj.com\/medical-ethics\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.bmj.com\/medical-ethics\/wp-json\/wp\/v2\/comments?post=241"}],"version-history":[{"count":0,"href":"https:\/\/blogs.bmj.com\/medical-ethics\/wp-json\/wp\/v2\/posts\/241\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.bmj.com\/medical-ethics\/wp-json\/wp\/v2\/media?parent=241"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.bmj.com\/medical-ethics\/wp-json\/wp\/v2\/categories?post=241"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.bmj.com\/medical-ethics\/wp-json\/wp\/v2\/tags?post=241"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}