Some values are so sacred that people do not want to even consider the possibility that there exist some individuals who would be better off without the sacred value. For example, smoking probably shortens the lives of plenty of people. ‘Smoking is bad’ is about as sacred of a public health value as there is. Yet, I am sure there are people who would be harmed if they quit smoking. Consider, for example, someone who smokes and will never develop heart disease or lung cancer, but will gain weight, be more depressed, and have far more anxiety if they stop smoking. What is the harm in acknowledging that some people like this exist? Acknowledging it does not necessarily imply that anti-smoking campaigns should stop. Yet, I have found that few people are willing to seriously consider the possibility.
An even more extreme example is the ‘life is good’ sacred value. I have not had much success in convincing people that there exist individuals who would have been better off not existing. Even though it seems really obvious to me, I can see people feeling very uncomfortable with the subject. They really don’t even want to allow themselves to consider the possibility.
I think I came up with a better way to present these ideas. Let’s see if this works.
First, I will make two points that I think most people will agree with.
1. Most people do care about quality of life, and would consider choosing a treatment that gives them a high quality of life for a slightly shorter period of time than a treatment that would lead to a low quality of life (picture, for example, 4 months of chemotherapy that extended your life by just a few days). I don’t think this is too controversial. This is why researchers sometimes consider quality-adjusted life years.
2. There are periods of time in your life when, if you could, you would choose to be unconscious. For example, suppose you have a severe migraine, are nauseated, or extremely depressed. If you could, safely, push a button and make yourself unconscious until the pain went away, I think many people would. Again, I think this is not controversial.
Now, imagine that at every instant of your life there is a quality of life (QoL) score. A negative QoL score at a given moment means that you are so miserable that you would rather be unconscious until the pain stops. So the QoL score is a continuous function of time. It will have many spikes (e.g., large positive spike if a friend tells a funny joke, or a large negative spike if you drop boiling water on your leg).
Below are some graphs of 3 different people’s QoL scores over time. These are smoothed out, because it would be too hard to display all of the spikes. Just imagine that if you zoomed in you would see a lot of variation. The smoothed curves just give you the general picture. I put an ‘X’ at the time the person died.
The first graph is someone who almost always preferred to be conscious. They had one really hard period of time in their life, but it was pretty short. They seemed to have a good life.
The next graphs shows someone who had a good life up until they were pretty old. Then things went downhill. This situation, unfortunately, might not be all that uncommon. See here and here, for some relevant discussion. The arrow on the curve shows the point at which the person would have been better off no longer existing. This should be uncontroversial, given how I defined QoL.
The last graph is especially unfortunate. This shows someone who had a pretty miserable existence their entire short life. (recall that this is a smoothed graph – they certainly might have had good moments). I don’t think it’s too hard to think of examples like this (you can picture some terrible diseases, famine, etc). This is a person who would have been better off not existing. Right?
It could very well be that the large majority of people are like the person in the first graph (I really don’t know). But it seems to me like we should at least be willing to acknowledge that there exists a set of people who are not like that. Why is this so hard?
If you think these graphs are reasonable, then we could think more generally about who would have been better off not existing. A simple way would just be to integrate the Q0L function from 0 until the time of death. If the value is positive, then it might be reasonable to conclude that they benefitted from living. And so on.
Aside: in case it is not obvious why it is important to talk about these things, it is my opinion that living things are often harmed by the ‘life is always good’ sacred value (see end of life care, for example). What about things like de-extinction? Or preventing extinction? I have heard people say that we need to keep some animals in cages to prevent their species from going extinct (the assumption is that preventing extinction is good for them). But is it? Is it possible that preventing their extinction (in the way that we do) harming them? If we do not have the conversation, I am not confident that we are getting the right answer.
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