![Sample our Medicine, Dentistry, Nursing & Allied Health journals, sign in here to start your FREE access for 14 days]({"type":"image" , "src" : "/sda/5944/TOC-Subject-Sample-2021-Medicine-Dentistry-Nursing-Allied-Health.jpg"})
Notes
1 I directly quote the authors throughout this commentary in anticipation of the possible response to my comments, “That’s not what was meant” by the authors. I hope to show the negative impacts of the actual words the authors use, regardless of intention.
2 As best I can tell, the authors are referring to Griffin’s three accounts of well-being, which is not necessarily the same concept as that which is under consideration in the target article’s analysis (Griffin Citation1986, Chapters 3 and 4). Griffin ultimately appears to be arguing for a very specific account of well-being such that we have a benchmark for the purpose of comparing lives to one another, and states at one point that “using the wrong conception of well‐being distorts the problem of interpersonal comparisons” (Griffin Citation1986, 119; emphasis added), which is at the very least a question-begging statement. Of interest for the present discussion, in the same book the authors cite, Griffin states that “The right balance [of the elements of a good life] is very likely to vary from person to person. …the ideal life for one of us would not be ideal for another” (Griffin Citation1986, 58).
3 Griffin himself names at least five criteria in his “list of prudential values” which seem to vaguely align with the authors’ three criteria: accomplishment, the components of human existence, understanding, enjoyment, and deep personal relations (Griffin Citation1986, 67–68). However, later he names only four “normal human desires”: living autonomously, having deep personal relations, accomplishing something with their lives, and enjoying themselves (Griffin Citation1986, 114). So the authors’ sourcing of the three criteria remains elusive.
4 It is unclear how those goods are “objective” such that the authors chose these examples as fulfilling the requisite criteria; I would be very interested to see the exhaustive list of “objective” goods. The argument could also be made that these are instrumental goods, at best.
5 Amazingly, the authors never seem to try to understand what Mr. J’s values actually are, let alone if his treatment preferences align with them. I’ll note only in passing that one of the “basic human instincts” the authors think may be getting in the way of Mr. J’s understanding of the situation is his desire to “stave off or avoid death” (9) and as such is leading him to (in the authors’ view) irrationally want to keep living. I admit I can’t figure out why the desire to avoid death means that the corresponding desire to stay alive means the latter desire is rendered irrational.
6 The philosophical literature on this point goes back at least as far as Hume and Kant. More recently, in his discussion of the impossibility of truly understanding another’s experiences, Nagel states, “If the subjective character of experience is fully comprehensible only from one point of view, than any shift to greater objectivity—that is, less attachment to a specific viewpoint—does not take us nearer to the real nature of the phenomenon: it takes us farther away from it” (Nagel Citation1974). Or, to paraphrase Trout, humans have no trouble noticing that other species have cognitively-bound limits to their self-reflective capabilities, let alone an objective stance toward their own mental states. Why should human beings be so lucky as to be the only species that has unfettered, direct, and “objective” cognitive access to such insights and understandings? (Trout Citation2016)
7 One real-life example that comes to mind is our Orthodox Jewish patients, whose tradition states that breath—even breath created by machine dependency—is life, and removal of those machines such that it causes death to occur is impermissible by Jewish law. If a patient has lived their whole life in accordance with this authoritative law and the deep religious commitments underpinning it, made decisions about life support for family members in accordance with the same Jewish law and commitments, and has stated that they would find meaning and value the same existence for themselves, the authors seems to make the claim within the framework of this article that as soon as the patient loses capacity, all of the above moral history no longer matters anymore because the patient fails to meet the authors’ own criteria for “the good life” such life support can be withdrawn, and that family members protesting this choice are “simply wrong about whether [the patient’s] life is worth living” (5).