Table Of ContentMORALITY, MORTALITY
VOLUME I
OXFORD ETHICS SERIES
Series Editor: Derek Parfit, All Souls College, Oxford
THE LIMITS OF MORALITY
Shelly Kagan
PERFECTIONISM
Thomas Hurka
INEQUALITY
Larry S. Temkin
MORALITY, MORTALITY, Volume I
Death and Whom to Save from It
F. M. Kamm
MORALITY, MORTALITY, Volume II
Rights, Duties, and Status
F. M. Kamm
MORALITY,
MORTALITY
VOLUME I
Death and Whom to
Save from It
F. M. Kamm
New York Oxford
OXFORD UNIVERSITY PRESS
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Copyright © 1993 by F. M. Kamm
First published in 1993 by Oxford University Press, Inc.
198 Madison Avenue, New York, New York 10016
First issued as an Oxford University Press paperback, 1998.
Oxford is a registered trademark of Oxford University Press
All rights reserved. No part of this publication may be reproduced,
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Library of Congress Cataloging-in-Publication Data
Kamm, Frances Myrna.
Morality, Mortality / F.M. Kamm.
p. cm. — (Oxford ethics series)
Contents: v. 1. Death and whom to save from it.
ISBN 0-19-507789-X; ISBN 0-19-511911-8 (pbk.)
1. Terminal care—Moral and ethical aspects. 2. Death.
I. Title. II. Series. R726.K35 1993
174'.24—dc20 92-9496
135798642
Printed in the United States of America
on acid-free paper
Preface
This book is concerned with death, with certain theoretical issues in the distribution
of scarce resources, and with the practical problem of the acquisition and distribu-
tion of organs for transplantation. Chapters 1 through 4 on death derive from
material written as far back as 1982, and an article "Why Is Death Bad and Worse
Than PreNatal Nonexistence," in Pacific Philosophical Quarterly, June 1988. On
various drafts, I received helpful comments from Thomas Nagel, Derek Parfit,
Raziel Abelson, and Lawrence Sager. The appendix on inclines and declines bene-
fited from presentation at the New Jersey Regional Philosophy Association meeting
in which I commented on work by Michael Slote. Chapters 5 through 7 developed
from an article, "Equal Treatment and Equal Chances," in Philosophy and Public
Affairs, Spring 1985. I was first prompted to write on the topic by Sharon Slovick
and have been the beneficiary of helpful discussions with Thomas Nagel, Derek
Parfit, John Taurek, William Wilcox, Lawrence Sager, Louis Kornhauser, and
David Wasserman. My views were presented at a New York Philosophy and Public
Affairs meeting, at a Central Division meeting of the American Philosophical Asso-
ciation, at Drew University, and at a meeting of the Society for Ethical and Legal
Philosophy. The audience discussions were very helpful. The material in chapters 8
to 10 derive from my article "The Choice between People, Commonsense Morality,
and Doctors," in Bioethics, Summer 1987. On these related topics I received
helpful comments from Derek Parfit, Shelly Kagan, Ronald Dworkin, Lawrence
Sager, and Louis Kornhauser. I also benefited from comments when the material
was presented at the Society for Ethical and Legal Philosophy, the Colloquium on
Law, Philosophy, and Social Theory at the New York University Law School in Fall
1989, and the Philosophy Department Colloquia of the University of California
(Berkeley) and the University of Chicago in 1991. The material in chapters 11
through 15 is related to my article "The Report of the U.S. Task Force on Organ
Transplantation: Criticisms and Alternatives" in The Mt. Sinai Journal of Medicine,
June 1989. I have received helpful comments from Derek Parfit, Thomas Scanlon,
Thomas Nagel, Louis Kornhauser, Drs. Linda Emmanuel and Joel Zinberg, and
Seana Shiffrin. I first discussed the issue of organ transplantation at the invitation of
Rosamund Rhodes at the Conference on Justice and Medicine, Mt. Sinai Medical
School in 1987, and am indebted to many people at Mt. Sinai, including Dr. Dan
Moros. I presented on the topic again at an Ethics Luncheon in the series organized
by Dr. Arthur Zitrin, New York University School of Medicine, at a Faculty Collo-
vice Preface
quium, New York University Law School (organized by Prof. Samuel Estreicher),
at the Ethics Colloquium Series, Harvard Medical School, at meetings of the Soci-
ety for Ethical and Legal Philosophy and the New York Society for Philosophy and
Public Affairs, at a working group of the Program in Ethics and the Professions at
Harvard University, in a DeCamp Lecture in Bioethics at Princeton University, at an
Ethics Grand Rounds at Harvard Medical School, at the University of Pittsburgh
Medical Center, and at a New York University Medical School Conference on
Transplantation. The comments of these audiences were very helpful, as were
conversations with Dr. Thomas Starzl and Richard Weil. I thank the editors of the
journals in which the articles appeared for permission to reprint sections.
My work on this book has been financially supported by a grant from the
American Council of Learned Societies, a New York University Presidential Fel-
lowship and Research Challenge Fund Grant, an American Association of Univer-
sity Women Fellowship, a Silver Fellowship in Law, Science and Technology at
Columbia University Law School, a Fellowship in Ethics and the Professions,
Harvard University, and a fellowship at the Center for Human Values, Princeton
University. Over the years, 1 have also benefited from the support of Dean Ann
Burton at New York University who provided funds for typing and other related
services. For all this help I am very grateful.
I am grateful to the typists who went through so many drafts, Nerssa Miller,
Marie Palumbo, Helen Snively, and Lynne Gay, to Leigh Cauman for her editorial
advice, and to Lynne Gay for help in creating the index. Stephanie Collings helped a
great deal with proofreading.
At Oxford University Press my greatest debts are to Angela Blackburn and the
editorial and production staff. They have been extraordinarily patient and helpful.
While writing the material in this book, I have received support and encourage-
ment from Mala Kamm, Samuel Kamm, Mara Alexander, Jane Cohen, Norman
Daniels, Jeffrey Gorden, and Janet Radcliffe Richards.
Most of the material in this volume developed post-Ph.D. thesis. As such it
could never have appeared in this form if Barbara Herman, Joshua Cohen, Baruch
Brody, Gerald Dworkin (when at M.I.T.), and various friends at the Columbia
University Department of Philosophy had not helped me in completing my Ph.D.
thesis at M.I.T. (This is a debt that should have been acknowledged in Creation and
Abortion, for that book had its origins in that thesis.)
Many of the topics in this book are also very much the product of my years at
New York University, its Department of Philosophy, its School of Law, and to some
degree, its School of Medicine. NYU and New York have been wonderful places in
which to work.
I am especially grateful to Thomas Nagel for his support and the example of his
intellect. On this project, in particular, my biggest debt over the years is to Derek
Parfit, for encouragement, discussion, and wonderfully detailed comments. (Even
he could not, however, save me from my many mistakes, which are my responsibil-
ity alone.) This book is dedicated to these two philosophers.
New York, New York F.M.K.
October 1992
Contents
Introduction, 3
I. DEATH: FROM BAD TO WORSE
1. Why Is Death Bad?, 13
2. The Asymmetry Problem: Death and Prenatal
Nonexistence, 25
3. Accounting for Asymmetry?, 39
4. Appropriate Attitudes toward Nonexistence, 56
Appendix: Inclines and Declines, 67
II. SAVING LIVES: GENERAL ISSUES
5. Is It Worse If More Die: Agent Relative or Non-Relative
Views?, 75
6. Is It Right to Save the Greater Number?, 99
7. Ideal Procedure, Nonideal Alternatives, and Proportional
Chances, 123
8. Are There Irrelevant Utilities?, 144
9. Sobjectivity: The Anatomy of the Subjective
and Objective in Moral Judgment, 165
10. Sobjectivity: Aggregation and Scales of Equivalents
and Cost, 180
viii Contents
III. SCARCE RESOURCES: THEORETICAL ISSUES, SPECIFIC
RECOMMENDATIONS, AND ORGAN TRANSPLANTS
11. Acquisition of Organs, 201
12. Distribution of Resources: Need and Outcome, 233
13. Distribution of Resources: Urgency and Outcome, 268
14. Distribution of Resources: Outcome, Waiting Time, and
Money, 284
15. Procedures for Distribution, 304
Bibliography, 331
Index, 335
MORALITY, MORTALITY
VOLUME I
