Is death bad for the individual who dies? We’re inclined, I think, to answer that it is. Answering in the affirmative, however, raises another question: When is death bad for the one who dies? Put differently, when does death harm its subject?
This puzzle, expressed by the philosopher Epicurus in his Letter to Menoeceus, has become known as the ‘Timing Problem.’ We’ve come across Epicurus on PolicyWise before in Dr. Peter Koch’s entry on harm. Wherever one comes down on the nature of harm, though, one will need to confront the Timing Problem.
The Timing Problem arises for any account of the nature of harm when applied to death. In order to be plausible, an account of harm needs to do one of two things: it either must provide us with good reason to give up our intuitive judgment that death is harmful, or it must solve the puzzle by identifying how and when death counts as a harm.
Epicurus argues that there can’t be a time at which death is bad for someone. After all, the thought goes, something can’t be bad for you before it happens. If death is the end of an individual’s existence, there isn’t a subject around to be harmed once death occurs.
But the conclusion that death is not harmful diverges drastically from how we typically treat death in clinical and policy contexts. Epicurus would likely say that this is bad news for our practices, but we’d be well within our rights to point out that a conclusion so at odds with our practices needs to meet a very high bar of justification before we accept it.
As it happens, many philosophers aren’t convinced by Epicurus’s conclusion. According to one popular objection, it doesn’t address the fact that death deprives an individual of the good things he or she would have had in the future.
On this view, the badness of death for its subject is a so-called deprivation harm: it prevents he or she from obtaining further goods. It has been pointed out, though, that this strategy raises puzzles of its own. For one thing, it suggests the existence of posthumous harms: ones that accrue to an individual’s life after their death.
While posthumous harms may strike us as strange, their existence would justify some of our most deeply-valued practices regarding the wishes of the deceased. Appealing to posthumous harms and benefits can potentially make sense of our thinking on a wide range of matters, from funeral arrangements to organ donation.
This consideration isn’t decisive, however, because it could be that honoring the wishes of the deceased is a good thing to do without being good for the deceased. We’ll therefore need to leave the Timing Problem unsettled for now.
Fortunately, this puzzle is an entry point rather than an endpoint when it comes to reflection about death and its relevance to medicine. This is because the philosophical challenges of the Timing Problem have led to important breakthroughs about how we understand dying. Death is now widely recognized as the last step of a dying process, and the prior steps of this process are ones for which the relevant individual is around and capable of experiencing harm.
This is an insight with a great deal of clinical and policy relevance. Once we expand our focus to include the dying process as a whole, we confront crucial questions about what forms of medical treatment it involves, where it happens, and with whom it happens.
In clinical contexts, the event of death itself is often only one part of a longer story, and its place in the story suggests that we can get a grip on its full significance only by considering what comes before it.