The Nature of Harm: A Wine-Dark Sea.

Abstract

In “Harmful Choices, the Case of C, and DecisionMaking Competence,” Pickering and colleagues advance an argument in favor of externalism, a view in which the competence of a decision maker is judged relative to factors external to their cognition (Pickering, Newton-Howes, and Young 2022). In advancing this argument, Pickering and colleagues focus on the external factor of harm: In their view, it is the harmfulness of a considered or chosen action that provides evidence against the competence of the decision maker. However, the proper identification of harmful choices and outcomes remains a demanding task, largely because our understanding of what harm is remains deeply incomplete. Despite 50 years of tempestuous debate, the metaphysics of harm remains an unsettled question. The existence of such a debate does not, in and of itself, provide evidence against the externalist position; rather, it is the theories of harm themselves that pose meaningful challenges for the externalist. Our purpose, here, is to illuminate these challenges. The canonical theories of harm can be divided into two opposing schools of thought: Comparitivism, in which facts about harm involve comparisons to past or potential states, and non-Comparitivism, in which facts about harm do not involve such comparisons. We begin by surveying these schools in turn, using the case of C to illustrate their judgments. The classical Comparitivist position, advanced by Joel Feinberg, centers on comparisons to counterfactuals: In Feinberg’s theory, one is harmed when one is made to be worse off than one otherwise would have been (Feinberg 1986). In the case of C, then, it is arguable that, following her refusal of dialysis, the worsening of C’s well-being constitutes a harm. A similar sort of analysis is offered by another Comparitivist position, advanced in Thomson (2011), which includes the consideration of prevention: by Thomson’s theory, C’s decision would constitute a harm to her insofar as it prevents her from being in a better state. The non-Comparitivist school, in contrast, rejects the relevance of such comparisons to determinations of harm. The classical non-Comparitivist view, advanced by Seana Shiffrin, holds that harm involves incongruency between one’s present state and what one wills (Shiffrin 1999). If you were to accidentally fall and break your arm, for example, Shiffrin’s theory holds that you are harmed insofar as you enter into a state that is incongruent with your will: You did not will to have your arm broken, and likely did will to do things that you now cannot. In the case of C, however, it was never in question that C willed to refuse dialysis and embrace the consequences thereof. She told the court that “they [the doctors] are doing their best ... and unfortunately that is not what I want,” and one of her family members told the court that C’s decision was “not only fully thought through, but also entirely in keeping with her value system and her personality” (Pickering, Newton-Howes, and Young 2022, 43). By Shiffrin’s theory, one is only harmed when one enters into a state that is incongruent with one’s will, entailing that a willed outcome cannot, by definition, constitute a harm to the decision maker. In the case of C, then, Shiffrin’s theory holds that C is not harmed by her decision, contrary to the judgment of Pickering and colleagues. A similar line of argument can be constructed using the non-Comparitivist theory briefly outlined by James Woodward: that harm to a person involves the violation of either a right possessed by that person or an obligation owed to that person (Woodward 1986). If