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Bioethics ISSN 0269-9702 (print); 1467-8519 (online) doi:10.1111/j.1467-8519.2009.01719.

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Volume 24 Number 9 2010 pp 481489

THE INSIGNIFICANCE OF PERSONAL IDENTITY FOR BIOETHICS biot_1719 481..489

DAVID SHOEMAKER

Keywords
personal identity, ABSTRACT
abortion, It has long been thought that certain key bioethical views depend heavily on
death, work in personal identity theory, regarding questions of either our essence
advance directives, or the conditions of our numerical identity across time. In this paper I argue
Don Marquis, to the contrary, that personal identity is actually not significant at all in this
David DeGrazia, arena. Specifically, I explore three topics where considerations of identity
Jeff McMahan are thought to be essential abortion, definition of death, and advance
directives and I show in each case that the significant work is being done
by a relation other than identity.

There has long been consensus that personal identity and to present such a case and an expression of skepticism
bioethics are importantly intertwined, in particular that about its prospects.
certain key bioethical positions depend heavily on the
truth of certain metaphysical accounts of identity. In
2003, David DeGrazia forcefully concluded an essay on THE NATURE OF THE PERSONAL
the topic in Philosophy & Public Affairs by saying, [W]e IDENTITY AT STAKE
cannot ignore personal identity theory in examining the
marginal cases [in bioethics]. . . .1 I think, to the con- Before beginning the main line of argumentation, I
trary, that we can for the most part, that personal identity need to take a moment to discuss the precise nature of
is far less significant to bioethics than is usually thought. personal identity at stake in the following claim, the one
To show this, Im going to examine arguments on three I will deny: considerations of personal identity are non-
main bioethical issues where personal identity has been derivatively significant for the bioethical issues of abortion,
thought to be non-derivatively important abortion, the definition of death, and advance directives. There are in
definition of death, and advance directives and argue general two closely related questions currently pursued in
that in each case it is something other than identity thats personal identity theory that are allegedly relevant here.
doing the relevant work. I leave open whether or not First, there is the question of what preserves our identity
there might be other examples of a bioethical argument across time. Second, there is the question of what our
plausibly depending non-derivatively on personal iden- essence actually is. Let me briefly discuss each.
tity, but one might think of this paper as both a challenge Regarding the first question, I will be exploring the
significance of criteria of diachronic numerical personal
identity to bioethics, criteria which identify the conditions
under which a person at one time is one and the same
being as some individual at a different time. Now up until
recently, criteria of personal identity were typically about
1
D. DeGrazia. Identity, Killing, and the Boundaries of Our Existence. what makes a person at one time identical to a person at
Philos Public Aff 2003; 31: 413442, p. 442. another time. But primarily because of the careful work

Address for correspondence: David W. Shoemaker, Bowling Green State University, Department of Philosophy, Bowling Green, OH 43403-0216.
Email: dshoema@bgsu.edu

2009 Blackwell Publishing Ltd., 9600 Garsington Road, Oxford OX4 2DQ, UK and 350 Main Street, Malden, MA 02148, USA.
482 David Shoemaker

of advocates of biological criteria of identity,2 the nature to be relevant to bioethics as well, but because discussion
of the debate has been transformed. One important con- of it would require a great deal of exposition and would
sideration here is that I was a newborn infant, it seems raise a host of other issues, I will set it aside here. Instead,
perhaps even a fetus but neither infants nor fetuses are I will focus simply on whether or not questions of our
persons, i.e. self-conscious entities with highly complex essence or our diachronic numerical identity have the
psychologies. But if I was indeed an infant, then person- significance for bioethics that has been claimed for them.
hood is a concept befitting me for only a phase of my life,
akin perhaps to adolescence, adulthood, fatherhood, and
the like. If so, then the boundaries of my identity may be
ABORTION
broader than the boundaries of my identity as a person, in
which case we should be more neutral in articulating the
Generally, there are two ways personal identity has been
general formula: instead of looking for conditions of
thought to be significant to the abortion debate. One is
person-to-person identity, we ought to be looking for
that it allegedly can provide support to a theory of moral
conditions of identity between a person at one time and
status. The other is that it allegedly can be used to distin-
an individual being at another, where of course such indi-
guish abortion from contraception. Let me begin with the
vidual beings might well be persons (or not).
first sort of move.
Personal identity may be something of a misnomer,
Those engaged in this project tend to favor a moderate
then, if it is taken to be about the conditions for the
to liberal pro-choice conclusion, one that actually likens
preservation of identity across time for all and only
early abortion to contraception. Jeff McMahan, for
persons. Indeed, the identity conditions for individuals
example, ostensibly rests part of his view of moral status
like us is now the most favored target of identity theo-
on his Embodied Mind account of personal identity,
rists, and such identity is typically taken to be a function
according to which you and I, who are essentially embod-
of our essence, which is the second relevant element of
ied minds, dont begin to exist until the organisms we
personal identity theory for our purposes. That is, a
inherit develop the capacity for consciousness, and from
determination of the essence of an individual like you and
that point on what preserves our identity is the continued
me will determine what the persistence conditions actu-
existence and functioning, in non-branching form, of
ally are for such entities. If, for example, you and I are
enough of the same brain to be capable of generating
essentially biological creatures, then our identity across
consciousness or mental activity.5 Now you and I, of
time will consist in continuity of that biological essence.
course, have significant moral status. An early fetus could
Similarly, if we are essentially psychological creatures
never be someone like you or me because an entity thats
(persons?), then our diachronic identity will consist in
essentially minded like we are is always minded and the
psychological continuity. As a result, questions of essence
early fetus lacks the physical substrate supporting the
have, for most personal identity theorists, become a
capacity for being minded. This, McMahan suggests,
crucial component of investigations into the nature of
implies that an early fetus lacks the special moral status
diachronic numerical identity. As DeGrazia notes, a
you and I have sufficient to make it seriously wrong to
prominent question in personal identity theory has
kill it.6 It is, in his terminology, a something rather than
become What are we human persons, most fundamen-
a someone. As a result:
tally: persons, human animals, or something else?3
There is one type of personal identity I will not be An early abortion does not kill anyone; it merely pre-
discussing, namely, the recently developed and deployed vents someone from coming into existence. In this
conception of narrative identity.4 On this view, various respect, it is relevantly like contraception and wholly
experiences and actions are gathered together into the life unlike the killing of a person. For there is, again, no
of one person via their being part of a coherent self-told one there to be killed.7
story about ones life. This sort of identity has been taken
Nevertheless, the fact that some entity has a different
2
essence from one of us and so could never be numeri-
For a very good example, see: Eric Olson. 1997. The Human Animal.
cally identical with one of us means neither that it has a
Oxford: Oxford University Press.
3
DeGrazia, op. cit. note 1, p. 414. different moral status from us nor that, if it does, its
4
For sustained development and discussion of the notion of narrative
5
identity, see: M. Schechtman. 1996. The Constitution of Selves. Ithaca, J. McMahan. 2002. The Ethics of Killing. Oxford: Oxford University
NY: Cornell University Press. For an application of narrative identity Press: 68.
6
to bioethical concerns, see: D. DeGrazia. 2005. Human Identity and Ibid: 269.
7
Bioethics. Cambridge: Cambridge University Press. Ibid: 267.

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The Insignificance of Personal Identity for Bioethics 483

different moral status is a function of that different This point is brought out more clearly in McMahans
essence. Now McMahan openly admits the first point, treatment of later-term abortions, the killing of more
noting that the conclusion about the early-stage fetus developed fetuses that are one of us, having passed the
having a different moral status also depends both on its point at which their organisms capacity for conscious-
not having a special sanctity that otherwise comparable ness has been activated. One might think that once one of
nonhuman organisms lack and on its not having the us has been brought into existence it will have the same
relevant sort of potential to become a person.8 Suppose, moral status as the rest of us, but this isnt yet the case for
though, that his later independent arguments succeed in McMahan. Rather, you and I have the high moral status
eliminating both exceptions. This result, then, might we enjoy because we are persons entities with the capac-
suggest that an appeal to our essence could at least do ity for self-consciousness and so deserve respect.10 But
some non-negligible work in supporting a theory of there are entities that, while individuals like us in virtue of
moral status, for such an appeal reveals a clear-cut foun- a common essence, are not persons, and so lack our high
dational difference between us and early fetuses what moral status; they are in fact governed solely by a differ-
seems an analogous difference between us and a sperm or ent account of the morality of killing.11 Any moral status
ovum and so, with buttressing by the non-sanctity and they have determining the seriousness of the wrongness
non-potential-persons arguments, such a point looks of killing them depends entirely on their time-relative
morally significant. interest in continuing to live, itself a function of the value
Now of course it should be obvious that metaphysical of their future and their expected psychological unity with
status implies nothing on its own about moral status the embodied mind that will undergo that future good.
this is a very old point and one that Im not interested in But because they lack the ability to anticipate, contem-
rehashing here. Indeed, all that McMahan needs here to plate, and form intentions about their future good, their
bridge the is/ought gap is the principle he is probably psychological unity with that future self is extremely
assuming, namely, if an entity lacks our essence (an weak, and so their time-relative interest in continuing to
embodied mind), it lacks our moral status (assuming also live is itself weak, rendering the wrongness of killing them
that it has no independent moral status in virtue of its far less serious than the wrongness of killing persons like
sanctity or potential personhood). But if this is the rel- you and me.12
evant bridge principle, it raises my second question So what role do the conditions of our essence and/or
above, namely, why should we think that moral status is our numerical identity play here? As it turns out, having
a function of essence? As it turns out, McMahan cant an embodied mind being a someone who meets the
really believe that it is. His focus is actually on the source conditions for personal identity across time isnt what
of interests in a creature, for they, absent actual person- does any of the work to generate moral status in the arena
hood, are what determine the moral wrongness of killing of abortion. For one thing, as we have just seen, being an
or harming it.9 But then what fundamentally matters is embodied mind isnt what generates full moral status; for
whether or not a creature has interests, not whether or that, one needs to be a person, an entity deserving of
not it shares our essence. As it turns out, of course, any- respect. For another, as we saw earlier, being an embod-
thing with an embodied mind has interests, but this is ied mind isnt even what generates partial moral status,
only a contingent matter: its possible for there to be which is generated instead merely by the having of inter-
disembodied minds with interests, or embodied minds ests. Furthermore, the degree to which ones interests
without interests. But presumably, were either to be the determine ones moral status depends on ones psycho-
case, McMahans moral radar would surely continue to logical unity with some future beneficiary of value, but
track those creatures with interests, the fact that they did psychological unity just isnt numerical identity.
or didnt have an embodied mind rendered irrelevant. As Now McMahan explicitly assumes that identity should
a result, even though its contingently true that all and coincide as closely as possible with our sense of what
only those creatures with embodied minds have interests, matters,13 but he also claims that the degree of warranted
what matters for morality is the interests part, not the egoistic concern for ones future (part of what matters)
embodied minds part. What our essential nature consists may rationally vary in accordance with the degree to
in is thus only derivatively significant here, significant which one will be psychologically unified with that future
only in virtue of the contingent fact that it delivers the 10
Ibid: 275276.
interests that are of genuine moral significance. 11
Thus McMahan calls his view a Two-Tiered Account of the morality
of killing. See ibid: 245265.
8 12
Ibid: 269. See, e.g. ibid: 275276.
9 13
See, e.g. ibid: 245265. Ibid: 54.

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484 David Shoemaker

self. So, insofar as the degree of ones prudential concern beneficiary self. But the complete lack of psychological
(partially) determines ones time-relative interests and unity between the early fetus and later minded being
insofar as the degree of said concern may diverge widely requires a very heavy discounting of the value of its future
from ones numerical identity (which admits of no in considering the fetuss stake in continuing life,19 and so
degrees), what determines ones moral status with respect the fetuss interest in staying alive could be outweighed by
to later-term abortions namely, ones time-relative virtually any conflicting interest of the mother (or anyone
interests does so independently of ones numerical else, I suppose). Assuming no other relevant impersonal
identity. considerations, then, early abortion looks to be justified
David DeGrazia explicitly rejects the idea that what with ease.
matters presumably, what grounds egoistic concern is The question under consideration is what identity has
numerical identity.14 This is because his essentialist- to do with the argument or verdict here, and the answer is
grounded criterion of numerical identity is biological: the obviously none. The only real disagreement between
essence of individuals like you and me is our animal DeGrazia and McMahan is over whether or not the early
nature, our biological life, such that X (a person) at one fetus is an individual like us: DeGrazia says it is;
time is one and the same as any Y at another time just in McMahan says it isnt. But in neither case does this turn
case Xs biological life is Ys biological life.15 But one can out to be relevant for their arguments justifying abortion.
easily see that a criterion like this will have a poor fit with Instead, what is relevant (and is the only relevant thing
our practical concerns, which more or less track psycho- for DeGrazia) is the relation that matters for prudential
logical relations (as he essentially admits).16 For instance, concern, namely, psychological unity, which is neither a
special self-concern (a present-future relation) and numerical identity relation itself nor a tracker of the
moral responsibility (a present-past relation) are surely numerical identity relation for either party.
grounded in psychological relations of some sort, not bio- Nevertheless, DeGrazia insists that personal identity
ethical ones, so while biological continuity is perhaps theory can illuminate the marginal cases and the connec-
necessary to sustain them, it isnt the sort of thing that tions between them,20 but it turns out that what he means
can make sense of them.17 As a result, DeGrazia appeals by this is that [a] plausible theory of what matters in
to the notion of narrative identity to ground some bioet- survival a part of personal identity theory, broadly con-
hical matters, an account of the different sense of iden- strued proves very important.21 So while questions of
tity I am setting aside here. essence or numerical identity themselves may not turn
Nevertheless, he does claim to make use of the biologi- out to be (non-derivatively) important for bioethical con-
cal criterion of numerical identity in the abortion case. In cerns, what matters in identity may, and if thats the case,
his view, unlike McMahans, the early fetus is in fact an then we can still say that personal identity theory is
individual-like-us, for its essence its biological organism important for bioethics.22
is in existence and individuated roughly two weeks after This is far too broad a construal of personal identity
conception (once the possibility of twinning is gone). In theory, though. Suppose one were to follow Parfit (and
this respect, he agrees with one of the constituent parts of his reasoning) in abandoning identity as what matters in
Don Marquis famous future like ours account of the survival.23 When investigating certain questions of pru-
wrongness of killing, or FLOA.18 Yet DeGrazia tries to dential rationality and morality, then, one might focus
deny Marquis conclusion that if a fetus has a valuable solely on the psychological relations of connectedness
future like ours then it has an equal interest to ours in and continuity that hold (or dont) intrapersonally as
not being deprived of it by adopting a version of grounding the relevant practical reasons. A Parfitian
McMahans time-relative interests account. He argues might take this to be the correct strategy, regardless of the
that what matters for determining the moral permissibil-
ity of depriving someone of his or her future is that 19
DeGrazia, op. cit. note 1, e.g. p. 433; emphasis in the original.
entitys time-relative interest in staying alive, itself deter- 20
Ibid: 416.
mined by that entitys psychological unity with its future, 21
Ibid: emphasis mine.
22
Indeed, DeGrazia claims that personal identity theory is generally the
14
DeGrazia, op. cit. note 1, e.g. p. 425. investigation of three things: (a) the conditions for our persistence
15
Ibid: 421422. across time, (b) the conditions of our essence, and (c) what matters in
16
See ibid., pp. 425426. For a more hedged view, see DeGrazia, op. cit. survival. (See: DeGrazia, op. cit. note 1, pp. 414415.) In what follows,
note 4, pp. 6065. See also Olson, op. cit. note 2, pp. 7072. I question the inclusion of (c) as a proper part of personal identity
17
See my: Personal Identity and Practical Concerns. Mind 2007; 116: theory.
23
317357, especially p. 322. Derek Parfit. 1984. Reasons and Persons. Oxford: Oxford University
18
Don Marquis. Why Abortion is Immoral. J Philos 1989; 86: 183202. Press: 253266.

2009 Blackwell Publishing Ltd.


The Insignificance of Personal Identity for Bioethics 485

truth of any particular theory of personal identity. immoral.27 He does so by essentially reiterating his origi-
Indeed, Parfit himself is agnostic about whether or not a nally stated view distinguishing contraception from abor-
psychological criterion or a version of the physical crite- tion. In abortion, whats deprived is the fetuss valuable
rion of personal identity is true.24 But if the true theory of future-like-ours, and thats what makes it wrong. One
identity is just irrelevant to our practical concerns, one might then worry that the valuable future of the sperm
might think there was no real point in figuring out which and/or unfertilized ovum would be deprived in contracep-
one is true. Yet if one takes that attitude into a study of tion too, making it also prima facie wrong, a result that
what matters in egoistic concern with respect to bioethi- would, Marquis insists, constitute a reductio of his view.
cal questions, say, how can one claim that what one is But he claims instead that the two cases are quite differ-
doing has anything at all to do with the study of personal ent, insofar as what makes killing someone (an adult
identity theory anymore? Nevertheless, this is essentially human or a fetus) wrong is the loss to the victim of her
what McMahan and DeGrazia are doing: the relation future life.28 But a necessary condition of this being so is
that matters for both psychological unity neither is that the future life that is lost would have been the actual
nor tracks their favored numerical identity relations, in life of the same individual who dies prematurely. . . .29
which case it becomes very difficult to see how putting all Killing the sperm or unfertilized ovum that were my pre-
the ethical weight on that (non-identity) relation actually cursors, then, could have constituted a loss to them only if
fits into an account of personal identity theory at all. One they would have been numerically identical with me. But
could easily just come to place ethical weight on the rela- neither could have been me insofar as that would have
tion of psychological unity utterly independently of any made them (by transitivity) numerically identical with
investigation at all into the nature of personal identity, in each other, which they obviously were not. As a result,
which case one would openly be doing what McMahan neither could have been deprived of the valuable future
and DeGrazia are more obliquely doing, namely straight- that is my life had my parents engaged in contraception at
forward ethical theory.25 the time I was conceived.30
Turn now to the second general way in which personal Here is an argument that seems on its face to get real
identity has been thought to be important to the abortion ethical mileage out of a metaphysical view of personal
debate, namely, as a way to distinguish abortion from identity, specifically, any view of identity that renders
contraception. Recall that DeGrazia denies Marquiss early fetuses one and the same individuals with the adult
anti-abortion conclusion in part by taking ethical weight human beings into which they grow. Such a view of iden-
off the biological criterion of personal identity. If we want tity is readily available, either by drawing from the sort of
to see whether or not a moral conclusion about abortion biological criterion DeGrazia defends, of course, or by
can rest on a theory of personal identity, therefore, we drawing from a soul criterion, according to which the
should see what happens if we try to put the weight back early fetus and later adult are one and the same individual
on something like a biological criterion by returning to because they possess one and the same soul.
Marquis. Nevertheless, despite appearances, Marquis ethical
In his reply to Earl Conees argument that there is no view just isnt non-derivatively dependent on conclusions
metaphysical support for a moral conclusion about abor- about numerical identity. To see why, note that what
tion,26 Marquis tries to show precisely where metaphys- makes killing the fetus wrong is that doing so deprives it
ics, and in particular personal identity theory, supports of its own valuable future. Marquis then takes a fetuss
his famous verdict that abortion is seriously prima facie ownership of a valuable future to entail the numerical
identity of the fetus with the individual who would oth-
erwise have lived through that future. But there is no such
24
Ibid: x (note added in 1985); 208209 and elsewhere. entailment between ownership and numerical identity.31
25
Another way to think about this point: what matters in survival, in For instance, ownership proper attributability doesnt
identity across time, may be very different from what matters in egoistic
necessarily obtain uniquely, as must identity. To say that
concern. So what matters in preserving what we ordinarily think of as
survival might be some biological relation, whereas what matters for
some X is mine, in other words, doesnt mean that X is
purposes of anticipation and self-concern might well be some psycho-
27
logical relation. One might, then, easily adopt the latter view indepen- Don Marquis. Does Metaphysics Have Implications for the Morality
dently of any investigation whatsoever into the nature of identity, and if of Abortion? Southwest Philosophy Review 2002; 18: 7378.
28
so it would be clear that one was engaged squarely in ethical theorizing. Ibid: 7778.
29
My point here is that this is essentially what DeGrazia and McMahan Ibid: 78; emphasis in original.
30
are doing. Ibid.
26 31
Metaphysics and the Morality of Abortion. Mind 1999; 108: 619 Ive argued for this point in Responsibility Without Identity,
646, p. 644. unpublished manuscript.

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486 David Shoemaker

mine exclusively. Just as one may jointly own property identity would still have only derivative importance to
with another, so too one may jointly own a valuable Marquis argument carrying weight only in virtue of its
future with another. This may be so in cases of marriage, delivering the ownership relation not the nonderivative
business partnerships, team sporting ventures, and so on, importance he assumes it to have.
where one enters into a relationship with other individu-
als, together creating and constituting a joint entity to
which various valuable things accrue, e.g. tax deductions, DEATH
profits, victories, and so on.32
The reason the ownership relation may obtain inde- Turn now briefly to the other end of life. What might
pendently of the numerical identity relation is the fact seem to be a purely conceptual matter determining the
that their relata are just different. What Marquis wants is definition of death is actually motivated by some major
an account of what makes some valuable future mine, but bioethical concerns. Probably the most pressing is the
that simply consists in a relation between me-now and question of when it is morally permissible to remove
some set of future experiences, say, not a relation between organs from someone for transplantation. The answer
me-now and some future experiencer. This difference often given to this question is only when the patient is
leaves room for the possibility of some valuable future dead. What does it mean, though, for a patient to be
being mine, where my relation to the future experiencer dead? The fresher organs are, the more viable they are for
is non-unique. To take a Parfitian science-fiction case, transplant, so we may have pragmatic reasons to under-
suppose I were to be fused with you tomorrow.33 Depend- stand death as ending the life of persons, that is, of psy-
ing on the details of the case (including the psychological chological creatures. But if thats the case, then what are
make-up of the resultant fused person), the future of we to say about the human organisms surviving the
the two-days-from-now person might truly be said to be persons who had inhabited them? Isnt what ends their
mine, or at least partially mine, pre-fusion, despite the lives the true death? Or are there perhaps multiple con-
fact that either I am not numerically identical with cepts of death in play?
the fused person or the identity of that person is I am going to focus on three different definitions of
indeterminate.34 death, each one alleged to depend squarely on a differ-
Consequently, if ownership is the relation that matters ent theory of personal identity. As we will see, none of
morally, and ownership doesnt entail numerical identity, them clearly do.
then theres no reason in principle why a sperm and an The first is Green and Wiklers famous ontological
unfertilized ovum couldnt jointly own a valuable future, defense of brain death irreversible cessation of brain
regardless of their individual lack of numerical identity function as constituting the proper understanding of
with that future experiencer, in which case the alleged death.36 They base this view on a psychological criterion
disanalogy between contraception and abortion is lost.35 of the identity of persons, a criterion they think is favored
Marquis moral conclusion directly rests, not on a view of by our intuitions in body-switching thought experiments.
numerical identity, but on a theory of ownership-of- Consequently, in order for Jones, a patient, to be alive,
future-experiences, a theory that remains to be worked then the patient must be alive and the patient must be
out. And even if it turns out that ownership of this Jones, and given that Jones is essentially a being with
sort does (contingently) depend on numerical identity, psychological properties whose identity over time is pre-
served by psychological continuity and connectedness,
32
See, e.g. Bennett Helms excellent Plural Agents. Nous 2008; 42: the irreversible loss of this psychological capacity via irre-
1749. versible loss of brain function signifies the cessation of
33
Parfit, op. cit. note 23, discusses various fusion cases on pp. 298299.
34 that persons existence, which of course means that
This would be metaphysical indeterminacy, not epistemological inde-
terminacy: its not that we just wouldnt know (or would have no way of Jones is dead.37
knowing) the identity of the fused person; rather, its that there would
36
just be no facts of the matter regarding whether or not this person would M.B. Green & D. Wikler. Brain Death and Personal Identity. Philos
be me, you, or someone else. Public Aff 1980; 9: 105133.
35 37
My own thought is that theres no difference between the early fetus Ibid. See p. 118 for the of course comment. Does this result mean,
and the sperm/ovum case with respect to ownership of a valuable future, then, that Jones organs are fair game? Not necessarily, for its possible
but instead of both having such a future, neither do. This is because, for that Jones has turned into Smith (through some radical psychological
one thing, I suspect a proper account of ownership would require discontinuity), yet it wouldnt thus be permissible to harvest Smiths
owners to possess some basic sort of psychological capacities, which organs (insofar as hes still alive). But this is just to say that, while the
these entities altogether lack. But Im not prepared to defend such a motivation for investigation into the definition of death has been the
view here. concern over the timing of organ harvesting, its not at all the case that

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The Insignificance of Personal Identity for Bioethics 487

The second and third accounts of death come from, far from obvious. A powerful reason to doubt it comes
respectively, DeGrazia and McMahan. Both are alleged from consideration of fission cases, of both the non-
to be grounded in their essentialist views about identity. fiction and science fiction varieties. When one amoeba
DeGrazia insists that you and I are essentially living splits into two, it seems the original ceases to exist
human animals, biological organisms, so that our ceasing without dying.43 This is also true of the embryo that twins
to exist just consists in the deaths of our organisms, and the sci-fi person who enters the fission machine. In
and he thinks the most plausible account of organismic such cases, there is no Y at the time of the split, twinning,
death is the circulatory-respiratory standard, according or fission with whom the original X is identical, precisely
to which human death is the permanent cessation of because uniqueness, an essential constituent of numerical
circulatory-respiratory function.38 identity, has been lost. Nevertheless, it seems bizarre to
By contrast, while McMahan does agree that a human say that X died at that point, that fission killed him, given
organism dies when it irreversibly loses the capacity for that everything else involved in ordinary survival remains
integrated functioning among its various major organs completely intact.44
and subsystems,39 this wont be what my death consists This is an important point, for it makes clear that
in, because Im not an organism; rather, Im essentially an preservation of ones essence can at most be one neces-
embodied mind, so I cease to exist that is, I die40 when sary condition for the preservation of ones numerical
the capacity for consciousness is irreversibly lost, and this identity. The inclusion of uniqueness as another neces-
happens as a result of loss of function in the higher brain, sary condition, however, reveals the conceptual gap
or cerebral death.41 This leaves us with two concepts of between ceasing to exist and dying: one may cease to exist
death, one for the death of organisms, the other for the where either uniqueness or ones essence is lost, whereas
death of persons. But given the practical concerns related dying has nothing to do with the loss of uniqueness at all.
to our interest in the nature of death regarding the If theres such a gap, then, its difficult to see what rel-
morality of organ transplants, life-prolonging treatments, evance appeals to either our essence or our numerical
and so forth the concept that matters is cerebral death, identity could have in this arena.
the death of persons like you and me.42 There may be objections, though, to the use of the
My worry about each of these three definitions has to fission case to block premise 3. For instance, one might
do with the relation that each theorist assumes holds insist that whats really at stake in considerations of
between numerical identity, ceasing to exist, and death. fission are the normative evaluations typically attached to
The general reasoning advanced by each view goes as death, and not the conceptual issue of prizing apart
follows (with each specific variation in brackets): ceasing to exist from death. In other words, we might
think that our concept of death has been shaped by con-
1. X exists only insofar as Xs numerical identity is
sidering ordinary cases of death, which are typically bad
preserved across time, i.e. X at t1 ceases to exist at or
for the dyer. As a result, we have closely associated
by t2 just in case there is no Y at t2 with whom X is
badness with death. Perhaps, though, the lesson of the
numerically identical.
fission case is that we were wrong to do so: some deaths
2. What preserves the identity of some individual across
(e.g. deaths by fission) may not be so bad at all. Indeed,
time is preservation of that individuals essence {psy-
the primary deployer of the fission case, Derek Parfit,
chological continuity, mind, biological organism}.
himself calls fission a way of dying.45 So it might well be,
3. If X ceases to exist, X dies.
then, that ceasing to exist, which is still dying, just isnt as
4. Thus, if Xs essence {psychological continuity, mind,
bad as we have long thought, that whats prized apart
biological organism} is not preserved, X dies.
is the concept of cessation-of-existence/death from its
This is the sort of argument many have thought ensures longstanding normative associations. Ceasing to exist/
the relevance of personal identity to the concept of death, death, on this view, may be about as good as ordinary
but this conclusion is unwarranted because premise 3 is survival.46
This is an interesting possibility. Our task, then, is to
a determination of the definition of death will settle the ethical issues at see whether or not there really are such normative
stake (nor do the advocates of this methodology believe it will).
38 43
DeGrazia, op. cit. note 4, p. 149; emphasis in original. Strangely, McMahan admits as much (see op. cit. note 5, pp. 27 and
39
Jeff McMahan. An Alternative to Brain Death. J Law Med Ethics 425), but he doesnt appreciate the force of the admission against his
2006 (Spring): 4448, p. 47. view.
40 44
Ibid. McMahan explicitly uses the phrases die and cease to exist Obviously, this argument draws on Parfit, op. cit. note 23, pp. 253
interchangeably 263.
41 45
Ibid: 4748. See also McMahan, op. cit. note 5, pp. 423426. Ibid: 264.
42 46
McMahan, op. cit. note 39, p. 48. Ibid.

2009 Blackwell Publishing Ltd.


488 David Shoemaker

associations with the concept of death. True enough, we conceptual gap at issue. Ceasing to exist doesnt entail
typically think the death of a person is bad for that dying, and unless thats the case it seems that whats
person. But this isnt the case with non-persons generally, relevant for the definition of death remains independent
where it seems the same concept of death is operative. of considerations of personal identity.50
Consider again the amoeba that splits. We dont typically
think death is bad for amoebas, yet it still seems strange
to say that the amoeba dies when it fissions out of exist-
ence.47 Perhaps similarly, suppose a human being in a ADVANCE DIRECTIVES
permanent vegetative state (PVS) were fissioned. Once
more, it seems bizarre to say that she has died, even The basic methodology should be clear by now, so my
though she has ceased to exist. What this suggests, then, treatment of the final issue will be brief. It is the case of
is that when we remove the typical normative associa- advance directives preceding severe dementia. The rel-
tions from death, we still get a substantive result from the evant question is usually thought to be, Is the pre-
fission case, namely, there does seem to be genuine con- demented signer of the directive numerically the same
ceptual gap between ceasing to exist and dying.48 individual as the later demented patient (someone who is
A different sort of objection would be to insist that, in by definition a non-person, lets say)? This is particularly
the real world at least, fission (of full-fledged human a problem in the case in which the younger signer (YS)
beings, anyway) just doesnt occur, so we can safely set directs treatment (or non-treatment) that the contented
such considerations aside and assume that cessation of demented patient (DP) claims not to want. Our strong
existence in all ordinary cases equals death. But this reply intuition is that YSs directive is authoritative over the
misses the point, for the bioethical debate about death is wishes of DP. Call this the Intuition. Identity-based argu-
a conceptual debate, an exchange about the proper defi- ments on the topic typically go as follows:
nition of death, and theres no reason at all to think the 1. YSs preferences are authoritative over DPs if and
relevance or application of our conceptual intuitions only if YS is numerically identical to DP.
must be restricted to the everyday or the likely (water 2. YS [is/is not] numerically identical to DP.
and XYZ, anyone?). 3. Thus, YSs preferences [are/are not] authoritative
One might, finally, still resist the conclusion by point- over DPs.
ing to the obvious fact that, if a living X ceases to exist,
then X is clearly no longer alive. One might then think it Start with the negative version of premise 2, something
naturally follows that (a) if X is no longer alive, X must a person-essentialist or psychological continuity theorist
be dead, and (b) if X is dead, then X must have died.49 But would likely maintain.51 This view yields what DeGrazia
the first inference doesnt necessarily follow. Suppose you calls the someone else problem.52 Here, notice that one
magically popped out of existence. It would no longer be can still deny the conclusion that YSs preferences arent
true of you that you are alive, certainly enough, but it authoritative, and thus rescue the Intuition, by denying
would also not necessarily be true of you that you are premise 1s assertion that numerical identity is necessary
dead: you would more likely be, it seems, neither. In any for authority, and indeed this is what many have done.
event, its an open question whether or not you would be One way to do this is by appealing to surviving interests,
dead, and to admit as much where it would also not be an
50
open question that you had ceased to exist reveals the There are other possible objections I dont have the space to canvass
here. One might be to draw from Lynn Rudder Bakers work to insist
that uniqueness and essence cannot come apart in fission, that the
47
Thanks to an anonymous referee for raising both the normative pre-fission persons unique first-person perspective will survive into one
associations worry as well as the amoeba reply. of the fission products or into neither (but not into both). (See Persons
48
One might think the response here, relying as it does on consider- and Bodies: A Constitution View (Cambridge: Cambridge University
ations of death to non-persons, leaves McMahan at least with a version Press, 2000). There is much theoretical machinery involved in this view
of the normative associations objection intact, for he wants to ground that would take a great deal of time to discuss and dissect, however, so
the definition of death for persons on personal identity theory. Never- I will set it aside here.
51
theless, insofar as the default view of death is surely that it is a unified See, e.g. Rebecca Dresser. Life, Death, and Incompetent Patients:
concept (applying equally to all entities capable of dying), and insofar as Conceptual Infirmities and Hidden Values in the Law. Arizona Law
a conceptual gap between ceasing to exist and dying is revealed when Review 1986; 28: 379381; and Rebecca Dresser. 1989. Advance Direc-
considering non-persons in fission cases, the burden of proof is squarely tives, Self-Determination, and Personal Identity. In Advance Directives
on McMahan to show why the normative associations argument alto- in Medicine. C. Hacker, R. Moseley & D. Vawter, eds. New York:
gether prevents any conceptual gap in the person-based fission case as Praeger.
52
well. See: D. DeGrazia. Advance Directives, Dementia, and the Someone
49
An assumption David Hershenov deploys in The Death of a Person. Else Problem. Bioethics 1999; 13: 373391; DeGrazia, op. cit. note 1,
J Med Phil 2006; 3: 107120. pp. 440441; and DeGrazia, op. cit. note 4, pp. 164167.

2009 Blackwell Publishing Ltd.


The Insignificance of Personal Identity for Bioethics 489

interests people have regarding certain states of affairs This point is made quite clear once we realize that some
whose (dis)satisfaction depends on what happens after authors actually counsel abandoning the Intuition itself,
they cease to exist.53 Another way is by appeal to substi- arguing instead that YSs preferences arent authoritative
tuted judgment, which depends on close family members over DPs, given that DP may still have an important sort
or loved ones to determine what treatment the formerly of autonomy.57 On this view, identity is explicitly irrel-
competent patient would have wanted (where the evant to a determination of the bindingness of the
advance directive counts as authoritative evidence for advance directive.
that). But in either case, the loss of identity is irrelevant to The debate isnt over identity, then, but rather over the
the preservation of the Intuition. nature of preferential authority directly, over what it is
On the other hand, one might claim to preserve the that renders some preferences authoritative when in
Intuition by embracing the positive version of premise 2, tension with others. Depending on what that consists in,
something a mind-essentialist or biological continuity then, YSs directive may be authoritative for DP regard-
theorist would likely do. This would allegedly render less of their (non-)identity. And alternatively, her direc-
YSs preferences authoritative over DPs. But for those tive may not be authoritative for DP, regardless of their
who adopt this option (e.g. McMahan and DeGrazia), (non-)identity. But in either case, numerical identity
the problem now is to figure out why this one and the simply isnt doing the relevant work. Whether numerical
same individuals earlier preferences are to be respected identity is in fact relevant for some other issues in bioet-
over her current preferences, when this is the opposite of hics, or whether theres some other sense of identity that
ordinary practice in other arenas. There are various is relevant to these issues instead, that will have to be a
replies here, having to do with how to place precedent discussion for another day.
autonomy into the hands of YS. McMahan appeals to the
time-relative interest account again.54 DeGrazia appeals
to considerations of narrative identity as a way to show Acknowledgements
how DPs experiences may or may not be unified into
My thanks to Douglas Portmore and Steven Wall for insightful remarks
YSs life in terms of what matters.55 But neither view on an early draft of this paper, and my thanks to David Hershenov,
depends on numerical identity to preserve the Intuition, John Lizza, Marya Schechtman and Mary Anne Warren for their
precisely because doing so depends on a particular insightful remarks on a later draft of this paper at a special session on
account of what makes certain preferences authoritative Persons, Human Organisms, and Bioethics at the 2008 Pacific APA
(organized by John Lizza). Im also grateful to the audience members at
over others, and identity seems to be neither here nor
my presentation of this paper at the 2008 Rocky Mountain Ethics
there with respect to that.56 Conference. Thanks also to a formerly anonymous referee at Bioethics
who I subsequently found out was Tim Campbell for his ex-
53
See, e.g. Allen Buchanan. Advance Directives and the Personal Iden- tremely careful and helpful remarks. Im grateful to the APA Newsletter
tity Problem. Philos Public Aff 1988; 17: 277302. on Philosophy and Medicine for permission in using here some of my
54
McMahan, op. cit. note 5, pp. 496503. arguments from Whats Identity Got To Do With It? (Fall 2008).
55
DeGrazia, op. cit. note 1, pp. 441442; op cit. note 4, pp. 173186. Finally, Im grateful to Bonnie Steinbock, whose support and advocacy
56
Two points are relevant here. First, Steven Wall has suggested a for this paper went above and beyond.
possible account of advance directives in which YS binds herself via the
directive, such that no matter what she might think or feel when David Shoemaker is Chair of the Department of Philosophy at Bowling
demented, her earlier wishes are to be authoritative. On such an Green State University. He has published several articles and a book on
account, it seems as if numerical identity might do some real work: what how considerations of personal identity might bear on ethics (or vice
renders the later self subject to the directive is precisely her numerical versa), and his current research is on the relation(s) between moral
identity with the earlier, binding self. I dont want to rule out the responsibility, intellectual disability, and the self.
possibility of such an account, but I havent seen one like it developed
before, so Ill remain agnostic until I can assess the details. (One initial
worry is that we let ourselves off the hook sometimes in such self- that appeals to identity are far less significant to bioethics than have
binding arrangements, so it would be unclear whether or not (a) there often been thought, and in particular they do little to none of the heavy
would be legitimate instances of letting off the hook in cases of lifting in these arguments, which is actually done by other relations. In
advanced directives, or (b) a hypothetical later competent self might the case of advance directives, whats doing the heavy lifting is the
have done so where the actual later self was pleasantly demented. establishment of authoritativeness in preferences. Given that if YS and
Second, Marya Schechtman has pointed out to me that it looks as if DP arent numerically identical, YSs preferences for DP may still be
considerations of numerical identity actually do at least some minimal authoritative, and given that if YS and DP are identical, YSs prefer-
work for DeGrazia and McMahan (and perhaps others). After all, ences may not be authoritative over DPs (as I point out in the next
theyre left with the problem of saying why YSs preferences should be paragraph above), identity considerations play very little role in
given precedence over DPs only because they are the same person. So addressing the main issues.
57
appeals to identity constitute at least some part of the argument. Fair See, e.g., Agnieszka Jaworska. Respecting the Margins of Agency:
enough. I dont necessarily want to insist here that identity plays no role Alzheimers Patients and the Capacity to Value. Philos Public Aff 1999;
whatsoever in these bioethical arguments; rather, I merely want to show 28: 105138.

2009 Blackwell Publishing Ltd.

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