Dementia and Death with Dignity

I forgive you, mother, I can hear you

And I long to be near you

But every road leads to an end

-Sufjan Stevens, song "Death with Dignity"

A death with dignity is exactly what it sounds like: a death free from indignities, such as those found in excessive suffering or in diseases that are progressive, ugly, and incurable.

In the U.S., as of June 2024, there are only 10 states plus Washington D.C. that allow death with dignity.(1) In each of these states, dementia is exempted because the law only applies to 1) a patient with 6 months left to live or less and 2) a patient that can fully consent to the procedure.(2) Dementia patients can, unfortunately for them, live for years after the worst of the disease has taken effect, and they are not, unfortunately for them, capable of consenting to their death. Ironically, it is exactly the long life under a life-ruining disease and the lack of a sound mind that contribute to dementia’s worthiness of death with dignity considerations.

I defend the following argument:

1) If late-stage dementia is a fate worse than death, then those who suffer from late-stage dementia should be given a death with dignity.

2) Late-stage dementia is a fate worse than death.

3) Therefore, those who suffer from late-stage dementia should be given a death with dignity.

You might recognize that you already agree with the argument. That wouldn’t be too surprising, given the general support for death with dignity according to polls.(3) What’s funny about these poll results is that folks are more supportive of death with dignity when the word “suicide” is not used. That makes sense to me:

“A doctor should be allowed to kill…”—I think not.

“I want the freedom to choose among end of life care options, including the option to end my life when I see fit.”—much better. Freedom sounds better than killing, even though both mean the same thing in this context.

This means the biggest obstacle to death with dignity is optics, not truth. 

For the first premise of the argument, it’s true by definition that it’s better to be dead than to suffer a fate worse than death. But the first premise contains more than just this self-evident truth. It contains implicit claims about legality, culture, and medical procedures—namely, that it should be legal for families and doctors to agree that a family member would be better off dead and to thereby pursue medical procedures accordingly, and that the wider culture should be on board with this. Moreover, there is the implicit claim that it’s morally right for a person to administer this death to the patient, and to do so even when the patient is a) innocent, b) a person with value, c) a person with a right to life, and d) not able to consent to their death. All of this opens up premise 1 to many objections.

Premise 2 is easy to defend. My mom was diagnosed with early onset dementia roughly 10 years ago, and is now in the late stage. Her symptoms include:

-unable to clothe self

-unable to feed self

-unable to bathe self or maintain hygiene

-unable to form new memories or recall old ones

-always at risk of getting lost; doors must be kept locked from the inside at all times

-reliant on others 24/7 to survive

-often bored, asks questions like “What can I do?”, but there is nothing she can do

-unable to be of help

-unable to hold a normal conversation

-unable to socialize properly; loss of social skills

-unable to participate in life in any meaningful way

-unable to improve in any way, and capacities worsen each day

-occasionally becoming self-aware and expressing despair over her situation

-constantly in a state of confusion and distress

-meltdowns whenever left alone; in constant need of emotional support 

-daily meltdowns, even when not alone, that last for hours

The last symptom on the list is the one that makes it clear to anyone who has lived with someone with this particular variation of dementia that this variation of dementia is a fate worse than death. The other symptoms make it all the more clear.

While the suffering of the patient in question is most important, it’s also important to not ignore the suffering of family members. My dad has become a full time caretaker and I can only guess at the extent of the stress this has caused him. There have been days where I struggle to get out of bed myself. Beyond my dad and I, my brother and his family, and my sister and her family, suffer too. Our neighbors, who have called 911 because my mom escaped the house and got lost, suffer too. Friends and church members who have seen her on Sundays suffer too. Folks are uncomfortable, disturbed, and saddened by the situation. When one person in a community suffers, the whole community suffers.

I'm 99% confident that if my mom at 40 years old saw what she would be like at 60, she would make plans to end her life early. The only reason she didn’t is because 1) it was a frog boiling in the pot situation, 2) because she didn't live in a society that was sophisticated enough to give her the option, and 3) she once remarked to me that she was okay with the situation (which wasn't really true; she expressed despair and misery from the beginning) because she was told she would be in a happy mood while the disease progressed. I don't know who told her this, but it was completely mistaken. She has daily emotional meltdowns and is in a constant state of either boredom, confusion, or distress. She especially would not accept the suffering caused to her family and friends.

Not only does the disease cause loved ones to suffer, there’s another serious consequence: How the disease causes the patient to be remembered. We want to be remembered well, but a disease like dementia makes that impossible for those afflicted. We don’t have many videos (I can’t think of any off the top of my head) of my mom before she changed. Given how slowly the disease progresses, it becomes harder and harder to remember her as her ordinary self. We want our family members to remember us well; we want to leave behind good memories. But the disease leaves memories of her in a wretched, undignified state. Far from leaving behind good memories, she will leave behind emotional scars. This is not her fault of course; the enemy is the disease; the enemy is the culture that opposes death with dignity.

This essay by philosopher Elizabeth Telfer mentions the financial costs of opposing euthanasia and how those resources could be put to better use.(4) While folks will protest caring about money more than a person’s life (something our oligarchic systems do anyway), there is a common sense point to be made here. If I were dying, I would not expect society to spend 100 billion dollars to keep me alive for 30 more minutes. That would clearly be unreasonable. It would be unreasonable to spend any amount of money to keep me alive for 10 years if the quality of life during those 10 years was unacceptable. So there simply is a point at which the money is worth more than the life. While this is an uncomfortable truth, it is one we must face.

There is an even further consequentialist argument in favor of death with dignity more generally: the advantages of death days. Here are two end of life scenarios, with one clearly better than the other: 

1) The parent dies, possibly in great pain from advanced disease, either unconscious or semi-conscious, confused and senile, alone in a hospital room.

2) The parent dies in peace, painlessly, after spending a day surrounded by loved ones, sober and awake and able to say goodbye to everyone.

Reliably achieving scenario 2 requires scheduling a death day in advance, which means ending the life of the parent prematurely. It can be difficult to know whether the parent would survive another week, or 6 months, or even years. But it can also be difficult to know the exact quality of life those extra months would have, or whether the parent would have a later chance to say goodbye. So it’s not the simplest calculation. Nonetheless, families should have the option of scheduling death days. But that would require common sense death with dignity laws to be enacted across the country. It would also require Americans to have a more mature attitude toward death, which is to say that it likely requires too much.

Objection 1: Laws allowing dementia patients to be euthanized will lead to abuse cases.

We might call this the safeguard objection. How can we implement death with dignity while safeguarding the right to life?(5) The fear is that doctors or nurses would have sole authority to end the lives of their patients, or that families would conspire to end the lives of otherwise healthy members.

Obviously, common sense death with dignity laws would not give any one person sole authority for deciding who lives and dies. We can safeguard against abuses by one or more of the following:

a) Requiring neutral, non-family, non-medical witnesses to the unbearable suffering of the patient;

b) Requiring a second opinion from a qualified physician as to the nature of the progressive, incurable disease of the patient;

c) Requiring physicians to opine on the possibility, efficacy, and burdensomeness of medication and alternative treatments; 

d) Requiring a neutral third party to review the case and approve it, such as a court judge (with or without a jury).

There is the worry that patients suffering from mental health issues would be wrongly administered death when they need therapy and medication. I share this worry, which is why I do not advocate for death with dignity to apply to those who have depression or similar mental health issues.

Currently, it is already the case that doctors could, if they wanted to, end the lives of vulnerable patients, and families could, if they wanted to, conspire to have family members killed. But we trust them to not do this. I don’t see how death with dignity laws, with common sense safeguards, would require us to rely any more on that trust. In fact, by not allowing death with dignity, you create situations where patient quality of life drops far below what is ethically acceptable. It is in these extreme cases that doctors and nurses will be most tempted to take it upon themselves to end patient lives without due process. Ironically, far from causing abuse cases, I can see how death with dignity laws would reduce abuse cases.

Objection 2: Euthanasia is an extreme measure. We should pursue treatment first. 

I agree. When you invent a cure for dementia, let me know?

Glibness aside, it’s true that the worst of my mom’s disease, at least until the very late stage, is her constant state of distress. Medical marijuana might be a solution to that problem.(6) (Of course, my mom is in Kansas where medical marijuana is illegal.)

I advocate for more options, more freedom. Both treatments and death with dignity should be available, and we can determine on a case by case basis which is the better path. I imagine a typical case would involve medication for the early stages of the disease, and then death with dignity when the untreatable symptoms become unbearable.

Some treatments are not worth pursuing. Medication that “zombifies” the dementia patient does nothing to solve the problems of relying on others and not being able to participate in life meaningfully.

Objection 3: This would force medical professionals to administer lethal medications against their conscience.(7)

No, this wouldn’t. Doctors who have a personal objection could simply be exempted.

It’s worth noting that in death with dignity lawsuits, doctors are often among the plaintiffs.(8) This makes sense: Patients, or their families, approach their doctors looking for common sense end of life options. Doctors wish to help, but can’t.

Objection 4: It’s always wrong to kill an innocent person.

Imagine getting into a skiing accident that left you paralyzed and brain damaged. You are bound to a bed for the rest of your life, and you’re only conscious enough for life to be a never-ending fever dream. Would you prefer to live this life, or would you prefer death? 

I would prefer death. While dying in a skiing accident is tragic, it would be far more tragic to be forced to suffer a fate worse than death for decades. You can either extend the tragedy by forcing someone to live without any quality of life, or you can truncate the tragedy and choose the lesser of two evils.

In this case, I would hope to be “killed” (practically speaking, I’m not alive in any relevant sense anyway) even though I am innocent.

Objection 5: It’s always wrong to kill someone without their consent.

Again, in the skiing scenario, even though I am unable to consent, I would hope that my family and doctors (and any judge or jury presiding my case) would have the common sense to recognize my fate as one worse than death and to end my life accordingly.

It’s arguable whether killing me in this case would count as violating my consent in any relevant sense. If I were able to communicate in this scenario, I would communicate my desire to die. Those around me can’t know this (unless I had expressed such a desire beforehand), but they could know that I would prefer death over being incurably bedridden and half-conscious if I were rational. Rational consent in this context is the consent I would give if I were capable of understanding the badness of my situation and thus the reasons for resolving that badness. Arguably, rational consent matters more than non-rational consent. 

It’s important to know why there is no consent. If there is no consent because the patient competently and rationally refuses consent, then euthanizing that patient would be clearly unjustified. But if someone refuses consent because of incapacity or irrationality, then euthanasia can still be justified if the patient is experiencing unbearable suffering due to a progressive, incurable, and effectively untreatable disease.

However, even if killing me in the skiing case counted as an evil violation of my consent, it would be nowhere near as evil as forcing me to suffer a fate worse than death for decades. The lesser of two evils should be chosen.

For a more moderate death with dignity law, we could require future consent be given by a patient at the time of a diagnosis to pursue death with dignity when the family feels it is time. In these cases, the patient is not capable of consenting at the time of death, but the wishes of the patient as their rational self would trump the wishes of the patient as their incapacitated or irrational self.

Objection 6: Who gets to decide what counts as a fate worse than death?

We do. To give us an idea of a reasonable definition of “fate worse than death”, here are three criteria the MAID laws in Canada include in their eligibility requirements(9): 

• have a serious and incurable illness, disease or disability;
• be in an advanced state of irreversible decline in capability;
• have enduring and intolerable physical or psychological suffering that cannot be alleviated under conditions the person considers acceptable.

We could conduct survey experiments to gather people’s answers to the skiing accident case, and variations of the case, to get a sense of what counts as a fate worse than death for the typical person. That data could in turn be used to create an empirically supported criteria for a fate worse than death. (Assuming such data hasn’t already been gathered.)

Objection 7: Euthanasia goes against Christian ethics.

I don’t know of any verse in the Bible that strictly forbids death with dignity. There is the Old Testament commandment of “Thou shalt not kill”, but Christians immediately qualify the commandment by saying killing in self-defense is fine. This is because we see the irrationality of forbidding people from killing in self-defense. Self-preservation is one of the hallmarks of rationality, and it’s difficult to fault someone for acting rationally. But if we can qualify God’s commands in this way, then we can continue to use our reasoning and qualify further, and the case I’ve laid out here provides an example of doing just that on behalf of death with dignity.

Deontic considerations

So far I have focused on the consequences of ending the lives of those whose fate is worse than death. But we should also consider the nature of the actions associated thereof, and whether they are the kinds of actions we can morally tolerate. From a deontological perspective, if an action violates someone’s right to life, for example, then that action is wrong even if the consequences of doing so are a net good.

Objection 8a: Euthanasia fails to treat people as an end unto themselves.

The opposite is the case: by caring about the person themselves, your compassion causes you to desire to see them free from unbearable suffering. Their suffering becomes yours because of your regarding them as an end unto themselves.

This objection would have force if the motivation behind death with dignity was purely to spare friends and family members from suffering. But this isn’t the case. Death with dignity can be justified purely on the grounds of the suffering of the patients themselves. The suffering of friends and family only provides bonus weight in favor of death with dignity.

Though, it is arguable that friends, family, and the wider community collectively suffer more than the patient. This would be due to the wider community a) outnumbering the patient and b) being starkly aware of their own suffering while the patient is unaware or only partially aware depending on capacity.

Objection 8b: Death is a harm and doctors are obligated to Do No Harm.

Why is death a harm? I would say: death is a harm because it precludes future flourishing for the one who dies, it destroys a web of flourishing (i.e., it damages a community’s structure), and it causes the (often sudden) agony of grief and loss to surviving loved ones.

In the case of a patient suffering from late-stage dementia, a) there is no significant flourishing precluded, only further (and worsening) suffering; b) the community’s structure was already damaged by the disease; and c) while death of the dementia patient would cause grief and loss to loved ones, they are the ones (in theory) advocating for death with dignity in the first place for reasons already discussed.

So in extreme cases, death is not a harm, or is the lesser harm. Therefore, by forcing the patient to live a fate worse than death, you are harming that patient. The system, as a whole, is failing to abide by “Do No Harm” by opposing death with dignity.

Objection 8c: To euthanize someone is to fail to have good intentions / a good will.

If we have already established that death is, in some rare and extreme cases, a net benefit for the one who dies, and if it’s clear that the one who brings about this death does so for that benefit, then it follows that intending such a death is not an evil intention.

Intentions matter greatly. We want those around us to be the right kinds of people and have the right kinds of motivations. If an action is the kind of action that comes only from the wrong kind of person, or only from the wrong motivations, then I agree that this action is evil regardless of its consequences. However, whether an action is such an action will of course depend on its consequences, as the motivation to perform an action depends on the action’s consequences. If the consequences are good (for others and not only for me), and my motivations are tied to those good consequences, then my motivations will be good too.

The concern is that by pursuing death with dignity we are acting selfishly, that we care more about our burdens than the lives of the unfortunate. But I am certain that is not what’s going on. It’s clear to me that we are the right kinds of people and we have the right kinds of motivations when we, with due process, prevent our loved ones from suffering a fate worse than death. As I mentioned before, it is because of our compassion that we suffer when they do; it is because of our love that we wish to see them dignified.

Objection 8d: Euthanasia fails to treat the patient with dignity.

The opposite is the case. The Elizabeth Telfer essay gives examples of aspects of dignity, including independence, autonomy, and privacy. I take indignities to be anything that humiliates, reduces, makes you weak or lesser, or robs you of your power or status. To be dignified is to be glorified, to be raised up, celebrated, to occupy a higher status, to be free, independent, and powerful. To be dignified is to be above, and to be undignified is to be below.

We can ignore death in cowardice, or we can rise above our fear and face it head on. We can be stripped of our power or have the freedom to die on our own terms. We can cling to life and let ourselves degrade into a sickly heap and die shriveled and unconscious, or we can be strong and let go at the right time, dying with poise and pride. We can die alone or with a goodbye. Which is the more dignified way?

Technically, there is no such thing as a death free from indignity, as death itself is one of the worst indignities one can suffer. Death reduces you to nothing. Yet, when it comes to fates worse than death, there is even worse indignity. When someone is suffering permanent dependence, weakness, embarrassment, pointless suffering, the inability to improve or participate in life in any meaningful way, and so on, then death is a more dignified state, especially when the condition can only get worse and eventually leads to death anyway. We should minimize the indignities we face when we face death and dying, and a death with dignity gives us that.

Hypocrisy

There is another deontic consideration: the consistency of action. The idea is that any hypocritical action is wrong, because to be hypocritical is to be self-contradicting, and to be self-contradicting is to be irrational.

This rejection of hypocrisy can be expressed in Jesus’ command that we should do unto others as we’d have them do unto us. But instead of this opening up an argument against death with dignity, it opens up an argument for it. If you wish for others to take on a certain attitude (e.g., mercy killing can be justified) in the case you find yourself suffering a fate worse than death, but do not yourself take on this attitude, then you are being hypocritical. We can show this in the following argument:

1) We should do unto others as we'd have them do unto us.

2) We would have others apply death with dignity to us in circumstances where our fates are worse than death and death is the only way out. (Like in the skiing accident case)

3) Therefore, we should apply death with dignity to others when their fates are worse than death and death is the only way out.

Here is a more nuanced version:

1) We should do unto others as we'd have them do unto us.

2) We would have the appropriate persons (family, doctors) be informed about what we consider to be a fate worse than death, and have death with dignity applied to us, authorized by such persons, in the case we suffer such a fate.

3) Therefore, we should be informed about what those individuals to whom we count as appropriate persons consider to be a fate worse than death, and apply death with dignity to them in the case they suffer such a fate.

There are problems with Jesus’ golden rule, and even with Kant’s universalization principle that tries to solve those problems.(10) Still, it's irrational to not take on the attitudes you wish others would take on.

One last point: humans run on hope. Humans can endure an incredible amount of suffering as long as there is a light at the end of the tunnel. One reason why children make our lives so meaningful is because they represent the future; they grow and improve over time. With a progressive disease like dementia, there is no improvement, only decline, only darkness at the end of the tunnel. Family members, friends, doctors, and caretakers are asked to hold on. It’s hard to hold on without hope.

With these objections answered, I conclude that there are no good moral arguments against death with dignity, even in extreme cases where consent is impossible due to incapacitation or irrationality. I can’t help but feel that most opposition to euthanasia is due to optics, emotions, or virtue signaling, not arguments. It’s easy to virtue signal. It’s much harder to live the nightmare day after day, year after year, praying for a miracle that will never come. Those who oppose death with dignity are paving a road to hell with good intentions. Until changes are made to our attitudes and our systems, patients and their families will continue to burn in that hell every day.

---

(1) https://deathwithdignity.org/states/.

(2) OREGON (1997): https://www.oregonlegislature.gov/citizen_engagement/reports/deathwithdignityact.pdf.

WASHINGTON (2008): https://doh.wa.gov/data-and-statistical-reports/health-statistics/death-dignity-act.

VERMONT (2013): https://legislature.vermont.gov/statutes/fullchapter/18/113.

CALIFORNIA (2015): https://www.cdph.ca.gov/Programs/CHSI/pages/end-of-life-option-act-.aspx.

COLORADO (2016): https://www.uchealth.org/colorado-end-life-options-act/.

D.C. (2016): https://dchealth.dc.gov/sites/default/files/dc/sites/doh/page_content/attachments/Death%20With%20Dignity%20Act.FINAL_.pdf.

HAWAII (2018): https://health.hawaii.gov/opppd/ococ/.

MAINE (2019): https://www.mainedeathwithdignity.org/wp-content/uploads/2023/02/QA-for-Death-with-Dignity.pdf.

NEW JERSEY (2019): https://www.nj.gov/health/advancedirective/maid/.

NEW MEXICO (2021): https://endoflifeoptionsnm.org/wp-content/uploads/2021/07/CH132-HB47-2021.pdf.

MONTANA: It was established by legal precedent, not statute, in 2009 that physicians will not be prosecuted for aiding in the death of a “competent and terminally ill patient.” See: http://eol.law.dal.ca/wp-content/uploads/2015/06/Baxter-v-Montana.pdf.

(3) https://news.gallup.com/poll/162815/support-euthanasia-hinges-described.aspx.

https://news.gallup.com/poll/16333/Three-Four-Americans-Support-Euthanasia.aspx.

https://news.gallup.com/poll/235145/americans-strong-support-euthanasia-persists.aspx.

https://deathwithdignity.org/wp-content/uploads/2023/06/toplines.DC-Death-with-Dignity.f.071015-1.pdf - from: https://deathwithdignity.org/states/district-of-columbia/.

(4) http://www.euthanasia.cc/telfer.html.

(5) See: https://www.cnn.com/videos/tv/2023/02/27/dr-madeline-li-euthanasia-canada-maid-paula-newton.cnn.

(6) See: https://premierneurologycenter.com/blog/medical-marijuana-for-alzheimers-and-dementia-what-we-know-so-far/.

(7) See the paragraph addressing “professional autonomy”: https://plato.stanford.edu/entries/euthanasia-voluntary/#MoraCaseForVoluEuth.

(8) See for example: https://www.nytimes.com/2023/09/16/health/aid-in-dying-new-jersey.html.

(9) https://www.justice.gc.ca/eng/cj-jp/ad-am/bk-di.html#s1.

(10) See the chapter on Kant, starting on pg 167, of The Fundamentals of Ethics, 5th ed., by Russ Shafer-Landau.

Depression in 25 Questions

I’ve heard Dr. Robert Sapolsky say in a widely viewed lecture on YouTube that depression is like diabetes. (https://www.youtube.com/watch?v=NOAgplgTxfc&rco=1; See also: https://www.youtube.com/watch?v=fzUXcBTQXKM&t=0s). With diabetes your pancreas fails to produce enough insulin. Likewise, with depression, your brain fails to produce enough serotonin or your body produces the wrong balance of hormones or something like that. However, I find that depressive symptoms almost always can be explained by life dissatisfaction. 

Take the following test and see what your score is. The test is 25 questions. A perfect score of +25 means you are one of the happiest people on the planet. Good for you! A score of 0 means your life is neutral. A score of -25 means you should, uh, be on suicide watch, maybe. If you score low (say, 0 or lower), then you probably shouldn’t attribute your depression to a chemical imbalance, and you probably shouldn’t expect taking a pill to do anything. 

1) Are you as athletic as you’d like to be?

Yes +1

No -1

Mix +0

2) Is your diet where you want it to be most days? (Think both in terms of health and enjoyment)

Yes +1

No -1

Mix +0

3) Are you as attractive as you’d like to be?

Yes +1

No -1

Mix +0

4) Are you happy with your charisma? (Sense of fashion, ability to make others laugh, ability to give good first impressions, etc.)

Yes +1

No -1

Mix +0

5) Are you happy with your social life?

Yes +1

No -1

Mix +0

6) Are you happy with your romantic life?

Yes +1

No -1

Mix +0

7) Are you creatively satisfied? (Have you created what you want to create?)

Yes +1

No -1

Mix +0

8) Are you intellectually satisfied? (Do you have answers to the questions you want answered?)

Yes +1

No -1

Mix +0

9) Do you have the skills you wish you did?

Yes +1

No -1

Mix +0

10) Are you satisfied with your achievements?

Yes +1

No -1

Mix +0

11) Are you happy with your childhood experiences?

Yes +1

No -1

Mix +0

12) Are you happy with your adolescent experiences?

Yes +1

No -1

Mix +0

13) Do you have a good relationship with your parents?

Yes +1

No -1

Mix +0

14) Do you have a good relationship with your other family?

Yes +1

No -1

Mix +0

15) Are you happy with your finances?

Yes +1

No -1

Mix +0

16) Do you work a dream job?

Yes +1

No -1

Mix +0

17) Are you working on the most important problems you could be working on?

Yes +1

No -1

Mix +0

18) Are you self-improving most days?

Yes +1

No -1

Mix +0

19) Do you admire yourself?

Yes +1

No -1

Mix +0

20) Are you happy with your current living situation?

Yes +1

No -1

Mix +0

21) Do you like the city you live in?

Yes +1

No -1

Mix +0

22) Are you close with any of your neighbors?

Yes +1

No -1

Mix +0

23) Do you feel happy most days?

Yes +1

No -1

Mix +0

24) Are you where you want to be in life?

Yes +1

No -1

Mix +0

25) Are you satisfied with your mental health?

Yes +1

No -1

Mix +0

At the risk of oversharing, I give my answers to each question.

1) Are you as athletic as you’d like to be?

No. My poor performance in sports led to an asthma diagnosis when I was young. My breathing is quite bad. I can go for walks but that's about it. -1

2) Is your diet where you want it to be most days? (Think both in terms of health and enjoyment)

I'm working on it; when I get sugar cravings I am restricting myself to only fruit (not fruit juice). I'm keeping healthy snacks around like fruit, dried fruit, and nuts. I include protein and fiber in every meal to maximize satiation per calorie. And I take multivitamins each day. I minimize shopping and cooking as I'd rather spend that time reading or writing, so my meals tend to be basic. +0

3) Are you as attractive as you’d like to be?

On one hand, it would be nice to know what it’s like to experience the halo effect, where social success and opportunities come far more easily by luck of the genetic draw. On the other hand, I don’t care too much because I’m aromantic. +0

4) Are you happy with your charisma? (Sense of fashion, ability to make others laugh, ability to give good first impressions, etc.)

No -1

5) Are you happy with your social life?

No; I have felt misplaced wherever I have been. I wish I could hang out with philosophers more -1

6) Are you happy with your romantic life?

If the question was “Do you derive a great deal of enjoyment from your romantic life?” then I would say no, because I don’t have one. But because the question is about being happy, I am happy single because I am aromantic. +1

7) Are you creatively satisfied? (Have you created what you want to create?)

It would be extremely fun to create a language (one that’s easy & fun to learn), create a fantasy lore system that features a fictional, idealistic society that uses this language, and then create a fantasy video game that uses that lore where the player learns the language slowly throughout the game. I would also like to turn all the melodies that pop into my head into full songs. I also have a dozen or so stories I’d like to write. I might get some of these projects done eventually if I’m lucky enough, but there is no way I’m getting them all done. -1

8) Are you intellectually satisfied? (Do you have answers to the questions you want answered?)

As an aspiring philosopher I think I’m supposed to say no, because philosophers are aware of just how little they know. While it’s true that debates can go on forever, from a broader, more basic point of view philosophy is very intellectually satisfying. I make progress every day. Philosophy gives you the only hope of building a worldview you can be proud of. +1

9) Do you have the skills you wish you did?

The most important skill to me is philosophical skill, and I’m pretty happy with what I can do there. I see my weaknesses though, so it’s always a work in progress. I wish my skills in other areas were way higher than they are, but they don’t matter nearly as much to me. +0

10) Are you satisfied with your achievements?

No; After I’ve written more good philosophy I will feel differently. -1

11) Are you happy with your childhood experiences?

It was pretty good overall +1

12) Are you happy with your adolescent experiences?

It was pretty bad overall -1

13) Do you have a good relationship with your parents?

My mom has dementia, making it impossible to have any real relationship there. For other reasons too I would say no -1

14) Do you have a good relationship with your other family?

It’s a bit complicated but not really -1

15) Are you happy with your finances?

No -1

16) Do you work a dream job?

No -1

17) Are you working on the most important problems you could be working on?

Yes! I feel like philosophical problems are the most important, and I’m working on those +1

18) Are you self-improving most days?

Yes, I’m working on myself physically, mentally, and professionally +1

19) Do you admire yourself?

I admire philosophers; I admire those who exhibit intellectual virtues such as passion for truth, bravery, and so on. I exhibit those virtues which is very cool. Even though I’ve never loved my circumstances, loving myself has not been an issue. +1

20) Are you happy with your current living situation?

No -1

21) Do you like the city you live in?

No -1

22) Are you close with any of your neighbors?

No -1

23) Do you feel happy most days?

No -1

24) Are you where you want to be in life?

No -1

25) Are you satisfied with your mental health?

No, I have a lot of anxiety and depression these days -1

My score is -10. Ouch! That’s awful!

This test is very simple and informal. Some of these questions should be weighed more than others. More questions could be added to get specifics about, for example, past trauma. The advantage though is that the test gives a quick and easy rough estimate of where you are (and what you could be working on).

Furthermore, this test includes only local questions, but could be expanded to include midway questions (how do you feel about your country, the state of the world, about social / political issues like gender and race; are you happy about how your governor is running things, etc) and broad questions (how do you feel about your eventual death, or the eventual death of your loved ones; are you happy about the way God is running things, etc).

If I’m being honest, expanding the test in this way would not improve my score at all!

I worry that depression is being treated as a disease (something has gone wrong with the body / brain) when it’s not a disease; it’s a natural consequence of living a low-quality life, or of experiencing trauma, or of holding depressing beliefs. It shouldn’t be surprising to find depressive symptoms given any of these. If someone believes life is meaningless and that there is no point in overcoming suffering or in making an effort, then of course that person is going to struggle to get out of bed. Unless we are prepared to say that chemical imbalances cause these depressing beliefs, then we shouldn’t assume a chemical imbalance when an alternative explanation is staring us in the face. Of course, I would have to engage the literature on the topic to have anything close to a proper argument.

Key moments in losing my Christian faith

• Existential crisis at ten years old where I worried that life on earth was bad, life in hell would be bad, and life in heaven would be bad too. I resolved this by concluding that life in heaven could not be bad. But this did plant the idea in my head that life could be fundamentally bad, i.e., that being born could be deeply unlucky. So my pessimistic traits were there from the beginning.
• Existential crisis at 12 years old when I realized that I wanted Christianity to be true. I wanted God to exist more than anything, and my greatest desire was to be with God (a desire that kept with me my whole life). My greatest fear was that God did not exist and that death was the end. The crisis came from this epiphany: if there was one thing I learned from my parents telling me no over and over again, as all parents do to their children, it’s that there is no connection whatsoever between reality and what I want. If anything, my wanting God and heaven to be real made it more likely that they weren’t.
• Ironically, this epiphany occurred on the day I came home from a spiritual retreat. But perhaps it’s not so ironic. Christianity teaches that the world is a certain way (God is in control, God loves us, etc), and then you come home and see that the world doesn’t work that way.
• The new atheist movement launched around this time in 2007. I’m on the internet, shocked at the certainty these folks have that Christianity is false. This combined with my own questioning leads to searching for answers.
• I was able to answer the questions that came to me, bolstering my faith. Is this the best atheism can do, I wondered. (The answer was no. But I didn’t know that yet.)
• But at 16 I became depressed that I couldn’t articulate my own beliefs, and even less defend them, nor could I penetrate the absolute certainty that non-Christians seemed to have against Christianity.
• I imagined taking on the worldview that the typical atheist seems to have. It seemed to lead to pessimism and nihilism, which I thought was self-defeating. The absurdity of life without God was to me an ace in the hole for Christians. I asked my parents for the book Reasonable Faith by William Lane Craig. I was delighted to find the chapter in there about the absurdity of life without God. This sealed my confidence that the problem of absurdity was our trump card against atheists.
• Problems began to arise in my life. I prayed to God to no avail. The more depressed and desperate I became, the more I needed Christianity to be true. Ironically, the folks for whom it should be the most obvious that a loving God doesn’t exist are often the strongest believers. That’s because they need it to be true or else their suffering isn’t worth it.
• The avalanche of books defending Christianity didn’t make things any simpler. Christianity, it turns out, has an impressive intellectual history. The new atheists kept shooting themselves in the foot by failing to engage with it. They made themselves look bad. Being a truth seeker is difficult enough that both sides have their share of failures.
• By this point Christians will be searching for keywords they can use to ascertain whether I was a genuine Christian. Yes, I prayed, went to church, read the Bible, walked with God, fell in love with Jesus and the gospel, was in awe of his words, said the sinner’s prayer, was convicted of sin, repented, experienced forgiveness of sin, had profound experiences of love from God, felt the presence of God, felt the joy of hope & the “peace that surpasses all understanding”, was baptized, regenerated, Holy Spirit, all of it. To reference Romans 10:9, I confessed with my mouth that Jesus is Lord and believed in my heart that God raised Jesus from the dead. I wrote songs and poems that flowed organically from my faith.
• But it’s not true. None of it. It was around 2021, 2022, at 26 / 27 years old that I finally was ready to let go.
• There was no watershed moment; just the accumulation of trying and failing to prove that Christianity is true.
• I remember as a teenager other kids at church went on mission trips. I felt guilty for not going. But I didn’t know how anyone could share the gospel with any confidence until the questions atheists brought up were answered. It frustrated me that Christians around me seemed oblivious to the challenges to Christianity.
• At around 14 I wanted there to be a Bible study where we take a single word like “grace”, “faith”, or “salvation”, and do a study on that word. It frustrated me that Christians were happy to use all these words without knowing what they meant.
• At 19 I attended a Bible study. The topic of prayer came up, and I asked the following question: Does prayer change the mind of God? If yes, does God’s mind need changing? If not, then why pray?
• Later I discovered decent theological answers to the question: The Christian could downplay the role of petitionary prayer over other kinds of prayer, such as praying to God for conviction and forgiveness of sin. (This doesn’t really work though, as Jesus said ask and you shall receive.) You could also say that God takes prayers into account when deciding between two equally good states of affairs to actualize. In that case, prayers don’t exactly change God’s mind, but they do give God an additional reason to select the path that ends up answering your prayers. So if God is at a tie between two paths, your prayer could break that tie, as now your happiness gives God a reason for actualizing one path over the other. (This doesn’t work either though, as God is apparently quite content in letting people go unhappy. Not to mention the fact that there has never been a clear case of someone’s prayer making the difference.) 
• Looking back, the situation was very funny. I was enthusiastic and very much expecting a lively dialogue to follow. But there was only awkward silence. I was not praised for asking a good question. I was ostracized. I was shocked at the anti-intellectualism of these Christians. William Lane Craig is right in saying that Christians are largely in “intellectual neutral”, though I think the situation is even worse. Christians are not genuine truth seekers. Though, most humans are not genuine truth seekers, so Christians aren’t exactly special in that regard. I do not say this is in a judgmental way. No one is at fault; it’s just the way things are.
• Here we see the anti-social nature of philosophy. We cannot separate Christianity as a belief system from Christianity as a tribe. By asking a question I was challenging the belief system (though, in my mind at the time, I was simply exploring truth). By challenging the belief system, I was upsetting the social order. That's why I was ostracized. For me it's about truth, but for others it's about other things, like fitting in.
• Around that same time, in my college English class the professor asked us what it means to be a university, and what it means to be a student. Then he asked us what Harvard’s motto was. He wrote it on the board: Veritas. He was trying to get us to realize, it seems to me, that universities are bastions of truth; people from all over the world gather to test their worldviews against each other. To be a student is to be someone who puts their worldview on the line. Truth is a battlefield in this way, where there is danger and the risk of your deepest sense of self turning out to be false. At least, this is an idealized view of what it means to be a university. I’m not sure how alive that ideal is these days.
• The seeds of intellectual virtue had been planted. I was a fledgling truth seeker, and even my novice abilities were beyond that of the members of my church.
• In March 2019 I read Graham Oppy’s “Why I am not a Christian” essay. This marked a turning point where I was becoming more open to considering the falsity of Christianity, and I was more willing to read “the other side”. I discovered the intellectual virtues, and I especially saw the importance of intellectual bravery, which involves engaging in arguments against your worldview. From then on I decided to accumulate the best arguments against Christianity. If Christianity survives such an analysis, then it’s a strong worldview worthy of a well-informed and rational person. If it doesn’t, then I will have been disabused of a false worldview.
• In 2020 I rekindled my relationship with God. In part this was thanks to Josh Rasmussen’s 2019 book How Reason Can Lead to God. Though, ironically, and only half-jokingly, I remarked to myself that this book was the strongest argument against Christianity I had ever seen. That’s because of how the argument from arbitrary limits seemed to clash with the Trinity, but Rasmussen has addressed that problem in interviews. Mostly, this rekindling was emotional.
• This rekindling was dampened by the debate between Joe Schmid and Randal Rauser in July 2020. (https://www.youtube.com/watch?v=68FxtG49ngY&t=1s) It was a devil’s advocate debate where Randal Rauser, the Christian, argued on behalf of atheism, and Joe Schmid, an agnostic, argued on behalf of God’s existence better than any Christian could. My Christianity predicted that people like Joe Schmid—well-informed, virtuous non-Christians—could not exist.
• That year I started going to church again and joined a Bible study. But this only lasted roughly half a year. It was very painful to go from the level of philosophy I was reading in my spare time to the kindergarten level of discussion in the Bible study.
• At that time I made some key observations: 1) I saw how well evolution explained church and religion; 2) I saw how tribal mechanisms that applied to religious social contexts equally applied to secular social contexts like that of my non-religious office job; 3) I saw how much people’s worldviews are determined by social influences; 4) I saw how much people’s worldviews are determined by material realities (how independent you are, how wealthy you are, how healthy you are, etc.). This calls for a unifying theory that explains tribal mechanisms, group think, social pressures, echo chambers, and so on, and evolution clearly gives us the framework to do this.
• I completely changed my mind on the absurdity of life without God. In 2019 I had the opportunity to take a philosophy of religion class, where I wrote a paper trying to demonstrate the irrationality of living a nihilistic life. The argument didn’t work. It entailed that all humans prior to the Bible were supposed to throw themselves off cliffs in despair, and that was clearly an absurd conclusion. Christians ask: If everything ends at death, and all paths lead to the same destination, then what difference does anything make? I realized that not only is there a difference between pain and happiness, but this difference is certain. I am certain that suffering is bad and that flourishing is good. The real experiences real people really have—that’s the difference. What we do in the here and now will either succeed or fail to maximize moments of flourishing for ourselves and others. It’s perfectly rational to live for the maximization of flourishing. Not only is this what we ought to do, but this is what we do do anyway! Indeed, even Christians live this way. Christians live to maximize flourishing like everyone else. That’s what heaven is—a place of perfect flourishing for all persons. The point is that Christians spend their time the same as everyone else: With friends, with family, with work, with hobbies, with projects they consider meaningful. (Note: Christians do not spend their time doing anything supernatural, like hanging out with angels or performing miracles. If only!) 
• I changed my mind about morality. Since high school, I thought morality was grounded in rationality somehow. But I also believed in divine command theory. The Euthyphro dilemma (And William Lane Craig’s poor responses to it) convinced me that divine command theory doesn’t make sense. First, I changed my mind that morality wasn’t dependent on God directly, but indirectly. Morality is grounded in more basic normative principles, such as principles of logic and rationality. These necessary truths are in turn grounded in God, who is the necessary foundation of reality. So morality was still indirectly dependent on God. But then I changed my mind about God being the best explanation of the necessary foundation. And so now I think God is not needed for moral facts (as Dr. Craig would argue), for moral knowledge (As Dr. Dustin Crummett would argue), or for moral motivation (as Dr. Anne Jeffrey would argue). God is not needed for morality at all. Indeed, I saw how Christian beliefs can impede moral progress, both individually and collectively.
• At one point I tried searching the Bible for affirmations of intellectual virtues. If the Bible had that, then that would be most impressive. But I didn’t find much. There is the extolling of wisdom in the wisdom literature, and truth itself is prized as valuable in various places. I was prepared to give an argument from virtue in favor of Christianity, but I ended up creating an argument from virtue against Christianity, much in line with the “meager moral fruits” argument. These, plus many more arguments besides, contributed to my eventual loss of faith.
• By the time 2022 / 2023 rolled around, the challenges to Christian belief, the explanatory power of naturalism, the failure of Christians to be genuine truth seekers, the failure of Christians to transcend biological tribal factors, and so on, all coincided and I could no longer hold on.
• Losing my deepest sense of self was not easy. My faith died a slow, agonizing death. C.S. Lewis called himself the most reluctant convert in England; I suppose I was the most reluctant deconvert in America.
• Now I’m pursuing philosophy full time with the goal of building a comprehensive case against Christianity and in favor of naturalism. It’s not enough to tear down worldviews; you must build a better alternative. Only then can real progress be made. So there is much work to do.

Solving a decision theory puzzle—how to avoid spending eternity in hell

I mentioned marginal cost in my previous post, which reminded me of a puzzle I solved a number of years back. I found the problem through Alex Pruss, but I don’t remember exactly where. But here it is:

You are in purgatory. Each day you spend in purgatory has a value of 0. Each day you spend in heaven is +1 and each day you spend in hell is -1.

God appears to you and gives you a deal. Spend one day in hell and you will get two days in heaven.

That’s obviously a good deal. You take a loss of -1 but you gain +2 for a profit of +1. So the rational thing to do is take the deal.

After you spend your day in hell God comes to you again with the same offer. Using the same logic, you take the deal again.

…You see where this is going.

God offers you the deal an endless number of times and you end up spending an eternity in hell!

So what went wrong?

My solution was the following: Consecutive days in hell are NOT worth -1. The marginal disutility grows exponentially. Let’s say each subsequent day in hell is 50% worse than the previous. Then we get the following series:

The disutility quickly gets out of hand.

But now let’s say God keeps sweetening the deal. Let’s assume that each day in heaven is +1 (though I could imagine each subsequent day in heaven being 50% better than the previous. It’s heaven after all!). On night 2, God offers 4.5 days in heaven for just 1 day in hell. This costs -2.25 for +4.5, which is a profit. God offers 6.75 days in heaven for the next day in hell. And so on. Soon God will offer millions of days in heaven for a single subsequent day in hell. It’s always a good deal, so you still end up in hell forever. 

However, there is no reason to assume that just because someone can withstand a -1 disutility that they could withstand a -1,000. Let’s say your absolute limit is -500 disutility. Then it would only be possible for you to spend up to 16 days in hell in a row. With God offering double rewards each day, you would receive 2,623 days (7+ years) in heaven at the cost of only 16 days in hell. Not bad!

There is nothing irrational in turning down God's deal when at your limit, and the number of days spent in hell is not arbitrary; it’s limited by your capacity for disutility and by the marginal disutility rate.

Reacting to William Lane Craig (and Josh Rasmussen) #889

In the question of the week #889 (https://www.reasonablefaith.org/writings/question-answer/evil-worlds-and-the-ontological-argument), Craig shares the following argument from Rasmussen, defending the possibility of God’s existence. For some context: The ontological argument proves that to demonstrate the metaphysical possibility of God’s existence just is to demonstrate God’s existence.(1) So an argument in favor of God’s metaphysical possibility is pretty serious. The Value Argument goes like this:

1) Some degree of value can be instantiated.

2) If some degree of value can be instantiated, then each degree of value can be instantiated.

3) Therefore each degree of value can be instantiated.

4) Maximal greatness is a degree of value.

5) Therefore, maximal greatness can be instantiated.

Steps 3 and 5 logically follow, so they are unassailable. I take premise 1 to be unassailable too; any moment of happiness I’ve had was some degree of instantiated value. So the only premises to attack are 2 and 4.

2 is easy to defeat. Generating a great deal of happiness is much harder than generating a small deal of happiness. The marginal cost of instantiating greater and greater degrees of value could make it impossible to instantiate the higher degrees of value. Compare: “If some amount of money can be made, then any amount of money can be made.”

4 is easy to defeat. Leibniz argued that our world must be the best possible world given the fact that God made it. Others have argued against this, saying that God could always add another happy person to the world, increasing the world’s overall value. So it’s impossible for there to be a maximally great world; you can always make it better. Likewise, you could argue that it’s impossible to be maximally great. God’s love could be made greater by loving an additional person. God’s creativity, majesty, power, and control could always be made greater by creating an additional universe. If this works, then maximal greatness is an impossible degree of value.

So I don’t find the argument nearly as persuasive as Craig does.

Knowing Rasmussen, I wouldn’t be surprised if he anticipated these responses and addressed them. If I get around to reading the original article, I’ll find out! I happen to have a preprint of Oppy, Rasmussen, and Schmid’s new entry on ontological arguments for the SEP. So I might just give that a read and see if this value argument is on there.

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(1) See How Reason Can Lead to God, 183-185.