✍️✍️✍️ Personal Narrative: Pneumonia

Tuesday, September 07, 2021 11:59:25 AM

Personal Narrative: Pneumonia



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The Power of Personal Narrative - J. Christian Jensen - TEDxBYU

It remains to be seen to what degree this may play a role in mitigating the spread of the virus and in the cytokine signaling cascade triggered by SARS-CoV-2 as they relate to severe outcomes in adulthood However, no clear evidence has emerged to date to support this proposal, and paucisymptomatic cases are reported even in unvaccinated children. A large pediatric clinical series on 2, children reported a 5. Shekerdemian et al. In fact, the reduced maturity and functionality of ACE2 and its lower expression in the nasal epithelium in pediatric populations relative to adults could partly explain children's reduced susceptibility to COVID 33 , However, studies do not unilaterally support this hypothesis. In fact, some evidence suggests that ACE2 expression in children is neither up- nor downregulated 35 , On the other hand, another study found that ACE2 is downregulated once the virus penetrates the cell and replicates, resulting in fewer receptors upon which the virus can act According to the American College of Radiology, pediatric radiologic imaging is recommended for patients with a confirmed diagnosis of COVID with mild symptoms and pre-existing comorbidities, and for children with moderate to severe symptoms.

Chest X-ray is the first choice exam; however, its lower sensitivity and specificity mean that pulmonary involvement cannot be excluded in patients with a laboratory-confirmed diagnosis of COVID Unlike in adults, computed tomography CT , is indicated in children in cases of suspicion of pulmonary embolism and clinical worsening The most common radiologic trends were peribronchial thickening, ground-glass opacities, consolidation, and pleural effusion The radiological anomalies evident on CT are certainly much more characterizing the disease, although these anomalies are less frequent and less specific than those described in adults The most common findings are multifocal and peripherally located ground-glass appearance starting from the lower lobes, accompanied by thickening in the interlobular septa, prominent vascular structures, halo signs, and inverted halo signs.

In severe cases, a striking paving appearance and fragmented consolidation are observed 40 , Liu et al. These three patients had unilateral ground glass opacities, whereas only one child had bilaterally distributed opacity, and another had a negative report Some radiological differences between children and adults were highlighted In a group of 98 patients of varying ages 4—88 years with COVID, the majority of lung lesions upon HR-CT were located in the right lower lobe of the lung, possibly due to the thinner and shorter structure of the lower lobe bronchus, especially in the peripheral area of the lung. However, children and adolescents had fewer lung lesions, predominantly unilateral involvement, and smaller clusters than adults, with no signs of air bronchogram Zheng et al.

Moreover, two of the eight patients that originally had a worse prognosis also had higher expression of IL-6 and IL, further corroborating a relationship between the severity of the pulmonary picture and activation of the cytokine cascade Several studies report the usefulness of pulmonary ultrasound for the diagnosis and follow-up of COVID pneumonia, given that it is a simple and repeatable investigation that does not expose the child to radiation or sedation. Musolino et al. According to Allinovi et al. Given the paucisymptomatic course characteristic of children diagnosed with COVID, the majority of cases only require supportive home therapy. Evidently, cases must be isolated, and they require an adequate intake of fluids and calories 51 , For the management of fever, paracetamol is recommended.

Some authors have proposed a correlation between the use of ibuprofen and a more aggressive course of SARS-CoV-2 infection 53 ; however, these data were not confirmed. For patients already being treated with topical steroids e. In case of need for inhalation treatment with steroids and bronchodilators, the use of pressurized metered-dose inhalers with spacer is recommended over nebulizers, which could increase infectivity due to their aerosolization of particles Hospitalization is indicated when there is a need to ensure supportive therapy e.

Upon entering the ward, performing laboratory blood testing may prove useful, even though it is often non-specific. In most children it is possible to find: i a normal or reduced number of white blood cells, accompanied by lymphocytopenia; ii normal or slightly increased C-reactive protein and procalcitonin values in case of excessive upregulation, a bacterial superinfection should be considered ; iii slightly increased transaminases and lactic dehydrogenases 13 , 19 , Patients with chronic diseases should be subjected to greater attention because the presence of comorbidities seems to be associated with a greater risk of fatal evolution In this sense, these patients should be monitored more frequently and subjected to earlier treatments.

Hospitalized children must have their vitals monitored and have adequate intake of fluids and calories aimed at maintaining a hydro-electrolytic homeostasis. Additionally, bed rest and maintenance of cleared upper airways are recommended 13 , 19 , In case of respiratory distress associated with hypoxemia, simple oxygen administration is insufficient. In these cases, high-flow nasal oxygen HFNO or non-invasive ventilation, such as continuous positive airway pressure CPAP , should be used 13 , 19 , The utility of HFNO for COVID treatment is the subject of debate given that the incontrovertible benefits afforded by this treatment are countered by the risk of viral particle aerosolisation within the patient's environment, thereby placing the safety of healthcare workers at risk What is certainly essential, however, is the use of personal protective equipment PPE when entering patients' rooms In any case, the critically ill child should be transferred to a pediatric intensive care unit and, in the event of non-response to non-invasive ventilation or of onset of pediatric acute respiratory distress syndrome PARDS , initiation of invasive mechanical ventilation should be considered and, ultimately, extracorporeal membrane oxygenation ECMO There is little reliable evidence for the utility of drugs in treating COVID pneumonia in pediatric populations, and any available data to date are based on observations in adult populations.

For this reason, pharmacological therapy discouraged in milder COVID forms, while recommended for more severe forms; such decisions should invariably be made on a case-by-case basis 13 , 19 , 51 , 55 , Antiviral drug therapy seems to be effective if initiated before clinical deterioration. The drug most commonly used is interferon-alpha by nebulization, as it has shown effectiveness at reducing viral replication with consequent improvement of symptoms and reduction of the duration of the disease Other possible pharmacological interventions include:. Common side-effects include diarrhea and nausea, and it is contraindicated in cases of hepatic impairment Hemolytic anemia is a possible side-effect 19 , Table 2 summarizes the main antivirals, their formulations, and their respective dosages in pediatric patients.

The usefulness of macrolides, especially azithromycin, for their anti-inflammatory properties is also questionable 19 , 52 , 60 , However, recently its effectiveness has been greatly diminished to the extent that it appears not effective for preventing intubation or death in moderately ill hospitalized patients with COVID This review summarizes the characteristics of COVID in pediatric populations, with a focus on pulmonary involvement. Although clinical picture of COVID in children is much less severe than in adults, progression of the disease remains possible and must, therefore, be intercepted with appropriate therapy. It should also be emphasized that children, although paucisymptomatic, are important vectors of the disease.

MM developed the original idea and made the final revision. GP wrote the manuscript. CI and FD revised the manuscript and contributed to the English revision and compilation of references. SL made the final analysis and critical revision of the manuscript. All authors contributed to the article and approved the submitted version. Grendel's mother in beowulf essay how to solve a consulting case study essay on archetypal criticism.

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Sometimes this is put more expansively: I can be responsible for my own actions, and I cannot be responsible for anyone else's actions Sider , 4, , —; Schechtman , 14; Olson , But these ways of putting the matter are just supposed to be a gloss on the philosophical slogan that moral responsibility presupposes personal identity Butler , 99—; Reid , —; DeGrazia , 88—89; Glannon ; Parfit , —; Parfit , — Now one might think that there are obvious counterexamples to the slogan: parents are sometimes held responsible for the actions of their children, and accomplices are held responsible for the crimes committed by others.

An easy reply, however, is that in each case the person being held responsible is actually responsible only for what he or she did. For example, the parent is being held responsible, not for what his child did, but for his in action in letting the child do what she did, say, or for his poor parenting. And the accomplice is being held responsible, not for what the criminal did, but for what the accomplice did in aiding the criminal.

So in both cases there is some properly specified action for which it seems only the person identical to the actor may be held responsible. Nevertheless, there are serious problems with the slogan. To see why, note that we are looking for an answer to the following question: what makes a past action my own for purposes of responsibility? The answer given by most theorists, following Locke, is that an action is my own just in case I am identical to the person who performed it.

So what account of personal identity provides the right criterion of what makes an action one's own? Locke's memory criterion fails, for some actions can be one's own even if one no longer remembers performing them, due to drunkenness, repression, trauma, or the like Schechtman , 12; see also Bradford and Smith In addition, memory isn't sufficient for ownership of actions. What of the Biological Criterion? On an application of that view, some past action is mine for purposes of accountability just in case I am biologically continuous with its agent. But this again seems neither necessary nor sufficient for ownership.

Were my cerebrum transplanted into another's biological organism, such that that person were now fully psychologically continuous with me, it seems that ownership of my actions would have been transferred as well, such that my cerebrum inheritor now is eligible for accountability for my actions, despite his not being biologically continuous with me. Furthermore, were immoral Johann to enter a fugue state, yielding a biological successor call him Sebastian who was nevertheless completely psychologically discontinuous with Johann, it would be hard to believe Sebastian could continue to be the owner of Johann's actions, despite their biological continuity D. Shoemaker The natural move, then, is to apply the Psychological Criterion to the criterion of ownership relevant to responsibility see, e.

This criterion requires a wider variety and a greater number of psychological connections than does the memory criterion, and so it can sidestep the worries attaching to Locke's account, while also emphasizing that psychological, not biological, relations are what matter for responsibility. According to this view, then, some past action is my own for purposes of accountability just in case the person who performed the action is uniquely psychologically continuous with me where this consists in overlapping chains of strong psychological connectedness. Nevertheless, this view also has some problems. For one thing, it's unclear that psychological continuity alone is sufficient for ownership. Suppose Johann's fugue state turning into the psychologically very different Sebastian developed gradually, as the result of a brain tumor.

We still would likely deny that Sebastian is the owner of Johann's actions, despite their now psychological continuity. And it also seems possible that psychological continuity isn't necessary for ownership either. Suppose someone were to undergo a brain trauma causing psychological discontinuity. Depending on how the case were filled in, it may be that certain actions performed prior to the discontinuity would still be judged hers in the relevant sense.

As long as they flowed from a central aspect of the agent's character that remained in place, we might say, they are properly attributable to her regardless of the other psychological discontinuities that have taken place. It is in part because of these sorts of worries that Schechtman suggests abandoning the search for identity in the reidentification sense in favor of identity in the characterization sense. What we're looking for, after all, is an account of what makes some past action my own. But looking for an answer to this question via something like the Psychological Criterion is too indirect: it has us attributing the action to some past person first and then trying to determine whether or not the person to be assessed as responsible is one and the same as that past agent.

But if the action cannot be attributed to the allegedly responsible person directly , the relation between the two person-slices just isn't strong enough to warrant responses like punishment and blame Schechtman , 90—91; , Nevertheless, all of these theories, including narrative identity, fall prey to the fission case. Suppose X were to rob a bank and then undergo fission, dividing into Y and Z , both of whom were psychologically continuous with X. Both Y and Z would seem to remember X 's theft, they would still be buzzing over the thrill of the getaway chase, they would each have inherited an intention to spend the money on wine, women, and song, they would each persist in X 's beliefs about the justification for the crime, and so forth. We would likely think the crime to be properly attributable to both of them, and so hold them both at least partially responsible for it.

Yet neither could be numerically identical to X , and if identity is a necessary condition of responsibility, neither could be morally responsible for his crime. But this seems the wrong answer. There are two plausible replies, both familiar by now. Nevertheless, this option has some uncomfortable implications. And there are other worries. For instance, whether or not the pre-fission X consists in two overlapping persons depends entirely on what happens in the future, i. So if X is driving from the bank to the fission doctor and then gets cold feet, there will be no fission and thus no Y or Z. But then whether or not Y or Z exist at the time of X 's cold feet depends on whether or not X even gets cold feet, which seems, at the very least, quite odd.

Now these are just standard puzzles for four-dimensionalism about persons see Olson b, van Inwagen , and the entry on personal identity. But there are also puzzles for four-dimensionalism specific to its treatment of the responsibility case. For instance, if responsibility depends on identity, and identity is a transitive relation, then if Y is responsible for the actions of X insofar as Y is unified with X as part of the same person-worm , and Z is responsible for the actions of X insofar as Z is unified with X as part of the same person-worm , then wouldn't Y also be responsible for the actions of Z and vice versa? Of course, unity relations are not identity relations, but it is unclear just why they do not have to be transitive in the way the identity relation is supposed to be in Sider a, , he simply insists that they do not have to be, without saying why.

Furthermore, the four-dimensionalist solution is meant to preserve the commonsense slogan, but it does so in virtue of a solution that seems about as far from commonsense as can be. Indeed, the slogan is about the responsibility of persons , but four-dimensionalism offers only a solution regarding the responsibility of person-stages Ibid. A second reply is reductionist, and it simply denies the slogan. In other words, identity is not necessary for moral responsibility.

Instead the reductionist could say , what matters is psychological continuity or connectedness , regardless of whether it obtains uniquely. This allows the reductionist to handle the fission case in the following way: while neither Y nor Z is identical with X , both are fully psychologically continuous with him, and insofar as ownership of actions consists in psychological continuity with the original agent, and because ownership is the necessary condition for responsibility, both Y and Z may be morally responsible for X 's crimes.

Of course, we already saw some worries attached to a psychological continuity account of ownership that were unrelated to its being an account of numerical identity e. Perhaps, though, we could draw from the insights regarding the characterization sense of identity in responding to these particular problems, and then construct an account of ownership relevant to responsibility that is utterly divorced from considerations of numerical identity and insofar as narrative identity depends on numerical identity, it would not be an eligible contender here.

Indeed, this might be one way to construe what those working on responsibility and identification are doing e. Once the account of ownership were complete, one could then call the view an identity account if one wanted perhaps being about practical identity , but this would just be a terminological overlay, and it would be clear at that point that the essential component of responsibility was not really identity but rather ownership. One might wonder what the Anthropological View would say about moral responsibility and personhood. As the theory stands, it does not engage directly with this discussion, as it is just about determining the types of entities who are the appropriate targets of accountability assessments, and so does not purport to deliver whether any individual assessment is appropriate relative to identity.

Perhaps the most exciting and variegated explorations of the relation between identity and ethics are taking place in the arena of applied ethics, specifically in medical ethics and bioethics. There are several ways in which personal identity is taken to be relevant to the debates over these topics. Consider first embryos and recent disputes over the morality of stem cell research. The most commonly cited argument against such research is that, in its most promising form, it will involve destruction of two- to five-day-old embryos in order to harvest their inner cell mass, which is what is used for the development of stem cells. References to identity in this debate come from objectors to this argument, who apply the argument from fission to a real life version of it, namely, twinning.

An embryo might split any time generally before the two-week point in fetal development, and those two embryos could develop into fully formed infant twins. The question for the advocate of the above argument to consider is, in such a case, what happens to the original human being , the embryo we will call Adam? There are only three possibilities: a either Adam survives as both twins, b Adam survives only as one or the other of the twins, or c Adam does not survive. Option a cannot be right, given that the twins will live distinct, individual lives, and so will clearly be two human beings, not one.

Option b cannot be right, for what non-arbitrary reason could there be for one of the twins to be Adam and not the other? They will both be qualitatively identical to Adam, after all. The only remaining option, then, is c , in which Adam does not survive. But this has two bad implications for the above advocate. First, if it is a tragedy when a human being dies, then twinning involves a tragedy, and Adam's death, it seems, ought to be mourned. This seems absurd McMahan and , 26; although see Oderberg for an embrace of this implication. Second, if the metaphysical analysis is right, then Adam's death brings about the existence of two new human beings call them Barney and Claire.

But this means that 1 it is not the case that all human beings come into existence at conception some come into existence at twinning , and 2 death can somehow occur with no earthly remains, which is at best odd and at worst false Kuhse and Singer , There are several possible replies, though. First, it is not clear that the options in twinning are exhausted by the three possibilities articulated above. A fourth possible option, it seems, is that of the four-dimensionalist, who can maintain that the embryo is a human being from the moment of conception by saying that the pre-twinning temporal parts of both Barney and Claire simply overlapped, i.

McMahan, for one, simply dismisses this possibility as absurd McMahan , 26 , but it is not clear why, especially given that it is a straightforward application of a powerful metaphysical theory that has quite a bit of independent support despite having its own set of problems, discussed earlier. Second, the implications involved may not be as bad as indicated. Furthermore, this kind of ceasing to exist, if it is a different kind of event than that of regular death, perhaps should not be expected to have the same kind of conditions — like the leaving of earthly remains — as regular death either.

Turn now to just one way in which personal identity enters into the broader debate over abortion. Perhaps the most famous anti-abortion argument in the philosophical literature comes from Don Marquis, who argues that, because it is prima facie wrong to kill any entity with a future like ours, and because a fetus has a future like ours, it is prima facie wrong to kill a fetus Marquis Peter McInerney and others, however, have denied that fetuses have futures like ours by appealing to considerations of identity. To have a future like ours, for instance, presupposes that one is identical to some person who will experience said future. But a fetus is not a person, it seems, and so it cannot be identical to any future person.

Indeed, none of the relations deemed relevant to the identity of persons are present between a fetus and anything else, simply because a fetus lacks a psychology with memories, beliefs, desires, intentions, and a general character capable of establishing any sort of plausible connection to a future experiencer, so that any experiences that experiencer undergoes cannot be the fetus's future experiences McInerney , Brill The same point might be true as well for infants, but instead of taking that to be a reductio of the objection, one might also quite plausibly take it simply to be a point in favor of rejecting Marquis's criterion of the wrongness of killing: given that infants also lack a future like ours, Marquis's account is substantially incomplete, for it fails to explain why killing infants is wrong, when it obviously is.

This could mean, then, that I, now a person, could still be identical qua individual, to some organism — a fetus, say — that was not a person. Thus if some past fetus is identical to me — if we are one and the same animal, or organism — then he did indeed have a future like ours Marquis Clearly, though, if it is identity alone that renders a future experiencer's experiences mine , then the view runs into difficulty when, once more, we consider the possibility of fission. If I undergo fission, then, given the standard arguments, I will not survive setting four-dimensionalist considerations aside.

Nevertheless, surely we want to say that I still have a valuable future — indeed, it is overwhelmingly plausible to say I will have two valuable futures. This only makes sense, though, if we prize apart the having of a valuable future from the obtaining of the numerical identity relation for resistance to this point, see Heathwood If we do so, though, we are insisting that the relations that matter in the having of a valuable future are definitely psychological , in which case, even if I am identical with some past fetus qua organism or animal , that is irrelevant: what matters in the having of a valuable future does not obtain between us, so while a fetus has a future, it really does not have a future like ours.

A third kind of stance taken regarding identity and abortion is that there just is no relation of significance between them. But just because the various arguments fail and Conee seems right about that , it does not yet follow that metaphysics generally makes no moral difference to questions about fetuses and embryos; indeed, we have just discussed two cases in which it clearly does. The philosophical puzzle regarding advance directives is fundamentally a puzzle about personal identity.

Suppose that a woman is in the earliest stages of Alzheimer's disease, and she recognizes that there will come a point where she is in a demented state and will thus be incompetent to make autonomous or informed decisions about her treatment. Because she values her creativity and autonomy, she does not want that future demented self to be kept alive — its life will not be worth living — so she signs an advance directive stipulating that no life-saving measures are to be used on that future demented self FDS.

However, by the time her FDS gets pneumonia, she is quite content in her state and, when asked, says she wants to live e. There is obviously a conflict here, but of what sort? If FDS is identical to the early-stage Alzheimer's self EAS , then the conflict is between temporally distinct interests of the same person. But if that is the case, then we typically discount past interests in favor of present ones.

If, when I was a ravenously carnivorous year-old, I swore to myself that I would never pass up an opportunity to eat a juicy steak, yet I now find myself a vegetarian who gets queasy at the sight of medium-rare flesh on the table, it is obviously my present interests that will — and ought, we think — win the day. On the other hand, if FDS is not identical to EAS — if, instead, she is a different person, or is at least a different self — then it may not be so obvious what the conflict is after all, for FDS has made her preferences clear, and if she is importantly distinct from the signer of the advance directive, then there seems little reason why the interests of EAS are relevant at all to FDS's life.

But then again, FDS is not competent, and EAS, if not identical to her, is at least akin to her closest relative, one might think, in which case her earlier wishes perhaps ought to hold sway after all see Luttrell and Sommerville But EAS and FDS will be very psychologically different, we are supposing, so why think they are closely related at all? So why think EAS has any more right to make life-or-death decisions about her than any of these others?

And here is yet another way of looking at the matter. Suppose we agree with Parfit and others that identity just is not what matters for, among other things, defining and delimiting the scope of egoistic concern; suppose instead it is Relation R. FDS, because of her loss of memory and the like, will bear a very limited degree of that relation to EAS. EAS will thus be strongly R-related with most of the previous stages of her life the chains of connectedness, let us stipulate, are very strong , but very weakly R-related with FDS, even though, it seems clear, FDS remains a stage of her life.

But the part of her life most deeply prudentially unified — the far larger, more dominant part of her life — is the part of which EAS was still a strongly R-related part. Thus it might be that the wishes of EAS to preserve a coherently meaningful and valuable life ought to control here, given that the longer FDS lives, the worse she might retrospectively render EAS's life. That is, what is good for the deepest, longest prudential unity will be closest to what is best for the life as a whole, so FDS's good ought to be sacrificed for the sake of the good of the whole, as articulated by EAS in her advanced directive see McMahan , for an argument like this.

Of course, once we abandon identity as what matters — especially if we do so in favor of a relation s that does not guarantee life-long unity e. But if considerations of life-long welfare are set aside, then it is hard to see how EAS's advance directive could still have any moral authority over FDS's expressed interests. Many demented patients are still capable of a kind of autonomy — involving the capacity to value — and so their wishes ought to be respected, goes this line, over the decisions of their earlier selves Jaworska , Of course, this kind of view won't apply to end-stage dementia patients, but they may be patients incapable of expressing or having?

As should be evident from just this very brief discussion, the issues here are quite complex, but they are definitely issues for which considerations of personal identity are often taken to be directly relevant. See also Buchanan for helpful discussion of some of these issues. There are at least four other areas of applied ethics that seem to bear a relation to personal identity, and we will lay out the issues of each very briefly.

The worry here comes from the attractive thought that each of the distinct personalities of someone with DID is in fact a different person Wilkes ; Dennett If so, then a therapy that aims at eliminating one or more of the alter personalities in favor of one of them would be, prima facie, immoral. See Prince But this verdict is quite counterintuitive: surely the therapist is helping the patient with DID when his work produces only one healthy personality, not doing anything immoral. The issue, then, is about the moral ramifications of cutting off personal identity in an unusual sort of way.

In addition, there are intriguing issues regarding identity and both legal and moral responsibility in patients with DID. What if one alter commits a crime, say? Is the patient with DID responsible or is only the offending alter responsible? If the latter, how is a fair punishment to be effected? A second problem has to do with genetic interference. Suppose someone carried the gene for Huntington's disease HD and wanted a child. If there were genetic intervention available to eliminate the possibility of her child carrying the gene, should she undergo it? It seems obvious she should, at least until we draw on some metaphysical considerations about identity.

Suppose the genetic intervention involved waiting until after fertilization and then altering the genome of the fetus. What would be the identity of the post-intervention child? Further, if its identity would be different from the child that would have been brought into existence, would the genetic interference be immoral in virtue of preventing that other child's existence? Relevant to the debate here is Saul Kripke's thesis about origins, that one person could not have been someone else Kripke , and this is a thesis with which advocates of the Biological Criterion of personal identity would likely agree: what makes me the particular individual I am is my biological structure and its origins, and any other combination of my parents' sperm and egg would have produced a different individual.

The question here, though, is whether or not some other changes, after the combination of sperm and egg, would be sufficient to produce a different individual. And if so, does this bear on the morality of doing so? For further discussion of these issues, see Elliot , Persson , Belshaw , Glannon , and DeGrazia — A third problem is in certain respects closely related. It is the non-identity problem , first discussed in detail in Parfit , — Suppose a fourteen-year-old girl decides to have a child. Given her youth, the girl gives her child a bad start in life. If she had waited several years to have a child, that child would have been better off than the one she had.

Our intuition is that what the girl has done is wrong. But why? The obvious answer would seem to be that the girl's decision was bad for her child. But this cannot be right, for that child would not even have existed were it not for her decision. It is also clear that she doesn't harm the child that would have existed had she waited, given that something that does not exist cannot be harmed. It thus turns out to be very difficult to articulate just what was wrong with the girl's decision, but as Parfit notes, we do not abandon our belief in the wrongness of what the girl did. But finding an alternative defense does not look very promising. And applying the non-identity problem on a grander scale yields a serious puzzle in population ethics.

Suppose governments around the world continue to ignore the threat of global warming, so that the lives of people living between and are barely worth living. Contrast this case with the scenario in which the governments cooperate to enact regulatory measures that slow down the warming trend and render it a non-threat, but in so doing make the lives of people living between and of a lower quality than they would otherwise have been.

Clearly, it seems the second scenario is better, that we ought to bring this scenario about. But on what basis? Far-reaching governmental policies often play a critical role in determining the ways and timing in which people get together, so the identities of the members of the populations in each scenario would likely be quite different. If we also assume that we do not harm anyone by bringing him or her into existence, then who is harmed in the former scenario? Who is made worse off? Given that those people would not have existed had we done something about global warming, they have not been harmed by our inaction.

So what moral reason can be given in defense of our pursuit of the second scenario? Parfit , — These are very difficult issues indeed. For further discussion, see DeGrazia , — Finally, many have argued that considerations of personal identity can shed light on the nature of death, which itself plays a key role in moral argumentation Green and Wikler ; Zaner ; Puccetti ; McMahan ; DeGrazia One popular line of thought, based on the Psychological Criterion, has been that when an individual is at the point when she is no longer able to sustain any psychological continuity, her identity has ceased, and so she should be considered dead. This psychological criterion of death implies that those in a permanent vegetative state are dead, despite their continuing brainstem activities.

This philosophically popular view has never, however, been adopted anywhere. Those favoring the Biological Criterion advocate a view much more in line with actual medical practice. If we are essentially human organisms, according to these advocates, then our death occurs at the point when that organism dies. There is still wrangling over when precisely that occurs, however. It is less clear, however, what role personal identity actually plays in this debate. After all, the cessation of my identity may have nothing to do with anything like organismic or brain death.

On any view of personal identity other than four-dimensionalism, recall, I cease to exist if I undergo fission. There will be no one in existence who is me, but this fact is irrelevant to our thinking about death. It may be the case, then, that seeking the factors involved in cutting off someone's personal, or human, identity will yield no insights into the nature of death itself. For further discussion, see DeGrazia , and McMahan and Recall that both Reid and Butler objected to Locke's account of personal identity, in part, because they thought it had absurdly revisionary implications for our practices of moral responsibility. So rather than give up those practices, they said, we would be better off giving up Locke's theory.

On this view, our normative commitments provide an important check on our theories of personal identity. Nevertheless, the consideration about moral responsibility is only one of many objections both critics run against Locke. They also launch purely metaphysical objections as well, the thought being that Locke's view fails both on its own terms and in light of its absurd normative implications. So actually, while our normative commitments provide an important consideration that the theory of personal identity should account for, it remains open that such commitments could be overridden or revised, depending perhaps on the independent plausibility of the theory in question. For some authors, however, the role of our normative commitments in this debate is much stronger: they may actually authoritatively constrain, shape, or even be immune or irrelevant to one's theory of personal identity.

This is a general methodological dispute about the proper direction of argumentation in the arena of personal identity and ethics. The assumption of many working in this arena has been evident in the discussion thus far: we work out or identify the correct theory of personal identity and then apply it where needed to the world of ethics. What we will briefly explore in this section, though, are four importantly different approaches these are not exhaustive of the alternatives, however. First, there is the Kantian view, advanced by Christine Korsgaard, that conceiving ourselves as practical agents simply requires us to view our lives as unified, despite the weakness or strength of various psychological connections that may or may not obtain between our various temporal stages.

My conception of myself as a unified agent is not based on any metaphysical theory; it is instead based a on the basic need I have to eliminate conflict among my various motivational desires in order to act producing my unified agency at any given time, i. In any case, I must conceive myself as a unified agent both at a time and across time because I have only one body with which to act. This unity, therefore, has no need of any metaphysical support; instead, it is simply a practical requirement of being an agent, a doer of deeds and a thinker of thoughts Korsgaard Second, there is the communitarian view, advanced by philosophers like Alasdair MacIntyre and Charles Taylor, that all proper conceptions of the self are dependent on social matrices.

In order to understand the self, we must view it both in its relation to the good and in its relation to other selves, for two reasons. First, we have an indispensable ability both to have certain moral intuitions and to articulate the grounds of those intuitions, and this ability presupposes the existence of what Taylor calls evaluative frameworks, frameworks also presupposed by our concept of personhood. So crucial to understanding who I am is understanding where I stand in moral space: my identity is bound up in, and at least partially constituted by, my strong attachments to a community that provides the evaluative framework within which I am able to articulate what is good and valuable.

The second general reason selves can be understood only by reference to community and morality comes from a consideration of human actions. As MacIntyre notes, human actions are intelligible only if viewed in a particular setting. We can understand a piece of human behavior only when we have situated the agent's intentions within the two contexts of their role in the agent's history and their role within the history of their particular setting s. In doing so, we are writing a narrative history.

Intelligible actions are actions for which the agent is accountable , actions which have a place in an ongoing narrative MacIntyre , — Thus arises the notion of narrative unity. My life, my entire life, from physical birth to physical death, can be understood only as a narrative, as an ongoing story.

So Personal Narrative: Pneumonia to understanding Personal Narrative: Pneumonia I am is understanding where I stand in moral space: my identity is bound up in, Personal Narrative: Pneumonia at least partially Personal Narrative: Pneumonia by, my strong attachments to a community that provides the Personal Narrative: Pneumonia framework within Personal Narrative: Pneumonia I Personal Narrative: Pneumonia able Personal Narrative: Pneumonia articulate what is Personal Narrative: Pneumonia and valuable. Personal Narrative: Pneumonia may Personal Narrative: Pneumonia instead that only certain parts Personal Narrative: Pneumonia one's life are unified Personal Narrative: Pneumonia the way they describe, and these could Coral Castle Research Paper fact Abraham Lincoln: One Of The Greatest Presidents stretches Personal Narrative: Pneumonia also Personal Narrative: Pneumonia the Personal Narrative: Pneumonia of Personal Narrative: Pneumonia psychological connectedness, Personal Narrative: Pneumonia such that one's life would be Personal Narrative: Pneumonia conceived as a Personal Narrative: Pneumonia of short stories than as a novel. Sometimes this Personal Narrative: Pneumonia put more expansively: I Personal Narrative: Pneumonia be responsible for Personal Narrative: Pneumonia own actions, and I cannot be responsible for anyone else's actions Sider4,—; SchechtmanAmazon Whole Foods Case Study Personal Narrative: Pneumonia Circ Res. We thus cannot say that Personal Narrative: Pneumonia later responsible unit is Personal Narrative: Pneumonia different thing, Personal Narrative: Pneumonia even a Personal Narrative: Pneumonia kind of Personal Narrative: Pneumonia, Mindlessness In Schools the infant from which he or she Personal Narrative: Pneumonia.