Almost Over: Aging, Dying, Dead is a glance at the indispensable perspective of philosopher F. M. Kamm about some of the most pressing issues regarding the human condition. Kamm considers an impressively wide range of issues related to aging, dying and death in their ethical, existential, practical and legal dimensions. The main philosophical problems addressed in the book are why death is bad for the person who dies, when it might make sense to end one's life or to resist the means to prolong it (given one's quality of life), how aging relates to meaning of life and end-of-life decisions, and the reasonableness of physician-assisted suicide and euthanasia, both as a personal matter and as a matter of public policy.

In chapter 1, Kamm argues against the dominant view on why death is bad for the person dying, namely Deprivationism. This is the view that death is bad because it deprives us of future goods. The more future goods one is deprived of, the worse the death is. Kamm successfully casts doubt on the view by advancing pressing objections and by defending plausible alternatives to Deprivationism. Kamm argues for three views about the badness of death: Willhavehadism, Alloverism and Insultism. Willhavehadism is the view that the badness of death is a function of how many goods a person's life will have had by the time of her death. The fewer goods one has at that time, the worse the death is. According to Alloverism, death is bad because it intrinsically involves what Kamm calls the Extinction Factor of death, the end of oneself as a conscious and self-conscious being. Insultism is the view that death is bad because it exhibits Insult Factors, for example, vulnerability and decline of capacities.

Chapters 2 and 3 are about when it might make sense to end one's life or resist means to prolong it, given one's quality of life. In chapter 2, her main interlocutor is philosopher Shelly Kagan. Kamm points to some internal tensions within Kagan's view. She challenges the standard view represented by Kagan by arguing for what she calls a Prudential Prerogative: it is consistent with prudential rationality for a person not to maximize the overall good in her life when doing so would be very hard for her. This implies that it is reasonable for a person to end her life or resist means to prolong it when there is great suffering involved, even if there is even greater good in her life after the suffering.

In chapter 3, Kamm critically examines the views on the topic of physician Atul Gawande and compares them to Kagan's when it is relevant. Gawande argues that what matters most at the end of one's life is maintaining meaningful projects. Kamm argues that the presence of those projects is neither necessary nor sufficient to justify ending one's life. A person might have meaningful projects, yet it might make sense to end her life, and even in the absence of meaningful projects, it might make sense to stay alive.

In chapter 4, Kamm considers some views about advanced care (care for people with advanced illnesses) and end-of-life care, especially as expressed in several public documents: “Patient-Centered Care and Human Mentality,” a report of the coalition to Transform Advanced Care, a study conducted by members of the Beth Israel Hospital in Boston and “Peace, Equanimity and Acceptance in the Cancer Experience.” Kamm uses her philosophical expertise to evaluate these documents, to identify potential problems, and to provide valuable suggestions to address them. For example, Kamm argues that some of these documents, which try to discover patients’ desires and values, involve nudging, imprecision, and framing effects. At numerous points, Kamm suggests changes to avoid those issues. This is an inspiring guide for philosophers interested in playing a role in the production of similar reports and research results, and in turn in being useful to practitioners seeking guidance in those reports and research.

In chapter 5, Kamm distinguishes between being old (or young) and being aged. The former is about quantity of life, how long one has been alive. The latter is about quality of life such that one is aged when some of one's capacities are limited in a way that is common in a typical human old age. Kamm considers F. Scott Fitzgerald's story “The Curious Case of Benjamin Button” in order to reflect about the direction and distribution of goods in a life. Unlike us typical human beings, when Benjamin is young (say 5 years old), he is aged (he has diminished capacities as distinctive in the last part of a typical human being's life). He gets to a high point and his capacities decline as he becomes older until he becomes a typical human baby. Aging and its significance for the meaning of life have not been given a lot of attention in the philosophy of well-being literature. Kamm's chapter on aging is a welcome addition to the topic.

In chapter 6, Kamm continues her reflection on when it makes sense to die. She focuses on people who are not terminally or even seriously ill, but whose capacities are declining. She critically examines the view of Ezekiel Emanuel in his 2014 article “Why I hope to Die at 75.” She focuses on Emanuel's view because it is a paradigmatic instance of a family of views according to which it is morally permissible and reasonable to omit easy means to save one's life when one is aged. Kamm considers some implications of such views for public and personal action. Kamm argues that if these views are right, then it is morally permissible to end one's life by suicide, physician-assisted suicide and euthanasia. This conclusion puts pressure on those like Emanuel who have opposed physician-assisted suicide and euthanasia.

In chapter 7, Kamm gives several self-standing arguments for physician-assisted suicide and euthanasia and considers potential objections to these arguments. Some of those objections are based on the writings of Supreme Court Justice Neil Gorsuch. Gorsuch's arguments are based on the doctrine of double effect and whether physician-assisted suicide and euthanasia involve the intention to kill.

In Chapter 8, Kamm considers physician-assisted suicide and euthanasia as legal and public policy matters. Kamm argues that even if there was no constitutional right to physician-assisted suicide and euthanasia, considerations about what public policy to adopt need not go beyond rights talk to benefits and harms per se. Potential harms might also involve rights violations. In a brief appendix, Kamm considers whether a version of Cost-Effectiveness Analysis is consistent with fairness.

By its own right the content of the book is interesting and hugely appealing to a wide audience, basically anyone interested in issues related to aging, death and dying. The fact that Kamm engages with practitioners, clinicians and policymakers adds relevance to the book for these professionals. Unfortunately, some features of the book limit its power to reach effectively a general audience. The book presupposes that the reader has the skills of an academic philosopher, often one already familiar with the topics. Many moves in the dialectic happen too fast or are not explicit enough. The book deals with a wide range of interrelated issues, which makes it very dense.

In my experience, the book is best read as a collection of essays rather than a systematic treatment of a single issue. A disadvantage is that often one would have liked to read more about something or see an argument laid out more explicitly. The advantage for the reader is that each chapter is relatively self-standing and so it can be read separately. This gives readers some flexibility since they can choose what chapters to read according to their interests. For example, philosophers of well-being can read chapters 1–3. Professionals of advanced care and end-of-life care interested on Kamm's take on key documents can read chapter 4. Those interested in physician-assisted suicide and euthanasia can read chapters 7 and 8. Those interested in aging can read chapters 5 and 6.

In the rest of this book review, I raise a couple of concerns, one about Kamm's views on the badness of death, the other about the way she engages with practitioners. To understand the difference between Deprivationism and Willhavehadism, consider the death of a 20-year-old who would have lived 5 more years and the death of a 50-year-old who would have lived 20 more years (hold constant the contents of each year of their lives). According to Deprivationism, death is worse for the 50-year-old because this person misses out on more future goods than the 20-year-old. In contrast, for Willhavehadism death is worse for the 20-year-old because by the time this person dies, she will have had fewer goods than the 50-year-old.

It is clear how these two views are about the same kind of bad. The disagreement between them is about what goods are relevant to determine the badness of a death, the ones the person will have had by the time she dies or the future goods that death deprives her of. It is not so clear what kinds of bads are involved in Alloverism and Insultism and so whether they are genuine alternatives to Deprivationism.

As far as I can tell, according to Kamm, Deprivationism is wrong as an account of the badness of death because how bad death is does not depend on the future goods that death deprives us of, and because Deprivationism does not account for the Extinction Factor and for the Insult Factor.

I have some questions about this picture. The first is about the nature of the bads that are involved in the Extinction Factor and the Insult Factor. Kamm seems to accept that they are different kinds of bads. The Extinction Factor is supposed to be an intrinsic bad, a bad for the person regardless of the contents of that person's life. The Insult Factor might not be about the contents of a life, but about its shape. The idea seems to be that there is something bad about going from having well-functioning to poorly working capacities and to descend to a point of vulnerability from a point of strength. Perhaps there is something undignified about the descent. But are these bads prudential? Are they bad in a non-prudential way? Are they a sui generis kind of bad? In general, it would have been good to know more about Kamm's thoughts on this.

There is also an implication for the conclusions that we should draw about Deprivationism. It is not clear why Deprivationism should provide an account of the bads that Alloverism and Insultism are about, especially if these bads are not prudential. Imagine that there are factors that make a life better or worse from the aesthetic point of view. However, we might not want to fault Deprivationism for not giving an account of that kind of bad.

The second concern is a general worry about what I see as a pattern in the way Kamm thinks through some contributions by physicians and other practitioners. Take for example what Gawande says about what he calls “the dying role.” The dying role is the position that a person occupies at the end of her life where she is able to set her affairs in order, make amends, pass on wisdom, share memories, etc. Gawande says that the dying role is “among life's most important roles” (p. 72).

Against Gawande, Kamm presents the following hypothetical. Imagine that medicine could deny the dying role to people and instead of time in the dying role, the person could be in perfectly good health and have meaningful projects. Does it make sense for the person to exchange this for the dying role? Kamm argues that if it does, it follows that Gawande is wrong and the dying role is not among life's most important.

Kamm acknowledges that perhaps the dying role is still worthwhile when there are no other sources of meaning and that it might be unwise to interfere with meaningful projects (including the dying role), just for the slim chance of a successful medical treatment. She points out that perhaps the dying role is more important for some people than for others. Perhaps it matters a great deal to those who have lived so badly that they need to find peace or make amends.

I have a couple of points to make about this. First, Kamm's reading of Gawande's position strikes me as too strong. Given Gawande's practical goals as a physician, we might want to read Gawande as saying that the dying role is one of the most important in life, given how we actually are and the current state of medicine. If this is so, Kamm's hypothetical would not show that Gawande's position is wrong. Second, the weaker position that Kamm is willing to accept might be much more interesting than Kamm seems to think it is. It sounds right that the dying role is more important for some people than others, but it is an empirical question how many people actually benefit from the dying role. Kamm does not provide empirical evidence, so, for all we know, it could very well be that all of us would benefit from being in the dying role.

These points of concern, however, can only arise about a rich and deep book that constantly invites us to think more and more carefully about vitally important issues for us mortal creatures.