Which Anaesthetic To Choose?
post by dadadarren · 2023-10-14T14:55:42.572Z · LW · GW · 15 commentsContents
Two Anaesthetics Reflective Inconsistency Decision Theories None 15 comments
In causal decision theory, the perspective/indexical aspect could lead to reflective inconsistency. This is generally regarded as a problem. Here I present a thought experiment to show why this view may require further review.
Two Anaesthetics
Suppose you are about to undergo a major operation. You can choose one of the following two anesthetics:
Drug A functions as follows:
- It paralyzes your body and relaxes your muscles
- It prevents long-term memory from forming for the duration of the operation
Drug B functions as follows:
- It paralyzes your body and relaxes your muscles (same as A)
- It renders you unconscious for the duration of the operation
Suppose the two drugs are equal in all other considerations such as safety, long-term side effects, etc. But Drug A is covered by your health insurance while Drug B requires you to pay 1 dollar out-of-pocket. What would you pick?
Reflective Inconsistency
Drug A would lead to the dreaded anesthesia awareness, that you will feel the excruciating pain and trauma of being operated on. To prevent it from happening, for the mere cost of 1 dollar, Drug B is the obvious choice.
Yet for moments after the operation, you would be wishing that you had chosen Drug A instead. The choice of drugs does not lead to any long-term difference, other than the fact that you would be 1 dollar richer if you had gone with Drug A. Furthermore, you know this before the operation.
If the later you dictate your current decision it would mean Drug A is the clear winner. (Consider this as a case of post-commitment, in contrast to pre-commitments where an earlier self takes away the decision at a later point, often appearing in decision-making problems such as Parfit's Hitchhiker) Hence the inconsistency.
Decision Theories
CDT has a naturally built-in indexical element. Considering the fact that the decision is based on a pre-operation perspective, it will choose Drug B over A.
However, for non-indexical decision theories, such as UDT or EDT, the approach would be less clear, and it could very well lead to choosing Drug A. Should it only consider the utility at the end of the experiment? Or should it get around the indexicals with some self-sampling assumptions like common camps in anthropics? Neither approach seems problem-free.
15 comments
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comment by Donald Hobson (donald-hobson) · 2023-10-14T15:50:06.259Z · LW(p) · GW(p)
Yet for moments after the operation, you would be wishing that you had chosen Drug A instead.
Why?
I can care about the whole 4d block. The journey not just the destination.
Suppose that the universe would cease to exist at some point in the future. And you will be alive to the end. At the last instant, nothing you can do can effect reality in any way. The future is empty either way. Therefore all past decisions were equally good?
No. When judging a decision, we look out over all the things effected, whether past or future.
Drug B without regret.
Replies from: dave-orr, Viliam, dadadarren↑ comment by Dave Orr (dave-orr) · 2023-10-14T16:40:05.648Z · LW(p) · GW(p)
I agree with this.
Consider a hypothetical: there are two drugs we could use to execute prisoners convinced with the death penalty. One of them causes excruciating pain, the other does not, but costs more.
Would we feel that we would rather use the torture drug later? After all, the dude is dead, so he doesn't care either way.
I have a pretty strong intuition that those drugs are not similar. Same thing with the anesthesia example.
↑ comment by dadadarren · 2023-10-15T00:21:18.717Z · LW(p) · GW(p)
Well, I didn't expect this to be the majority opinion. I guess I was too in my head.
But to explain my rationale: The effects of the two drugs only differ during the operation, their end results are identical. So after the operation, barring external records like bank account information, there is no way to even tell which drug I took, their result would be the same. Taking external records into consideration, the extra dollar in the bank would certainly be more welcomed.
The memory-inhibiting part was supposed to preclude the journey consideration. From a post-operation perspective, there is no experience of a "journey" to talk about. Now it's clear to me that people would evaluate it regardless of the memory part.
Replies from: nathaniel-monson↑ comment by Nathaniel Monson (nathaniel-monson) · 2023-10-15T02:54:57.593Z · LW(p) · GW(p)
I don't think the end result is identical. If you take B, you now have evidence that, if a similar situation arises again, you won't have to experience excruciating pain. Your past actions and decisions are relevant evidence of future actions and decisions. If you take drug A, your chance of experiencing excruciating pain at some point in the future goes up (at least your subjective estimation of the probability should probably go up at least a bit.) I would pay a dollar to lower my best rational estimate of the chance of something like that happening to me--wouldn't you?
comment by nim · 2023-10-14T17:12:32.937Z · LW(p) · GW(p)
Based on my understanding of how medicine actually works in the world, I find it highly implausible that such a pair of drugs with truly identical long-term medical outcomes could exist.
If there is truly no difference at all between clinical outcomes, how did they gather the data about one drug inhibiting memory formation via the mechanism of unconsciousness and the other inhibiting memory formation via a presumably different mechanism? If we know that drug A causes anesthesia awareness and drug B does not, how do we know that? There has to have been some observable difference in the drugs' effects. If there was no observable difference in their effects, the whole thought experiment would not make sense.
Maybe drug A paralyzes everything but the pupils. Maybe drug A lets the patient continue breathing on their own instead of requiring the services of a vent tech. If that's how we can tell that it's causing anesthesia awareness, those features of it are likely to be medically relevant in some cases.
Maybe we know patients are conscious under drug A due to a spike in stress hormones measured in the blood or something. If so, that's likely to impact patient outcomes -- we know that stress and immune response and healing all interconnect in complicated ways.
In short, if someone claims to me that two drugs are perfectly identical except one causes anesthesia awareness, I will distrust the whole experiment, because only erroneous or incomplete data would lead to the mutually exclusive claims of "there are important differences between the drugs" and "there are no important differences between the drugs".
comment by Samuel Hapák (hleumas) · 2023-10-14T21:22:33.231Z · LW(p) · GW(p)
If I would have to choose between drug A and no drug at all, I will take no drug any time. Why would I want to not have the memories but live through the experience? That’s really silly.
Replies from: Dagon↑ comment by Dagon · 2023-10-14T21:33:52.602Z · LW(p) · GW(p)
This is a good extension. If there were a paralytic (so they can actually operate without you flinching) that didn't affect experience or memory, would you prefer that, and why?
Personally, I'm skeptical that pain leaves no trace on one's psyche, regardless of whether short-term memories are being suppressed. But I know of no studies or tests for that, so one's assumptions about things like that are going to dominate the choice here.
Replies from: hleumas↑ comment by Samuel Hapák (hleumas) · 2023-10-14T21:39:37.650Z · LW(p) · GW(p)
Well, first I would prefer actual anesthetic that would render me unconscious. But if that’s not available, then I would rather retain my memories than not.
Replies from: Dagon↑ comment by Dagon · 2023-10-14T22:37:21.027Z · LW(p) · GW(p)
Fascinating set of preferences. I have to admit that I don't understand. I can understand the "all experiences and memories thereof are valuable" position, where you would prefer not to be unconscious. I can undersand the "don't care about non-remembered experiences" position, where you'll take the memory-eraser to save $1.
I don't understand the model of value and impact of experiences which leads to a preference to be fully unconscious, but also rather be unconscious, but ALSO would rather remember the pain than forget it.
↑ comment by Samuel Hapák (hleumas) · 2023-10-14T23:06:54.690Z · LW(p) · GW(p)
Well, I am not a masochist. I don't like experiencing pain. Do you? ;-)
Yet, I experienced lot's of painful moments in my life, as I guess everyone. And I mean both physical and psychological. Now, I am not traumatised by these memories. I am not trying to get rid of them, why would I? They are often valuable lessons and they help me better calibrate what to expect from the future experiences.
For many, I am glad they happened. I believe that some amount of painful experiences is good for people to experience. Pain makes you grow.
For some, I don't think the value for pain was good enough and if I could choose, I would rather not experience them. But, does that mean I should wish to get rid of the value (memory) now that the price is paid (pain?)? That would be silly, wouldn't it?
Replies from: Dagon↑ comment by Dagon · 2023-10-14T23:18:02.255Z · LW(p) · GW(p)
I could choose, I would rather not experience them. But, does that mean I should wish to get rid of the value (memory) now that the price is paid (pain?)?
Well, yeah. The price (of remembering/re-experiencing the pain occasionally) is ongoing. It's not as immediate or intense as the original experience, but it's still there. My question is about the VALUE you get from the memory - it's hard for me to model that this value is positive, but not positive enough to avoid wishing the experience hadn't happened..
Replies from: hleumas↑ comment by Samuel Hapák (hleumas) · 2023-10-15T08:01:28.947Z · LW(p) · GW(p)
Well, I guess that our memories work differently then. I truly don’t have a single memory that I would wish not to have. I see them as value. I don’t really feel that I am paying any price just by having them.
comment by ProgramCrafter (programcrafter) · 2023-10-15T10:55:01.386Z · LW(p) · GW(p)
I think this is a highly frequent real-world scenario.
You have a week to complete optional but boring task that can benefit you in future or to do nothing (procrastinate? can this word apply to optional tasks?). Afterwards, you totally forget the emotions you had and are left with whatever you have done.
I think that people tend to really forget whether their activity was dull or interesting over time.