 Now consider some worries about extrinsic instrumentalism, which says that something is extrinsically good or bad for us only if it causes us to have things that are intrinsically good or bad for us. This view overlooks something that Thomas Nagel (1970) noted in his seminal essay “Death,” namely the fact that things may be extrinsically good or bad for us, other things being equal, by virtue of causing us not to have—by virtue of precluding our having—things that are intrinsically good or bad for us. Consider that being rendered unconscious prior to surgery is extrinsically good for a patient who otherwise would endure great suffering when the physicians apply the knife, in that it keeps him from suffering, and not because it causes him to accrue pleasure or some other good. Of course, after waking, the patient might also accrue pleasure or some other good as an indirect result of having been sedated, but in view of the suffering that it averts, being sedated is extrinsically good for him whether he receives that indirect bonus or not. As well, being made unconscious might be extrinsically bad for a person, say when it precedes, not surgery, but rather some joyous occasion he will miss because he is not conscious while it occurs. It is extrinsically bad for him, in this case, because it prevents him from taking joy in the occasion he misses. This remains true whether or not he also accrues some pain or other intrinsic evil as an indirect result of being sedated.