The practical difficulty of drawing a distinction does not dissolve the metaphysical reality of that distinction, as cases like the Craniotomy versus Hysterectomy illustrate structural differences in causal chains.

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Craniotomy versus Hysterectomy(as a specific case example): Two different medical procedures (one involving the skull, one involving the uterus) used here as examples to show how two things can be structurally different.
Metaphysical reality(as used in metaphysics): The deepest or most fundamental level of existence—the underlying nature of things beyond what we can directly see or measure.
causal chain(Avicenna's cosmological argument in Ilāhiyyāt VIII): An ordered series of causes within a given causal type (formal, material, efficient, or final) that Avicenna argues must terminate in a First Cause
distinction(One of the two components of Arendtian plurality): The aspect of plurality by which no two human beings are ever interchangeable, each being endowed with a unique biography and perspective on the world

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