Abstract
Many people believe that we formulate advance directives in order to care for our own future and that our directives have moral authority just when this is competently done. By implying that the signer of the directive cannot survive serious mental impairment, popular philosophical thinking about personal identity threatens to undermine this pair of convictions. Some philosophers react by denying the second conviction. According to them, advance directives should be followed even if the signer and the patient are two. The paper discusses three justifications for this claim and finds them all lacking. The ethics of advance directives cannot ignore the metaphysics of the person.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Similar content being viewed by others
Notes
- 1.
- 2.
Similar views (or views with similar consequences) are held by Baker (2000, p. 11), Shoemaker (2011, p. 360), and Lowe (2015, p. 146). Moreover, there is reason to believe that most contemporary adherents of the psychological view of personal identity are implicitly committed to something like the Parfitian position; see Olson (1997, pp. 22–27) and Witt and Olson (2020, § 2).
- 3.
Perhaps they needn’t, but this is another story; see Witt (2020).
- 4.
Birnbacher might be an exception; see Birnbacher (2016, p. 286).
- 5.
In the quoted passage Holm writes that the lack of identity should not ‘solely’ govern the relations between signer and patient. But I have been unable to find what the limited role of personal identity that is implied by this remark might be.
- 6.
- 7.
Note once more how the second condition’s formulation muddies the waters. In demanding that narrative fit requires continuers to be ‘faithful to who the patient was’ (my emphasis) the quoted passage suggests that the patient is the signer—something Blustein officially denies. Given his Parfitian assumptions about our persistence, the continuation of the signer’s narrative can only be faithful to who the signer was.
- 8.
See also Müller et al. (2017, 300f). Some philosophers claim that advance directives have moral force because they contain the signer’s ‘surviving interests’ and because satisfying these interests improve the signer’s life even after she is dead and gone; see Buchanan and Brock (1990, pp. 162–164) and Shoemaker (2010, 488f). The view is obviously related to the pragmatic approach, but deserves a discussion of its own.
References
Alexander, Larry and Moore, Michael. 2016. Deontological Ethics, ed. by E.N Zalta. Stanford Encyclopaedia of Philosophy.
Baker, Lynne Rudder. 2000. Persons and Bodies: A Constitution View. Cambridge: Cambridge University Press.
Beauchamp, Tom L., and James F. Childress. 2013. Principles of Biomedical Ethics. New York: Oxford University Press.
Birnbacher, Dieter. 2016. Patientenverfügungen und Advance Care Planning bei Demenz und anderen kognitiven Beeinträchtigungen. Zeitschrift für Ethik in der Medizin 28: 283–294.
Blustein, Jeffrey. 1999. Choosing for Others as Continuing a Life Story: The Problem of Personal Identity Revisited. Journal of Law, Medicine and Ethics 27: 20–31.
Brock, Dan W. 1993. Truth or Consequences: The Role of Philosophers in Policy-Making. In Life and Death. Philosophical Essays in Biomedical Ethics ed. by Dan W. Brock, 408–416. Cambridge: Cambridge University Press.
Buchanan, Allen E. and Dan W. Brock. 1990. Deciding for Others. The Ethics of Surrogate Decision Making. Cambridge: Cambridge University Press.
Davis, Dena S. 2014. Alzheimer Disease and Pre-Emptive Suicide. Journal of Medical Ethics 40: 543–549.
DeGrazia, David. 2005. Human Identity and Bioethics. Cambridge: Cambridge University Press.
DeMarco, Joseph P., and Samuel H. LiPuma. 2016. Dementia, Advance Directives, and Discontinuity of Personality. Cambridge Quarterly of Healthcare Ethics 35: 674–685.
Dresser, Rebecca. 1986. Life, Death, and Incompetent Patients. Conceptual Infirmities and Hidden Values in the Law. Arizona Law Review 28: 373–405.
Dresser, Rebecca. 1995. Dworkin on Dementia. Elegant Theory, Questionable Policy. The Hastings Center Report 25 (5), 32–38.
Dresser, Rebecca, and John A. Robertson. 1989. Quality of Life and Non-Treatment Decisions for Incompetent Patients. A Critique of the Orthodox Approach. Law, Medicine & Health Care 1: 234–244.
Dworkin, Ronald M. 1993. Life’s Dominion. An Argument About Abortion, Euthanasia, and Individual Freedom. New York: Knopf.
Furberg, Elisabeth. 2012. Advance Directives and Personal Identity: What is the Problem? Journal of Medicine and Philosophy 37: 60–73.
Harvey, Martin. 2006. Advance Directives and the Severely Demented. Journal of Medicine and Philosophy 31: 47–64.
Holm, Soren. 2001. Autonomy, Authenticity, or Best Interest: Everyday Decision-Making and Persons with Dementia. Medicine, Health Care and Philosophy 4: 153–159.
Jecker, Nancy. 2016. Advance Care Planning: What Gives Prior Wishes Normative Force? Asian Bioethics Review 8: 195–210.
Jox, Ralf. 2006. Der ‘natürliche Wille’ als Entscheidungskriterium: Rechtliche, handlungstheoretische und ethische Aspekte. In Entscheidungen am Lebensende in der modernen Medizin: Ethik, Recht, Ökonomie und Klinik, ed. Jan Schildmann, Uwe Fahr, and Jochen Vollmann, 73–90. Berlin: Lit Verlag.
Kuczewski, Mark G. 1994. Whose Will Is It, Anyway? A Discussion of Advance Directives, Personal Identity, and Consensus in Medical Ethics. Bioethics 8: 27–48.
Kuhse, Helga. 1999. Some Reflections on the Problem of Advance Directives, Personhood, and Personal Identity. Kennedy Institute of Ethics journal 9 (4): 347–364.
Lohmar, Achim. 2017. Falsches moralisches Bewusstsein. Eine Kritik an der Idee der Menschenwürde. Hamburg: Meiner.
Lowe, E. J. 2015. The Probable Simplicity of Personal Identity. In Personal Identity ed. by Georg Gasser and Matthias Stefan, 137–155. Cambridge: Cambridge University Press.
McMahan, Jeff. 2002. The Ethics of Killing. Problems at the Margins of Life. New York: Oxford University Press.
Merkel, Reinhard. 2004. Zur Frage der Verbindlichkeit von Patientenverfügungen. Eine notwendige Ergänzung der bisher in Deutschland geläufigen Argumente. Zeitschrift für Ethik in der Medizin 16: 298–307.
Müller, Sabine, Merlin Bittlinger, and Henrik Walter. 2017. Threats to Neurosurgical Patients Posed by the Personal Identity Debate. Neuroethics 10: 299–310.
Olson, Eric T. 1997. The Human Animal. Personal Identity Without Psychology. Oxford: Oxford University Press.
Olson, Eric T. 2017. Personal Identity. In Stanford Encyclopaedia of Philosophy, ed. by Edward N. Zalta.
Parfit, Derek. 1984. Reasons and Persons. Oxford: Clarendon Press.
Quante, Michael. 1999. Precedent Autonomy and Personal Identity. Kennedy Institute of Ethics Journal 9: 365–381.
Schechtman, Marya. 1996. The Constitution of Selves. Ithaca, London: Cornell University Press.
Schöne-Seifert, Bettina, Uerpmann, Anna Lena, Gerß, Joachim, Herr, Davi. 2016. Advance (Meta-) Directives for Patients with Dementia Who Appear Content: Learning from a Nationwide Survey. Journal of the American Medical Directors Association 17 (4): 294–299.
Shoemaker, David. 2009. Personal Identity and Ethics. A Brief Introduction. Peterborough: Broadview Press.
Shoemaker, David. 2010. The Insignificance of Personal Identity for Bioethics. Bioethics 24 (9): 481–489.
Shoemaker, Sydney. 2006. Identity and Identities. Daedalus 135: 40–48.
Shoemaker, Sydney. 2011. On What We are. In The Oxford Handbook of the Self, ed. Shaun Gallagher, 352–371. Oxford: Oxford University Press.
Vogelstein, Eric T. 2016. Autonomy and the Moral Authority of Advance Directives. Journal of Medicine and Philosophy 41 (5): 500–520.
Witt, Karsten. 2020. In Defence of Advance Directives in Dementia. Pacific Philosophical Quarterly 101: 2–21.
Witt, Karsten, and Eric T. Olson. 2020. Against Person Essentialism. Mind. DOI 10.1093/mind/fzaa016.
Witt, Karsten, Johanne Stümpel, and Christiane Woopen. 2017. Caregiver Burden and the Medical Ethos. Medicine, Health Care and Philosophy 20: 383–391.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2020 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Witt, K. (2020). Personal Identity and the Moral Authority of Advance Directives. In: Kühler, M., Mitrović, V.L. (eds) Theories of the Self and Autonomy in Medical Ethics. The International Library of Bioethics, vol 83. Springer, Cham. https://doi.org/10.1007/978-3-030-56703-3_4
Download citation
DOI: https://doi.org/10.1007/978-3-030-56703-3_4
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-56702-6
Online ISBN: 978-3-030-56703-3
eBook Packages: Religion and PhilosophyPhilosophy and Religion (R0)