Dworkin on Dementia: Elegant Theory, Questionable Policy

Dresser, Rebecca

doi:10.2307/3527839

Cited by 234 publications

(106 citation statements)

References 5 publications

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“…And if the author and the future individual are not the same person, the directive cannot be applied. Regarding the second assumption, some (Dresser, 1995;Shiffrin, 2004) have argued that there are significant problems with the claim that the author can extend her autonomy, via what has been labelled precedent autonomy, into the future in the way needed for advance directives to be legitimate. The existence of this type of autonomy appears to entail problematic consequences.…”

Section: Introductionmentioning

confidence: 99%

Advance directives and knowledge of future selves

Buford

2017

Palgrave Commun

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A number of concerns have been raised with respect to advance directives. Advance directives are intended to allow a person who is currently capable of giving informed consent to determine how they are to be treated at a later time at which they are not competent to give such consent. For example, an advance directive such as a living will might specify that should a patient face severe dementia, certain forms of treatment should not be provided if needed to prolong life. Or an individual might fill out a do-not-resuscitate order asking not to be revived in the event of a heart attack. This article discusses three distinct arguments that have been offered against the legitimacy of some or all advance directives. After laying out each argument, focus is given to a potential response to one of the arguments in particular, an argument labelled the "Ignorance Argument". The argument contends that the potential application of any advance directive is plagued by a host of epistemic issues that are serious enough to hamper the very expression of autonomy advance directives are designed to allow for. A possible response to the argument is developed. The response suggests that the argument may place unduly severe constraints on the type of selfknowledge needed to underwrite the expression of a person's autonomy through the creation of an advance directive. The response identifies some connections between the different arguments. An answer is also given to a recent criticism, offered by Eric Vogelstein (2016), which questions the existence of the type of autonomy needed to underwrite advance directives.

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Section: Introductionmentioning

confidence: 99%

Advance directives and knowledge of future selves

Buford

2017

Palgrave Commun

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“…In representing and explaining the past and present, a narrative may form expectations about future events (Teichert 2004, p. 183) and what a person is likely to want or do in the future, even if these are not specifically attuned to the particular circumstances that person finds herself in. Whilst some have argued that a person who lacks capacity may have different interests from when they had capacity or, in some circumstances (such as patients with dementia) may be viewed as a different person (see for example Dresser, 1995), here we are interested in how best to meet to requirements of the Mental Capacity Act in the assessment of best interests.…”

Section: Drawing On Narrative Approachesmentioning

confidence: 99%

Patient narrative: an ‘on-switch’ for evaluating best interests

Johnston

Banner

Fenwick

2016

Journal of Social Welfare and Family Law

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This article examines how the wishes, feelings, values and beliefs of adults lacking capacity can be evaluated and the extent to which they are given effect in best interests' decisionmaking. One way of fulfilling the clinician's legal responsibilities to take a patient's preferences into account is to explicitly link these to the notion of narrative. Narratives provide a compelling grounding and give weight to views and values that may have been informally and consistently expressed in the past. An evaluation of recent case law suggests that the trajectory of a person's life, their character and personality, and the perspectives of those with whom the patient has valued relationship are given increasing judicial recognition.Attending to the narrative of the patient could lead to a more sophisticated judgement of best interests than an objective 'balance sheet' approach would allow and enable greater alignment with the UN Convention on the Rights of Persons with Disabilities.

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“…This objection seems even stronger when considering the opposite scenario, in which the living will insists on the continuation of every treatment available to sustain life, while the patient suffers from severe physical pain that is not relieved by palliative medicine. Many consider it simply unjustifiable to force patients with dementia to endure severe pain for the amount of time that currently available medical technology might allow (Dresser 1995).…”

Section: Conflicts In Valuesmentioning

confidence: 99%

Advance Directive

Arima¹,

Akabayashi²

2014

Encyclopedia of Global Bioethics

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This entry will discuss the historical developments, legal policies, and ethics related to advance directives. The historical and political information discussed is mostly based on cases from the USA and Benelux countries (Belgium, the Netherlands, and Luxembourg). The development of the US legal system is particularly important, due to its elaboration and influences on other countries. The Benelux countries also deserve special mention, due to their recent legalization of active euthanasia and the use of advance directives as a means to request it. The second half of this entry will discuss moral issues that relate to advance directives. Though the binding authorities of advance directives are strongly supported by the values of self-determination and the best interests of the individual, various objections to such binding authority will be addressed. Some objections point to the prevalence of practical obstacles that hamper the realization of these two values through the use of advance directives. Other objections emphasize the need for balancing these supporting values against other values that could prevent the absolute authority of advance directives from being realized.

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Dworkin on Dementia: Elegant Theory, Questionable Policy

Abstract: When patients have progressive and incurable dementia, should their advance directives always be followed? Contra Dworkin, Dresser argues that when patients remain able to enjoy and participate in their lives, directives to hasten death should sometimes be disregarded.

Cited by 234 publications

References 5 publications

Advance directives and knowledge of future selves

Advance directives and knowledge of future selves

Patient narrative: an ‘on-switch’ for evaluating best interests

Advance Directive

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