Advance Directives and Personal Identity

University dissertation from Acta Universitatis Stockholmiensis

Abstract: Advance directives are instructions given by patients – or potential patients – specifying what actions ought to be taken for their health in the event that they are no longer capable to make decisions due to illness or incapacity. Over the last decades, there has been a rising tide in favour of advance directives: not only is the use of such directives recommended by most medical and advisory bodies, they are also gaining increasing legal recognition in many parts of the world.This book, however, takes as its point of departure one of the most commonly discussed medical-ethical arguments against granting advance directives moral force: the Objection from Personal Identity. The adherers of this objection basically asserts that when there is lacking psychological continuity between the person who formulated the advance directive and the later patient to whom it supposedly applies, this seriously threatens the directive’s moral authority. And, further, that this is so because lacking sufficient psychological continuity implies that the author of the advance directive is numerically distinct from the later patient.Although this argument has some initial appeal, most philosophers in the advance directives debate maintain that the Objection from Personal Identity fails, but suggest different reasons as to why. Whereas some argue that the objection has no force because it rests on faulty beliefs about personal identity, others argue that we ought to grant advance directives moral authority even if the author and the later patient are numerically distinct beings. This book investigates some of the most influential of these arguments and reaches the conclusion that the Objection from Personal Identity has more to it than is usually recognized in the medical-ethical debate. Lacking sufficient psychological continuity between author and later patient, it is concluded, does threaten the moral authority of the advance directive.

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