Advancing an Advance Directive Debate

Buford, Christopher

doi:10.1111/j.1467-8519.2008.00667.x

Cited by 11 publications

(3 citation statements)

References 6 publications

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“…Of course, we would still be left without an account of how it is that an advance directive authored by me could apply to a distinct individual. Further, some (Buford, 2008;Buford, 2014) have questioned the viability of accounts that attempt to reject the claim that identity is necessary for the legitimate employment of an advance directive. The main worry is that no other relation is up to the task of grounding the legitimacy of advance directives in the very cases the directive is created to address; one of the obvious replacement candidates, psychological continuity, is absent in some of the cases (for example, persistent vegetative state scenarios) where advance directives are often deemed applicable.…”

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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“…Granted advanced directives (AD) are meant to smoothen the pathway especially where treatment/intervention refusals are concerned, this in practice may not be the case, as there could be a personhood-based challenge to the AD. 21,28,29 The situation pitches the strength of autonomy against personhood (as a number), philosophically speaking. 30 The following issue was raised in this situation: is the patient with dementia at the EOL the same person the AD he or she signed meant to apply to.…”

Section: Discussionmentioning

confidence: 99%

End-of-Life Issues in Caring for Patients With Dementia

Coleman

2011

Am J Hosp Palliat Care

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The number of people suffering with dementia is increasing in the general population and the trend is projected to continue as people live longer, especially in countries with developed economies. The most common cause of dementia (among the many other causes) is Alzheimer's dementia, which is considered a terminal illness. The disease could eventually lead to death, or death could occur as a consequence of co-morbid physical complications. The problem of end of life (EOL) care for patients suffering from dementia though spoken of and written about, does not get the attention and system support as for example patients suffering from cancer receive. Many reasons have been advanced for the current state of affairs where EOL issues for patients suffering from dementia are concerned. This article attempts to revisit the issues, and the reasons, that may contribute to this. Some guidelines on palliative management in cases of patients suffering from severe dementia exist; the evidence base for these guidelines though is relatively weak. The ethical and legal issues that may influence or impact on the decision to initiate the palliative care pathway in the management of EOL issues for dementia patients in the terminal or end stage of the illness is highlighted. Initiatives by the department of health in England and Wales, and other bodies with interest in dementia issues and palliative care in the United Kingdom to ensure good and acceptable EOL pathways for patients with dementia are mentioned.

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“…62 However, there is an ongoing philosophical debate about the question of if and why ADs have a moral authority at t2. 63,64,65, 66,67 At first sight, the answer appears to be a clear "yes", because the application at t2 is exactly why the person composed his or her AD at t1. This logic has been questioned, however, by several authors in bioethics, as to whether ADs have moral authority in cases in which the necessary conditions of personal identity are not present at t2.…”

Section: Moral Authority Of Adsmentioning

confidence: 99%

Do New Neuroimaging Findings Challenge the Ethical Basis of Advance Directives in Disorders of Consciousness?

Friedrich¹,

Wolkenstein²,

Jox³

et al. 2018

Camb Q Healthc Ethics

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Some authors have questioned the moral authority of advance directives (ADs) in cases in which it is not clear if the author of the AD is identical to the person to whom it later applies. This article focuses on the question of whether the latest results of neuroimaging studies have moral significance with regard to the moral authority of ADs in patients with disorders of consciousness (DOCs). Some neuroimaging findings could provide novel insights into the question of whether patients with DOCs exhibit sufficient psychological continuity to be ascribed diachronic personal identity. If those studies were to indicate that psychological continuity is present, they could justify the moral authority of ADs in patients with DOCs. This holds at least if respect for self-determination is considered as the foundation for the moral authority of ADs. The non-identity thesis in DOCs could no longer be applied, in line with clinical and social practice.

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Advancing an Advance Directive Debate

Cited by 11 publications

References 6 publications

Advance directives and knowledge of future selves

Advance directives and knowledge of future selves

End-of-Life Issues in Caring for Patients With Dementia

Do New Neuroimaging Findings Challenge the Ethical Basis of Advance Directives in Disorders of Consciousness?

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