Advance Directives, Dementia, and the Someone Else Problem
DeGrazia (David)
Source: DeGrazia - Human Identity and Bioethics, 2005, Chapter 5
Paper - Abstract

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Philosophers Index Abstract

    After briefly introducing advance directives as a basis for medical decision-making, this paper elaborates 'the someone else problem' in the context of severe dementia. The paper then reconstructs the reasoning that leads to this putative problem and exposes the important underlying assumption that we are essentially persons. An alternative view of what we are1, one that regards personhood as inessential, is then considered, before several arguments are advanced in favor of that alternative view. The paper next explores implications for advance directives: 'The someone else problem' is effectively dissolved, while it is noted that a related problem (one beyond the paper's scope) may persist. A few implications beyond advance directives are also identified. (edited)
  1. Introduction
  2. The Nonidentity Thesis and the Someone Else Problem
    … 2.1 The Reasoning
    … 2.2 Critique of This Reasoning
    … 2.3 The Odd Implications of the Nonidentity Thesis
  3. Has Narrative Identity2 Been Disrupted?
  4. Views That Vindicate Advance Directives On the Basis of Precedent Autonomy
    … 4.1 Appeals to Precedent Autonomy on the Assumption That Numerical Identity3 Matters
    … 4.2 Appeals to Precedent Autonomy without the Assumption That Numerical Identity4 Matters
  5. Skepticism about Precedent Autonomy
  6. The Importance of Time-Relative Interests
  7. Concluding Reflections
    … 7.1 Several Theses
    … 7.2 A Note about Medical Decision Making

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