Hostname: page-component-78c5997874-m6dg7 Total loading time: 0 Render date: 2024-11-15T03:55:25.067Z Has data issue: false hasContentIssue false
  • English
  • Français

Dementia, death and advance directives

Published online by Cambridge University Press:  19 October 2012

JONATHAN WOLFF
JONATHAN WOLFF*
Affiliation:
Professor, Department of Philosophy, University College London, London, UK
*
*Correspondence to: Professor Jonathan Wolff, Professor of Philosophy, University College London, Gower Street, London WC1E 6BT, UK. Email: j.wolff@ucl.ac.uk
Get access Rights & Permissions [Opens in a new window]

Abstract

This article considers the ethics of advance directives, especially in relation to conditions such as dementia. For some choices, such as over whether one's life should end at home or in a hospice, advance directives can be very enlightened and helpful. For others, such as those to end the life of an autonomous subject, against their will, have no moral appeal and would rightly be ignored. In a wide range of intermediate cases, given our typical lack of insight into how changes in our health condition will affect us in other ways, we should be very cautious indeed in promoting the use of advance directives in end-of-life decisions, at least where a reasonable quality of life remains. There may be some reasons for giving priority to the earlier autonomous self over a later, contented but non-autonomous self, but these reasons seem far from compelling.

Type
Articles
Information
Health Economics, Policy and Law , Volume 7 , Issue 4 , October 2012 , pp. 499 - 506
Copyright
Copyright © Cambridge University Press 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Albrecht, G. L.Devlieger, P. J. (1999), ‘The disability paradox: high quality of life against all odds’, Social Science & Medicine, 48: 977–988.Google Scholar
Brock, D. W. (1993), ‘A proposal for the use of advance directives in the treatment of incompetent mentally Ill persons’, Bioethics, 7: 247–256.Google Scholar
Dresser, R. (1995), ‘Dworkin in dementia: elegant theory, questionable policy’, The Hastings Center Report, 25: 32–38.Google Scholar
Dworkin, R. (1993), Life's Dominion, London: HarperCollins.Google Scholar
Firlik, A. D. (1991), ‘Margot's logo’, Journal of the American Medical Association, 265: 201.Google Scholar
Gastmans, C.De Lepeleire, J. (2010), ‘Living to the bitter end? A personalist approach to euthanasia in persons with severe dementia’, Bioethics, 24: 78–86.Google Scholar
Hope, T. (1992), ‘Advance directives about medical treatment: making up one's mind while one still has a mind’, British Medical Journal, 304(6824): 398.Google Scholar
Jaworska, A. (1999), ‘Respecting the margins of agency: Alzheimer's patients and the capacity to value’, Philosophy and Public Affairs, 28: 105–138.Google Scholar
Jones-Lee, M. W., Hammerton, M.Philips, P. R. (1985), ‘The value of safety: results of a national sample survey’, The Economic Journal, 95(377): 49–72.CrossRefGoogle Scholar
Reader, S. (2009), ‘It is monstrously wrong that patients cannot ask for euthanasia’. Times Higher Education Supplement, 8 January, http://www.timeshighereducation.co.uk/story.asp?storycode=404913 [5 December 2010].Google Scholar
Widdershoven, G.Berghmans, R. (2001a), ‘Advance directives in psychiatric care: a narrative approach’, Journal of Medical Ethics, 27: 92–97.Google Scholar
Widdershoven, G. A. M.Berghmans, R. L. P. (2001b), ‘Advance directives in dementia care: from instructions to instruments’, Patient Education and Counseling, 44: 179–186.Google Scholar
Wolff, J., Edwards, S., Richmond, S., Orr, S.Rees, G. (2011), ‘Evaluating interventions in health: a reconciliatory approach’, Bioethics (Online Early View).Google Scholar