Abstract

This paper argues that one’s authority to issue advance directives governing one’s medical care is limited in ways that have not been appreciated. It focuses on advance directives issued by people who go on to suffer from dementia. An adequate account of decision-making for those with dementia should be able to do justice to two related aspects of that condition. First, for practical purposes, sufferers of dementia both are and are not the same people they were before. Second, the “otherness” of the demented self reflects an unraveling rather than a becoming. The demented self is not a new self but rather the same old self in the process of disintegrating. The paper suggests that Christine Korsgaard’s treatment of personal identity provides a helpful framework for understanding these aspects of dementia. It also gives an account of decision-making for those with dementia that is sensitive to these aspects of dementia.