Abstract

Treatment decisions for incompetent patients are frequently based on the patient's prior expressed wishes when competent. The merit of this approach is that it is consistent with a respect for patient self-determination and extends the rights of the competent patient to cover incompetence. However, this approach has been challenged on the grounds that the neurological deficit or dementia that has rendered the patient incompetent has also sufficiently impaired or destroyed the patient's psychological states so as to destroy the psychological characteristics that constitute personal identity. Hence the incompetent patient is not the same person as the prior competent person and therefore has no authority to make treatment decisions for the incompetent patient. ;In this work I attempt to resolve the objection to this approach to decision-making for incompetent patients stated above. I examine the use of advance directives as a means by which the competent person can make future treatment decisions, and discuss the different approaches to decision-making for incompetent patients described in recent legal cases. Furthermore, there is an extensive discussion of the concepts of person and personal identity. I examine the connection between the concept of person and the possession of rights, and the necessary conditions of personhood and personal identity. A number of rival accounts of personhood and personal identity are discussed, and I argue that we can present plausible descriptions of these concepts that will include the incompetent patient in all but the most severe cases of neurological deficit. This work investigates the distinctions between the identity and survival relations, and attempt to determine whether it is possible for you or I to survive the loss of personhood. We discuss the conditions of survival and whether you or I are essentially persons. I conclude that we can describe the incompetent patient in such terms that he or she can be regarded as a survivor of the competent person even though the incompetent patient may no longer be a person, and hence the moral authority of advance directive is upheld