Abstract

In lieu of an abstract, here is a brief excerpt of the content:Personal Identity and the Moral Authority of Advance DirectivesAndrea OttSection 1What is the metaphysical basis for respecting an advance directive first drawn up by an individual who is competent but who is at present rendered incapacitated?1 What are the roles of autonomy, personal values, integrity, and beneficence contained within said respect? In this section the positions of two prominent philosophers, Ronald Dworkin and Jeff McMahan, will be analyzed with regard to the above questions. While the two thinkers have different scholastic orientations—with Dworkin primarily a philosopher of law and McMahan an ethicist and metaphysician—their conclusions regarding the respect of the wishes of the competent-turned-demented are remarkably similar. Namely, they both argue that the values and desires held by the previously competent agent trump any current (contrary) wishes. What this amounts to for Dworkin involves respecting the autonomy of the dominant, competent part of the life where countermanding such autonomy would be worse for the life as a whole. For McMahan this means respecting the precedent autonomy generated by the deep prudential unity relations which form the basis for egoistic concern; this concern is often the basis for drafting a directive regarding future care in the first place.I will argue in this paper that if McMahan is to be consistent with his position regarding prudential unity relations then he will, in fact, not arrive at the same conclusion as Dworkin.2 Consistency will demand that the demented patient’s directive should not be followed because the demented individual will, at best, be only weakly connected to the previously autonomous, decision-capable agent. Therefore, I will argue, the moral authority [End Page 38] of the advance directive will be similarly weakened. According to McMahan, Dworkin maintains that the precedent autonomous decision has moral authority, for he assumes that the individual in question is understood to be one “temporally extended individual,” so that what is best for her life now will, in fact, be what is best for her life as a whole (501). McMahan claims to support Dworkin’s conclusion, albeit for different reasons. McMahan supports the execution of the directive out of some sort of respect for the earlier “reasonably full and complete life with its own deep prudential unity” (502). I argue that McMahan, though ostensibly in agreement with Dworkin, will have to acknowledge that the weakened prudential unity relations which make the life as a whole matter less will also undercut the moral authority of the directive. In other words, the moral authority of an advance directive weakens as the prudential unity relations weaken.Ultimately, I believe, Lynne Baker and her metaphysics of constitution can provide the best direction when faced with dilemmas such as The Advance Directive. Baker can do this and avoid the charge of positing a “post-person” (the basis for McMahan’s criticism of other versions of psychological accounts of personal identity). I use her metaphysics of constitution and derivative properties within a novel explanation of prudential concern for the organism without positing identity. I argue, in section 2, that the organism made the decision for advance care when it was derivatively (in Baker’s sense) a person. We can thus avoid the charges of (1) new entities “popping” into existence and (2) a person binding a nonperson. Such a metaphysics of constitution may thus offer some hope of adjudication within debate concerning these matters.Now I shall turn to the thought experiment in The Ethics of Killing that forms the basis of this discussion. True to the general style of his work, Jeff McMahan asks the reader to consider a thought experiment. To avoid any misinterpretation of the facts, I reproduce The Advance Directive in full below:A woman whose life has been devoted to creative intellectual work finds herself in the very early stages of Alzheimer’s disease. Given her nature, her values, and the character of her previous life, she believes that for her to continue to live in a demented state would be horribly degrading, worse than simply ceasing to exist. She accepts, however, that her life will continue to be worth living as long as she remains competent; therefore to commit...