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Advance Directives and the Problem of Personal Identity

Author: DIANA BUCCAFURNI
Published in GVER, Vol. 5 No. 2

Two objections against the authority of advance directives for some
incompetent persons are advanced in this paper. First, that under a psychological
continuity account of personal identity, the authority of existing advance directives
for now-demented persons is morally questionable because now-demented persons are
different persons from their formerly competent selves responsible for creating the
directive. Honoring advance directives in these cases violates contemporaneous
autonomy. Second, that even if personal identity does survive dementing illness,
honoring advance directives for now-demented persons is nevertheless morally
problematic because it violates contemporaneous autonomy, under a certain
conception of marginal autonomy of which some demented persons are still capable.

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