Dementia, Advance Directives, and Discontinuity of Personality

We argue that an advance directive (AD) is not invalidated by personality changes in dementia, as is claimed by Rebecca Dresser. The claim is that a new person results under such personality changes, and that the former person cannot write an AD for the new person. After stating the argument against...

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Bibliographic Details
Published inCambridge quarterly of healthcare ethics Vol. 25; no. 4; pp. 674 - 685
Main Authors DEMARCO, JOSEPH P., LIPUMA, SAMUEL H.
Format Journal Article
LanguageEnglish
Published New York, USA Cambridge University Press 01.10.2016
Subjects
Advance Directive Adherence
Advance Directives
Bioethics
Changes
Decision Making
Dementia
Dementia - psychology
Dementia disorders
Discontinuity
Ego
Humans
Identity
Individuality
Mental Competency
Personal development
Personality
Personality traits
Self concept
Social contract
Strength
New York
United States > US
dementia
advance directives
personal identity
personality change
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Summary:We argue that an advance directive (AD) is not invalidated by personality changes in dementia, as is claimed by Rebecca Dresser. The claim is that a new person results under such personality changes, and that the former person cannot write an AD for the new person. After stating the argument against ADs in cases of dementia, we provide a detailed examination of empirical studies of personality changes in dementia. This evidence, though not strong due mainly to low sample sizes and different notions of personal identity, does not support Dresser’s position. Given the weakness in the empirical evidence, we turn to a philosophical defense of ADs based on a social contract view supporting the current interests of those writing ADs. Additionally, we argue that personality change is not equivalent to change in personal identity, as would be required by the argument against ADs in cases of dementia.
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ISSN:0963-1801
1469-2147
DOI:10.1017/S0963180116000396