Hostname: page-component-cd9895bd7-gvvz8 Total loading time: 0 Render date: 2024-12-28T21:31:02.337Z Has data issue: false hasContentIssue false
  • English
  • Français

Dementia, Advance Directives, and Discontinuity of Personality

Published online by Cambridge University Press:  16 September 2016

JOSEPH P. DEMARCO  and
SAMUEL H. LIPUMA
Get access Rights & Permissions [Opens in a new window]

Abstract:

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.

Keywords

advance directivesdementiapersonality changepersonal identity
Type
Articles
Information
Cambridge Quarterly of Healthcare Ethics , Volume 25 , Special Issue 4: Clinical Neuroethics , October 2016 , pp. 674 - 685
Copyright
Copyright © Cambridge University Press 2016 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Notes

1. Davis D. Alzheimer disease and pre-emptive suicide. Journal of Medical Ethics 2014;40(8):543–9, at 546.

2. Buchanan A. Advance directives and the personal identity problem. Philosophy & Public Affairs 1988;17(4):277–302, at 281–2.

3. Dworkin, R. Life’s Dominion: An Argument about Abortion, Euthanasia, and Individual Freedom. New York: Vintage Books; 1988.Google Scholar

4. Dresser, R. Dworkin on dementia: Elegant theory, questionable policy. The Hastings Center Report 1995;25(6):32–8.CrossRefGoogle ScholarPubMed

5. See note 3, Dworkin 1988, at 20.

6. See note 3, Dworkin 1988.

7. See note 4, Dresser 1995.

8. See note 4, Dresser 1995.

9. Caddell, L, Clare, L. The impact of dementia on self and identity: A systematic review. Clinical Psychology Review 2010;30(1):113–26.CrossRefGoogle ScholarPubMed

10. See note 9, Caddell, Clare 2010, at 113.

11. See note 9, Caddell, Clare 2010, at 115.

12. See note 9, Caddell, Clare 2010.

13. See note 9, Caddell, Clare 2010, at 121.

14. See note 9, Caddell, Clare 2010, at 118.

15. See note 9, Caddell, Clare 2010, at 118.

16. Klein, SB, Cosmides, L, Costabile, KA. Preserved knowledge of self in a case of Alzheimer’s dementia. Social Cognition 2003;21(2):157–65.CrossRefGoogle Scholar

17. See note 16, Klein et al. 2003, at 161.

18. See note 16, Klein et al. 2003, at 161.

19. See note 16, Klein et al. 2003, at 163.

20. See note 16, Klein et al. 2003.

21. See note 16, Klein et al. 2003.

22. Kennisa, M, Rademakera, AR, Geuzea, E. Neural correlates of personality: An integrative review. Neuroscience & Biobehavioral Reviews 2013;37(1):73–95.CrossRefGoogle Scholar

23. Sabat SR, Collins M. Intact social, cognitive ability, and selfhood: A case study of Alzheimer’s disease. American Journal of Alzheimer’s Disease 1999;14(1):11–19, at 18–19.

24. See note 24, Sabat, Collins 1999, at 17.

25. Feinberg J. The Moral Limits of the Criminal Law, Vol. I: Harm to Others. New York: Oxford University Press; 1984, at 33.

26. See note 25, Feinberg 1984, at 37.

27. See note 25, Feinberg 1984.

28. Pitcher, G. The misfortunes of the dead. American Philosophical Quarterly 1984;21(2):183–8.Google Scholar

29. Partridge, E. Posthumous interests and posthumous respect. Ethics 1981;91(2):243–64.CrossRefGoogle Scholar

30. See note 29, Partridge 1981, at 255.

31. See note 29, Partridge 1981, at 258.

32. See note 29, Partridge 1981, at 258.

33. See note 29, Partridge 1981, at 261.

34. See note 29, Partridge 1981, at 261.

35. See note 29, Partridge 1981.

36. Genova G. Still Alice: A Novel. New York: Pocket Books; 2007, at 116.

37. Kales HC, Gitlin LN, Lyketsos CG. Assessment and management of behavioral and psychological symptoms of dementia. British Medical Journal 2015;350(h365):1–16.

38. Rhoden NK. The limits of legal objectivity. North Carolina Law Review 1990;68 N.C.L. Rev:845–65, at 864–5.

39. See note 2, Buchanan 1988, at 281–2.

40. Pascalev A, Giordano J. Neuroscience and medical futility: A neuroethical analysis and proposal. Abstract. Meeting of the International Neuroethics Society, Chicago, IL; 2015 Oct 15–16.