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Personal Identity and the Moral Authority of Advance Directives

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Theories of the Self and Autonomy in Medical Ethics

Part of the book series: The International Library of Bioethics ((ILB,volume 83))

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Abstract

Many people believe that we formulate advance directives in order to care for our own future and that our directives have moral authority just when this is competently done. By implying that the signer of the directive cannot survive serious mental impairment, popular philosophical thinking about personal identity threatens to undermine this pair of convictions. Some philosophers react by denying the second conviction. According to them, advance directives should be followed even if the signer and the patient are two. The paper discusses three justifications for this claim and finds them all lacking. The ethics of advance directives cannot ignore the metaphysics of the person.

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Notes

  1. 1.

    See Dresser (1995, p. 37) and Birnbacher (2016, p. 290). I thank Susanne Boshammer for drawing my attention to this point.

  2. 2.

    Similar views (or views with similar consequences) are held by Baker (2000, p. 11), Shoemaker (2011, p. 360), and Lowe (2015, p. 146). Moreover, there is reason to believe that most contemporary adherents of the psychological view of personal identity are implicitly committed to something like the Parfitian position; see Olson (1997, pp. 22–27) and Witt and Olson (2020, § 2).

  3. 3.

    Perhaps they needn’t, but this is another story; see Witt (2020).

  4. 4.

    Birnbacher might be an exception; see Birnbacher (2016, p. 286).

  5. 5.

    In the quoted passage Holm writes that the lack of identity should not ‘solely’ govern the relations between signer and patient. But I have been unable to find what the limited role of personal identity that is implied by this remark might be.

  6. 6.

    See also Kuczewski (1994, 42f.) and Jecker (2016, pp. 206–208); for critical discussion see DeGrazia (2005, pp. 183–186), Shoemaker (2009, pp. 180–183).

  7. 7.

    Note once more how the second condition’s formulation muddies the waters. In demanding that narrative fit requires continuers to be ‘faithful to who the patient was’ (my emphasis) the quoted passage suggests that the patient is the signer—something Blustein officially denies. Given his Parfitian assumptions about our persistence, the continuation of the signer’s narrative can only be faithful to who the signer was.

  8. 8.

    See also Müller et al. (2017, 300f). Some philosophers claim that advance directives have moral force because they contain the signer’s ‘surviving interests’ and because satisfying these interests improve the signer’s life even after she is dead and gone; see Buchanan and Brock (1990, pp. 162–164) and Shoemaker (2010, 488f). The view is obviously related to the pragmatic approach, but deserves a discussion of its own.

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Authors and Affiliations

  1. Köln, Germany

    Karsten Witt

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  1. Karsten Witt
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Correspondence to Karsten Witt .

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Editors and Affiliations

  1. Department of Philosophy, University of Twente, Enschede, Overijssel, The Netherlands

    Michael Kühler

  2. Institute of Social Sciences, University of Belgrade, Belgrade, Serbia

    Veselin L. Mitrović

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Witt, K. (2020). Personal Identity and the Moral Authority of Advance Directives. In: Kühler, M., Mitrović, V.L. (eds) Theories of the Self and Autonomy in Medical Ethics. The International Library of Bioethics, vol 83. Springer, Cham. https://doi.org/10.1007/978-3-030-56703-3_4

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