Abstract
When talking about personal identity in the context of medical ethics, ethicists tend to borrow haphazardly from different philosophical notions of personal identity, or to abjure these abstract metaphysical concerns as having nothing to do with practical questions in medical ethics. In fact, however, value of and moral authority for respecting a patient’s self-regarding decisions can only be made sense of if we make certain assumptions that are central to a particular, psychological picture of personal identity, namely, that patients will remain psychologically connected to a certain degree with their future selves.
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Notes
- 1.
Göran Duus-Otterström (2011) lists several additional potential categories of reasons, and it might be the case that certain people have their own idiosyncratic reasons for valuing choice.
- 2.
Considerations linked to the representative and symbolic value of choice are often conflated to a certain extent in the literature on medical ethics (see Buchanan and Brock 1989, 38–9; Glover 1977, 81). This is likely because the discussion is often framed in terms of discerning whether choices have value beyond the obvious instrumental dimension.
- 3.
This, of course, doesn’t guarantee that the decision you make will have high instrumental value for your distant-future self, nor does it rule out the possibility that someone can make a decision with high instrumental value for a future person despite a lack of psychological connectedness. Just as with possession of knowledge, or freedom from coercive elements, psychological connectedness simply serves to increase the chances that the decision will have high instrumental value, to the degree that we can count on the decision having instrumental value if made by a particular person in particular circumstances.
- 4.
On these grounds is important here; Allen Buchanan and Dan Brock mount a compelling argument that advance directives can be justified after significant personality change (that they take to sever identity) on other grounds (1989, 163–5), which we will explore below.
- 5.
Michael Kühler makes a similar point about narrative identity in the context of surrogate decision making in his paper in this volume.
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White, L. (2020). Personal Identity and Self-Regarding Choice in Medical Ethics. 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_3
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