scholarly journals Do New Neuroimaging Findings Challenge the Ethical Basis of Advance Directives in Disorders of Consciousness?

2018 ◽  
Vol 27 (4) ◽  
pp. 675-685
Author(s):  
ORSOLYA FRIEDRICH ◽  
ANDREAS WOLKENSTEIN ◽  
RALF J. JOX ◽  
NIEK ROGGER ◽  
CLAUDIA BOZZARO

Abstract:Some authors have questioned the moral authority of advance directives (ADs) in cases in which it is not clear if the author of the AD is identical to the person to whom it later applies. This article focuses on the question of whether the latest results of neuroimaging studies have moral significance with regard to the moral authority of ADs in patients with disorders of consciousness (DOCs). Some neuroimaging findings could provide novel insights into the question of whether patients with DOCs exhibit sufficient psychological continuity to be ascribed diachronic personal identity. If those studies were to indicate that psychological continuity is present, they could justify the moral authority of ADs in patients with DOCs. This holds at least if respect for self-determination is considered as the foundation for the moral authority of ADs. The non-identity thesis in DOCs could no longer be applied, in line with clinical and social practice.

1999 ◽  
Vol 27 (1) ◽  
pp. 20-31 ◽  
Author(s):  
Jeffrey Blustein

Philosophically, the most interesting objection to the reliance on advance directives to guide treatment decisions for formerly competent patients is the argument from the loss of personal identity. Starting with a psychological continuity theory of personal identity, the argument concludes that the very conditions that bring an advance directive into play may destroy the conditions necessary for personal identity, and so undercut the authority of the directive. In this article, I concede that if the purpose of a theory of personal identity is to provide an answer to the question What is it for a person to persist over time?, then reflection on personal identity poses a potentially serious threat to the moral authority of advance directives. However, as Marya Schechtman observes, questions about how a single person persists through change are not what most of us are interested in when we think about who a person is. Rather, we are interested in what it means to say that a particular set of actions, experiences, and characteristics is that of a given person rather than someone else.


2018 ◽  
Vol 45 (4) ◽  
pp. 249-256 ◽  
Author(s):  
Govind Persad

This paper takes a novel approach to the active bioethical debate over whether advance medical directives have moral authority in dementia cases. Many have assumed that advance directives would lack moral authority if dementia truly produced a complete discontinuity in personal identity, such that the predementia individual is a separate individual from the postdementia individual. I argue that even if dementia were to undermine personal identity, the continuity of the body and the predementia individual’s rights over that body can support the moral authority of advance directives. I propose that the predementia individual retains posthumous rights over her body that she acquired through historical embodiment in that body, and further argue that claims grounded in historical embodiment can sometimes override or exclude moral claims grounded in current embodiment. I close by considering how advance directives grounded in historical embodiment might be employed in practice and what they would and would not justify.


2021 ◽  
Vol 17 (1) ◽  
pp. 71-82
Author(s):  
Rashwet Shrinkhal

It is worth recalling that the struggle of indigenous peoples to be recognised as “peoples” in true sense was at the forefront of their journey from an object to subject of international law. One of the most pressing concerns in their struggle was crafting their own sovereign space. The article aims to embrace and comprehend the concept of “indigenous sovereignty.” It argues that indigenous sovereignty may not have fixed contour, but it essentially confronts the idea of “empire of uniformity.” It is a source from which right to self-determination stems out and challenges the political and moral authority of States controlling indigenous population within their territory.


Conatus ◽  
2020 ◽  
Vol 5 (1) ◽  
pp. 71
Author(s):  
David Menčik

This paper intends to discuss some aspects of what we conceive as personal identity: what it consists in, as well as its alleged fragility. First I will try to justify the methodology used in this paper, that is, the use of allegories in ontological debates, especialy in the form of thought experiments and science fiction movies. Then I will introduce an original thought experiment I call “Who am I actually?,” one that was coined with the intent to shed light on several aspects of the issue under examination, that is, the fragility of personal identity. Then I will move on to Christopher Nolan’s film The Prestige, as well as to Derek Parfit’s ‘divided minds’ thought experiment, to further discuss the fragility of personal identity; next to identity theft, the prospect of duplication is also intriguing, especially with regard to the psychological impact this might have on both the prototype and the duplicate. I will conclude with the view that spatial and temporal proximity or coexistence, especially when paired with awareness on behalf of the duplicates, would expectedly result in the infringement of the psychological continuity of one’s identity.


2012 ◽  
pp. 42-67
Author(s):  
Luigi Balestra ◽  
Riccardo Campione

The essay analyzes the development of the right of self-determination in medical treatments and the changes it has had on the relationship between doctor and patient. In this perspective, the paper aims, in particular, to verify the limits of the self-determination principle in cases of refusal of life-saving treatment and in the hypothesis of advance directives. It also analyzes the possibility of providing compensation for damages in case the right to self-determination is undermined.


Author(s):  
Marya Schechtman

While many areas of philosophy are concerned with issues of personal identity, the investigation most usually referred to as ‘the problem of personal identity’ within analytic philosophy centers on the question of what makes individuals at different times the same person. This is a complex and difficult question because we change a great deal over the course of our lives. A woman of 50, for instance, is made up of largely different matter from her ten-year-old self, and looks quite different. Her beliefs, desires, and values have probably changed a great deal; she has a host of memories and relationships that her ten-year-old self did not have, and she fills quite different social roles. Despite all of this we might unequivocally judge that the woman before us is the same person as the ten-year-old. Philosophers of personal identity seek to describe what it is that constitutes the identity of the fifty-year-old and the ten-year-old (if they are indeed identical). As it is usually conceived, the question of personal identity is a metaphysical question and not an epistemological question. Rather than asking how we know when someone at one time is identical to someone at another time, it asks what it is that actually makes it the case that they are the same. This question is also a question of numerical identity rather than qualitative or psychological identity; it is about the relation that makes something the self-same entity over time rather than about what makes entities indistinguishably similar to one another (see Identity). This last distinction is important to make because in everyday speech talk of personal identity is often connected to questions about what someone truly believes or desires, or what is fundamentally important to them, and not about what makes them a single entity. Everyday talk of identity is thus connected to judgments about similarity of character or personality. Historically, there have been three main approaches to addressing the metaphysical question about the numerical identity of persons over time. One defines identity in terms of the continuation of a single immaterial substance or soul; one in terms of psychological continuity; and one in terms of bodily or biological continuity, although there have been several other approaches offered as well. All of these accounts have had their adherents, and all have their difficulties. The bulk of philosophical discussion of personal identity during the late twentieth and early twenty-first centuries has focused on the relative merits of psychological and biological approaches. For most of this period psychological accounts were dominant. These views, inspired by John Locke, hold that a person at time t2 is the same as a person at earlier time t1 just in case there is an overlapping chain of psychological connections (memories, beliefs, desires, etc.) between the person at t2 and the person at t1. They have a great deal of intuitive appeal, capturing the widely held sense that if biological and psychological continuity were to diverge, the person would go where the psychological life goes, but they have also been subject to some important objections. Many of these are related to the fact that psychological continuity does not have the same logical form as identity. For instance, a person existing now could in principle be psychologically continuous with two people in the future, but cannot be identical to both of them since they are not identical to each other. Toward the end of the twentieth century, biological accounts of identity re-emerged with new vigour, mounting a serious challenge to the dominance of psychological accounts. Defenders of the biological approach say that we are, most fundamentally, human animals who persist as long as a single human organism does. The biological approach allows that psychological continuity may be of tremendous importance to us, and that we may identify with our psychological states, but insists this continuity is no part of what determines our literal persistence as single entities. Biological theorists point out that if we think of persons as entities distinct from human animals we will be left with a number of awkward questions about the relation between persons and animals, making psychological continuity theories deeply implausible. In response, defenders of the psychological approach have argued that biological accounts suffer from many of the same deficits with which they charge psychological theories. A metaphysical view in which persons are constituted by human animals has also been offered to show a way in which a psychological account of identity can avoid the difficulties with explaining the relation of persons to human animals uncovered by animalists. As the debate between animalists and psychological theorists has continued, a variety of other views have been put forward, including narrative accounts of identity and minimalist accounts which place identity in the continuation of bare sentience. Over time a number of interesting general questions.


Metaphysica ◽  
2020 ◽  
Vol 21 (1) ◽  
pp. 129-149
Author(s):  
Nils-Frederic Wagner ◽  
Iva Apostolova

AbstractStandard views of personal identity over time often hover uneasily between the subjective, first-person dimension (e. g. psychological continuity), and the objective, third-person dimension (e. g. biological continuity) of a person’s life. Since both dimensions capture something integral to personal identity, we show that neither can successfully be discarded in favor of the other. The apparent need to reconcile subjectivity and objectivity, however, presents standard views with problems both in seeking an ontological footing of, as well as epistemic evidence for, personal identity. We contend that a fresh look at neutral monism offers a novel way to tackle these problems; counting on the most fundamental building blocks of reality to be ontologically neutral with regards to subjectivity and objectivity of personal identity. If the basic units of reality are, in fact, ontologically neutral – but can give rise to mental as well as physical events – these basic units of reality might account for both subjectivity and objectivity in personal identity. If this were true, it would turn out that subjectivity and objectivity are not conflictive dimensions of personal identity but rather two sides of the same coin.


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