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Descendants and advance directives

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Abstract

Some of the concerns that have been raised in connection to the use of advance directives are of the epistemic variety. Such concerns highlight the possibility that adhering to an advance directive may conflict with what the author of the directive actually wants (or would want) at the time of treatment. However, at least one objection to the employment of advance directives is metaphysical in nature. The objection to be discussed here, first formulated by Rebecca Dresser and labeled by Allen Buchanan as the slavery argument and David DeGrazia the someone else problem, aims to undermine the legitimacy of certain uses of advance directives by concluding that such uses rest upon an incorrect assumption about the identity over time of those ostensibly governed by the directives. There have been numerous attempts to respond to this objection. This paper aims to assess two strategies that have been pursued to cope with the problem.

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Notes

  1. Davis (2007).

  2. Buchanan (1988), DeGrazia (1999), Dresser (1994).

  3. We should understand ‘severe dementia’ to correlate with what Martin Harvey calls stage 3 dementia; a state that involves a conscious aware subject with both diminished agency and self-awareness. Harvey (2006).

  4. Dworkin (1993).

  5. A principle such as (NEC) seems most at home within a deontological framework. If we instead adopt a consequentialist stance, such principles may be more difficult to justify. For more on this topic see Furberg (2012).

  6. For an explicit definition of such continuity see Parfit (1971).

  7. There are theories of personal identity that qualify as roughly psychological but do not require for numerical identity the diachronic links necessary for psychological continuity to obtain. See for example Baker (2000) and McMahan(2002). Such views may be consistent with the numerical identity of Milo-at-40 and Milo-at-65. However, these views will presumably rule out the identity of Milo-at-40 and Milo in a permanent vegetative state (PVS); this is also a case where an advance directive might be thought to be applicable.

  8. A psychological theorist may balk here and claim that continuity has not been disrupted since there will be some psychological links, in the form of connections or capacities, between Milo-at-65 and Milo-at-40 (c.f. Shoemaker 1984). Whether this is the case will depend on the details of the account in question and the severity of Milo-at-65’s dementia, but presumably the psychological theorist will concede that some degree of psychological change is sufficient for an individual to go out of existence; we could thus modify our description of Milo-at-65 to account for this fact. The PVS case would also still pose a problem for those adherents of the psychological account that deny that the requisite links could fail to obtain in the case of Milo-at-40 and Milo-at-65. Thanks to an anonymous referee for raising this issue.

  9. Olson (1997).

  10. Maclean (2006). Another possible supporter is Craig Edwards who states (and later endorses) during a discussion of Dworkin’s case of Margo, “she [Margo with dementia] is also the biological extension of ‘Margo, the person,’ and therefore the beneficiary of that person’s interests.’ Edwards (2011).

  11. DeGrazia (1999), p 390.

  12. See for example Shoemaker’s Brown and Robinson case in Shoemaker (1963).

  13. See Snowdon (1991).

  14. If identification can hold across distinct lives, then DeGrazia is wrong when he claims “what we are talking about here can be understood in terms of qualitative dissimilarity, major change in an individual over time”. DeGrazia (1999), p. 390. My emphasis.

  15. DeGrazia (2005), p 198 fn. 58.

  16. That an advance directive can apply in the absence of numerical identity also weakens DeGrazia’s case against those, like Jeffrey Blustein, who argue that narrative identity is sufficient for the applicability of advance directives. DeGrazia (2005), 185 states, “[I]t is a grotesque error of philosophical logic to think that I will have interests or any other properties when there is no me.” Blustein (1999).

  17. Thanks to an anonymous referee for broaching concerns that led to the inclusion of the next three paragraphs.

  18. DeGrazia (2005), p 199.

  19. DeGrazia (2005), p 180.

  20. DeGrazia (2005), p 180.

  21. Menzel and Steinbock (2013).

  22. DeGrazia (2005), p. 196. My emphasis.

  23. Such identification will thus require more than “believing and feeling that the older man will be he.” DeGrazia (2005), p. 176.

  24. Maclean, pp. 315–316.

  25. Maclean himself appears to endorse (Analogy). “However, my argument is not based on the parent’s role as career, but more fundamentally on the parent’s relationship to the child. Just as it is the nature of the parent’s relationship to the child that justifies the parent having the strongest claim to act as the child’s career, so it is the nature of the relationship between the past and present-self that allows the past self a prima facie claim to act, through an advance directive, as decision-maker.” p. 316.

  26. One should also be concerned with any relevant disanalogies between the two relationships. This is discussed by Maclean, pp. 318–319. However, this is most pressing if the argument appears cogent after questions such as (A) and (B) have been answered. As will become clear, I don’t think this argument meets that condition.

  27. Montague (2000).

  28. For example, see the Maclean quote above.

  29. Buford (2008).

  30. Dresser (1993).

  31. Though I am skeptical of where she draws the line, this objection could be phrased in terms of Laura Purdy’s concept of a ‘minimally-satisfying life.’ Purdy (2005).

  32. Feinberg (1970).

  33. Austin (2007).

  34. David Archard calls this the ‘parental package view’. Archard (2010).

  35. The ‘numerically distinct’ qualification is important here. As an anonymous referee pointed out, it doesn’t seem problematic to think that I am part of the cause of my continued existence.

  36. This type of view might be combined with the position that children are akin to property of the parent. See for example Page (1984).

  37. Archard, ‘The Obligations and Responsibilities of Parenthood.’

  38. Austin, p. 58.

  39. Austin, p. 58.

  40. This position is of course not without its supporters. See Robertson (1991).

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Acknowledgments

I would like to thank two anonymous referees for comments that led to the improvement of the current paper. I also thank Mark Vopat for reading and commenting on an earlier version of this paper.

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    Christopher Buford

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Buford, C. Descendants and advance directives. Monash Bioeth. Rev. 32, 217–231 (2014). https://doi.org/10.1007/s40592-015-0024-0

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