When Suicide is not a Self-Killing: Advance Decisions and Psychological Discontinuity—Part II

Cambridge Quarterly of Healthcare Ethics:1-12 (forthcoming)
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Derek Parfit’s view of personal identity raises questions about whether advance decisions refusing life-saving treatment should be honored in cases where a patient loses psychological continuity; it implies that these advance decisions would not be self-determining at all. However, rather than accepting that an unknown metaphysical ‘further fact’ underpins agential unity, one can accept Parfit’s view but offer a different account of what it implies morally. Part II of this article argues that contractual obligations provide a moral basis for honoring advance decisions refusing life-saving and/or life-sustaining medical treatment; advance decisions have similarities to contracts, such as life insurance policies and will-contracts, that come into effect when the psychological discontinuity is through death.



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Role obligations.Michael O. Hardimon - 1994 - Journal of Philosophy 91 (7):333-363.
Personal Identity and Individuation.Bernard Williams - 1957 - Proceedings of the Aristotelian Society 57:229-252.
What is suicide? Classifying self-killings.Suzanne E. Dowie - 2020 - Medicine, Health Care and Philosophy 23 (4):717-733.

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