Challenging, with several powerful arguments, some of our deepest beliefs about rationality, morality, and personal identity, Parfit claims that we have a false view about our own nature. It is often rational to act against our own best interersts, he argues, and most of us have moral views that are self-defeating. We often act wrongly, although we know there will be no one with serious grounds for complaint, and when we consider future generations it is very hard to avoid conclusions (...) that most of us will find very disturbing. (shrink)

Several attractive principles about prudential concern and moral responsibility seem to speak against animalism. I criticize some animalist responses to this kind of problem, and suggest another answer, which has similarites with the most important argument in favor of animalism: the “thinking animal” argument.

According to Peter van Inwagen, visible inanimate objects do not, strictly speaking, exist. In defending this controversial thesis, he offers fresh insights on such topics as personal identity, commonsense belief, existence over time, the phenomenon of vagueness, and the relation between metaphysics and ordinary language.

Recent legal rulings concerning the status of advance statements have raised interest in the topic but failed to provide any definitive general guidelines for their enforcement. I examine arguments used to justify the moral authority of such statements. The fundamental ethical issue I am concerned with is how accounts of personal identity underpin our account of moral authority through the connection between personal identity and autonomy. I focus on how recent Animalist accounts of personal identity initially appear to provide a (...) sound basis for extending the moral autonomy of an individual - and hence their autonomous wishes expressed through an advance directive - past the point of severe psychological decline. I argue that neither the traditional psychological account nor the more recent Animalist account of personal identity manage to provide a sufficient basis for extending our moral autonomy past the point of incapacity or incompetence. I briefly explore how analogies to similar areas in law designed to facilitate autonomous decision, such as wills and trusts, provide at best only very limited scope for an alternative justification for granting advance statements any legal or moral authority. I conclude that whilst advance statements play a useful role in formulating what treatment is in a patient’s best interests, such statements do not ultimately have sufficient moral force to take precedence over paternalistic best interest judgements concerning an individual’s care or treatment. (shrink)

Although advance directives are widely believed to be a key way to safeguard the autonomy of incompetent medical patients, significant questions exist about their moral authority. The main philosophical concern involves cases in which an incompetent patient no longer possesses the desires on which her advance directive was based. The question is, does that entail that prior expressions of medical choices are no longer morally binding? I believe that the answer is “yes.” I argue that a patient’s autonomy is not (...) respected by honoring the desires she used to have but no longer does. I also consider and reject the view that honoring an advance directive that reflects the patient’s previous values must be in that patient’s best interests. If that is correct, then advance directives in the kind of case at issue are not morally binding. (shrink)

Philosophers of mind have not in general been very attentive to metaphysics. This book is a salutary exception to this general observation. A philosopher of mind—at least the body of her very influential work would be classified by most philosophers as belonging to the philosophy of mind—attempts to ground a theory of the relation between human persons and their bodies in an extended essay on the metaphysics of the natural world. Baker is a materialist : in her book, you and (...) I and everyone we know is a material thing. But then how are we material persons related to our bodies, which are also material things? Unlike many materialists, she rejects the following answer to this question: We are identical with our bodies. The bulk of this review is no more than a summary of her answer to the “person-body question.” My summary will use language very different from hers, since it will rely heavily on the language of parthood, and she is extremely hostile to any attempt to use the concept “part” in connection with her theory. Nevertheless, the use I make of this concept is innocuous, and my representation of her answer to the person-body question is accurate. (shrink)

The question of when we have justification for overriding ordinary, everyday decisions of persons with dementia is considered. It is argued that no single criterion for competent decision-making is able to distinguish reliably between decisions we can legitimately override and decisions we cannot legitimately override.

It has long been thought that certain key bioethical views depend heavily on work in personal identity theory, regarding questions of either our essence or the conditions of our numerical identity across time. In this paper I argue to the contrary, that personal identity is actually not significant at all in this arena. Specifically, I explore three topics where considerations of identity are thought to be essential – abortion, definition of death, and advance directives – and I show in each (...) case that the significant work is being done by a relation other than identity. (shrink)

What does it mean to say that this person at this time is 'the same' as that person at an earlier time? If the brain is damaged or the memory lost, how far does a person's identity continue? In this book two eminent philosophers develop very different approaches to the problem.

We can start with some science fiction. Here on Earth, I enter the Teletransporter. When I press some button, a machine destroys my body, while recording the exact states of all my cells. This information is sent by radio to Mars, where another machine makes, out of organic materials, a perfect copy of my body. The person who wakes up on Mars seems to remember living my life up to the moment when I pressed the button, and is in every (...) other way just like me. (shrink)

This paper is about the neglected question of what sort of things we are metaphysically speaking. It is different from the mind-body problem and from familiar questions of personal identity. After explaining what the question means and how it differs from others, the paper tries to show how difficult it is to give a satisfying answer.

Most philosophers writing about personal identity in recent years claim that what it takes for us to persist through time is a matter of psychology. In this groundbreaking new book, Eric Olson argues that such approaches face daunting problems, and he defends in their place a radically non-psychological account of personal identity. He defines human beings as biological organisms, and claims that no psychological relation is either sufficient or necessary for an organism to persist. Olson rejects several famous thought-experiments dealing (...) with personal identity. He argues, instead, that one could survive the destruction of all of one's psychological contents and capabilities as long as the human organism remains alive--as long as its vital functions, such as breathing, circulation, and metabolism, continue. (shrink)

In this essay I explore the idea that the solution to some important problems of personal identity lies in the philosophy of language: more precisely in the nature of first-person reference. I will argue that the “linguistic solution” is at best partly successful.

In his book, Eric Olson (2007) makes some criticisms of a response to the problem of the thinking animal (also called the ‘too many minds’ or ‘too many thinkers’ problem) which I have offered, on behalf of the neo-Lockean psychological continuity theorist. Olson calls my proposal ‘personal pronoun revisionism’ (though I am not suggesting any revision). In what follows I shall say what my proposal actually is, defend it and briefly respond to Olson's criticism.

Physician-assisted suicide laws in Oregon and Washington require the person's current competency and a prognosis of terminal illness. In The Netherlands voluntariness and unbearable suffering are required for euthanasia. Many people are more concerned about the loss of autonomy and independence in years of severe dementia than about pain and suffering in their last months. To address this concern, people could write advance directives for physician-assisted death in dementia. Should such directives be implemented even though, at the time, the person (...) is no longer competent and would not be either terminally ill or suffering unbearably? We argue that in many cases they should be, and that a sliding scale which considers both autonomy and the capacity for enjoyment provides the best justification for determining when: when written by a previously well-informed and competent person, such a directive gains in authority as the later person's capacities to generate new critical interests and to enjoy life decrease. Such an extension of legalized death assistance is grounded in the same central value of voluntariness that undergirds the current more limited legalization. (shrink)

Almost all jurisdictions where physician-assisted death is legal require that the requesting individual be competent to make medical decisions at time of assistance. The requirement of contemporary competence is intended to ensure that PAD is limited to people who really want to die and have the cognitive ability to make a final choice of such enormous import. Along with terminal illness, defined as prognosis of death within six months, contemporary competence is regarded as an important safeguard against mistake and abuse, (...) arguably the strongest objections to legalizing PAD.The insistence on contemporary competence is problematic. It means that someone who has dementia is ruled out as a candidate for PAD, even if she is terminally ill and suffering terrible and unrelievable pain. It also rules out individuals with strong and unwavering desires not to end their life in dementia. (shrink)

: In this paper, I consider objections to advance directives based on the claim that there is a discontinuity of interests, and of personal identity, between the time a person executes an advance directive and the time when the patient has become severely demented. Focusing narrowly on refusals of life-sustaining treatment for severely demented patients, I argue that acceptance of the psychological view of personal identity does not entail that treatment refusals should be overridden. Although severely demented patients are morally (...) considerable beings, and must be kept comfortable whilst alive, they no longer have an interest in receiving life-sustaining treatment. (shrink)

[A] man does not consist of memory alone. He has feeling, will, sensibilities, moral being…. And it is here … that you may find ways to touch him.—A. R. Luria1.

We argue that animalism is the only materialist account of personal identity that can account for the autonomy that we typically think of ourselves as possessing. All the rival materialist theories suffer from a moral version of the problem of too many thinkers when they posit a human person that overlaps a numerically distinct human animal. The different persistence conditions of overlapping thinkers will lead them to have interests that conflict, which in many cases prevents them both from autonomously forming (...) and acting on the same intentions. These problems are exacerbated by problems of self-reference plaguing the overlapping thinkers. We contend that the impossibility of simultaneous autonomous action by animals and persons provides a reason to favor animalism over Neo-Lockeanism, Four-Dimensionalism, Constitution theory, and brain-size views of the person. We anticipate and reject arguments that the autonomy of the person and the animal can be shown to be compatible by relying upon either the Parfitian thesis that identity isn’t what matters or claiming that animals acquire the interests of the person they constitute. (shrink)

In medizinethischen Kontexten bezeichnet der Ausdruck „Odysseus-Verträge“ Selbstbindungen, die in der vorausschauenden Bitte von Patienten an ihre Ärzte bestehen, eigene spätere Behandlungspräferenzen nicht zu befolgen. Umstritten ist jedoch, ob eine vorhergehende Anweisung ein Handeln gegen den Patientenwillen in der aktualen Behandlungssituation rechtfertigt. In diesem Beitrag wird die Frage nach der Verbindlichkeit von Odysseus-Anweisungen erörtert. Zunächst wird gezeigt, dass die Befolgung einer Odysseus-Anweisung eine Form des paternalistischen Handelns darstellt und die Frage nach der Verbindlichkeit von Odysseus-Anweisungen daher in diejenige nach der (...) Rechtfertigung paternalistischen Handelns zu überführen ist . Im Folgenden wird als Rechtfertigungsmodell für paternalistisches Handeln ein Zustimmungsmodell verteidigt , dem zufolge eine paternalisierende Maßnahme durch die antizipierte spätere Zustimmung des Patienten zu dieser Maßnahme gerechtfertigt wird . Nach einer Erörterung des Einwandes, dass damit die besonderen normativen Probleme von Odysseus-Anweisungen aus dem Blick geraten , werden abschließend Fälle untersucht, in denen aufgrund eines irreversiblen Kompetenzverlustes keine spätere Zustimmung zur paternalisierenden Maßnahme mehr möglich ist. In diesen Fällen, so die These, ist ein paternalistisches Handeln gegen den aktualen Patientenwillen nicht gerechtfertigt; kommt es hier also zu einem Konflikt zwischen dem in der Vorausverfügung dokumentierten und dem aktualen Patientenwillen, ist letzterer zu respektieren .In the context of medical ethics, the term „Ulysses contract“ denotes an advance directive by means of which a patient binds himself for the future by instructing a doctor to act against his foreseen future preferences. There is some controversy, however, about whether a person’s prior decisions should be regarded as mandatory for the doctor even when they conflict with her present desires. In this contribution, I address the questions whether and under what circumstances Ulysses instructions should be regarded as binding. In Part , I attempt to show that observing a Ulysses instruction means acting paternalistically and that therefore the question whether Ulysses contracts ought to be respected should be transformed into the question how paternalistic action can be justified. Parts and are concerned with the justification of paternalistic action. On the basis of a conception of welfare as being tied to the person’s interests and preferences, I defend a consent-based model of justification . More specifically, I suggest that the patient’s anticipated later consent to a precedent paternalistic action should count as its justification . In what follows, I attempt to rebut the objection that this account does not do justice to the specific normative problems of Ulysses contracts . Finally, I examine cases in which, due to an irreversible loss of competence, a paternalistic action cannot be assented to by the patient. I argue that in these cases, acting against the patient’s present wishes cannot be justified. If in such a case a patient’s present request runs contrary to the past request expressed in the advance directive, the former should be respected. (shrink)

When patients have progressive and incurable dementia, should their advance directives always be followed? Contra Dworkin, Dresser argues that when patients remain able to enjoy and participate in their lives, directives to hasten death should sometimes be disregarded.

This paperback edition reproduces the complete text of the Essay as prepared by professor Nidditch for The Clarendon Edition of the Works of John Locke. The Register of Formal Variants and the Glossary are omitted and Professor Nidditch has written a new foreword.

Honoring a living will typically involves treating an incompetent patient in accord with preferences she once had, but whose objects she can no longer understand. How do we respect her precedent autonomy by giving her what she used to want? There is a similar problem with subsequent consent: How can we justify interfering with someone''s autonomy on the grounds that she will later consent to the interference, if she refuses now?Both problems arise on the assumption that, to respect someone''s autonomy, (...) any preferences we respect must be among that person''s current preferences. I argue that this is not always true. Just as we can celebrate an event long after it happens, so can we respect someone''s wishes long before or after she has that wish. In the contexts of precedent autonomy and subsequent consent, the wishes are often preferences about which of two other, conflicting preferences to satisfy. When someone has two conflicting preferences, and a third preference on how to resolve that conflict, to respect his autonomy we must respect that third preference. People with declining competence may have a resolution preference earlier, favoring the earlier conflicting preference (precedent autonomy), whereas those with rising competence may have it later, favoring the later conflicting preference (subsequent consent). To respect autonomy in such cases we must respect not a current, but a former or later preference. (shrink)

There is a flood of papers being published on new ways to diagnose Alzheimer disease before it is symptomatic, involving a combination of invasive tests , and pen and paper tests. This changes the landscape with respect to genetic tests for risk of AD, making rational suicide a much more feasible option. Before the availability of these presymptomatic tests, even someone with a high risk of developing AD could not know if and when the disease was approaching. One could lose (...) years of good life by committing suicide too soon, or risk waiting until it was too late and dementia had already sapped one of the ability to form and carry out a plan. One can now put together what one knows about one's risk, with continuing surveillance via these clinical tests, and have a good strategy for planning one's suicide before one becomes demented. This has implications for how these genetic and clinical tests are marketed and deployed, and the language one uses to speak about them. The phrase ‘there is nothing one can do’ is insulting and disrespectful of the planned suicide option, as is the language of the Risk Evaluation and Education for Alzheimer's Disease studies and others that conclude that it is ‘safe’ to tell subjects their risk status for AD. Further, the argument put forward by some researchers that presymptomatic testing should remain within research protocols, and the results not shared with subjects until such time as treatments become available, disrespects the autonomy of people at high risk who consider suicide an option. (shrink)

Williams (1970) argues that our intuitions about personal identity vary depending on how a given thought experiment is framed. Some frames lead us to think that persistence of self requires persistence of one's psychological characteristics; other frames lead us to think that the self persists even after the loss of one's distinctive psychological characteristics. The current paper takes an empirical approach to these issues. We find that framing does affect whether or not people judge that persistence of psychological characteristics is (...) required for persistence of self. Open-ended, abstract questions about what is required for survival tend to elicit responses that appeal to the importance of psychological characteristics. This emphasis on psychological characteristics is largely preserved even when participants are exposed to a concrete case that yields conflicting intuitions over whether memory must be preserved in order for a person to persist. Insofar as our philosophical theory of personal identity should be based on our intuitions, the results provide some support for the view that psychological characteristics really are critical for persistence of self. (shrink)

As witnessed by recent films such as _Fight Club_ and _Identity_, our culture is obsessed with multiple personality—a phenomenon raising intriguing questions about personal identity. This study offers both a full-fledged philosophical theory of personal identity and a systematic account of multiple personality. Gunnarsson combines the methods of analytic philosophy with close hermeneutic and phenomenological readings of cases from different fields, focusing on psychiatric and psychological treatises, self-help books, biographies, and fiction. He develops an original account of personal identity and (...) offers a provocative interpretation of multiple personality: in brief, "multiples" are right about the metaphysics but wrong about the facts. (shrink)

A very clear and powerfully argued defence of a most important and surprisingly neglected view."--Derek Parfit, All Souls College, Oxford. "If Dr. Olson is right, we are living animals and what goes on in our minds is wholly irrelevant to questions about our persistence through time....[Should] transform philosophical thinking about personal identity."--Peter van Inwagen, University of Notre Dame.

When philosophers address personal identity, they usually explore numerical identity: what are the criteria for a person's continuing existence? When non-philosophers address personal identity, they often have in mind narrative identity: Which characteristics of a particular person are salient to her self-conception? This book develops accounts of both senses of identity, arguing that both are normatively important, and is unique in its exploration of a range of issues in bioethics through the lens of identity. Defending a biological view of our (...) numerical identity and a framework for understanding narrative identity, DeGrazia investigates various issues for which considerations of identity prove critical: the definition of death; the authority of advance directives in cases of severe dementia; the use of enhancement technologies; prenatal genetic interventions; and certain types of reproductive choices. He demonstrates the power of personal identity theory to illuminate issues in bioethics as they bring philosophical theory to life. (shrink)

As witnessed by recent films such as _Fight Club_ and _Identity_, our culture is obsessed with multiple personality—a phenomenon raising intriguing questions about personal identity. This study offers both a full-fledged philosophical theory of personal identity and a systematic account of multiple personality. Gunnarsson combines the methods of analytic philosophy with close hermeneutic and phenomenological readings of cases from different fields, focusing on psychiatric and psychological treatises, self-help books, biographies, and fiction. He develops an original account of personal identity and (...) offers a provocative interpretation of multiple personality: in brief, "multiples" are right about the metaphysics but wrong about the facts. (shrink)

What is a human person, and what is the relation between a person and his or her body? In her third book on the philosophy of mind, Lynne Rudder Baker investigates what she terms the person/body problem and offers a detailed account of the relation between human persons and their bodies. Baker's argument is based on the 'Constitution View' of persons and bodies, which aims to show what distinguishes persons from all other beings and to show how we can be (...) fully material beings without being identical to our bodies. The Constitution View yields answers to the questions 'What am I most fundamentally?', 'What is a person?', and 'What is the relation between human persons and their bodies'? Baker argues that the complex mental property of first-person perspective enables one to conceive of one's body and mental states as one's own. (shrink)

Personal identity deals with questions about ourselves qua people (or persons). Many of these questions are familiar ones that occur to everyone at some time: What am I? When did I begin? What will happen to me when I die? Discussions of personal identity go right back to the origins of Western philosophy, and most major figures have had something to say about it. (There is also a rich literature on personal identity in Eastern philosophy, which I am not competent (...) to discuss. Collins 1982 is a good source.). (shrink)

In 1993, Professor of Jurisprudence, Ronald Dworkin of Oxford University and Professor of Law at New York University, delivered the Georgetown Law Center’s thirteenth Annual Philip A. Hart Memorial Lecture: "Life’s Dominion: An Argument About Abortion and Euthanasia." Dworkin is Professor of Philosophy and Frank Henry Sommer Professor of Law at New York University. He received B.A. degrees from both Harvard College and Oxford University, and an LL.B. from Harvard Law School and clerked for Judge Learned Hand. He was associated (...) with a law firm in New York (Sullivan and Cromwell) and was a professor of law at Yale University Law School from 1962-1969. He has been Professor of Jurisprudence at Oxford and Fellow of University College since 1969. He has a joint appointment at Oxford and at NYU where he is a professor both in the Law School and the Philosophy Department. He is a Fellow of the British Academy and a member of the American Academy of Arts and Sciences. Professor Dworkin is the author of many articles in philosophical and legal journals as well as articles on legal and political topics in the New York Review of Books. He has written Taking Rights Seriously (1977), A Matter of Principle (1985), Law’s Empire (1986), Philosophical Issues in Senile Dementia (1987), A Bill of Rights for Britain (1990), Life’s Dominion (1993), and Freedom’s Law (1996). (shrink)