One Human Life or Different Persons : Over the Validity of Advance Directives

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  • 一つの人生か別の人格か : 事前指示の有効性をめぐって
  • ヒトツ ノ ジンセイ カ ベツ ノ ジンカク カ ジゼン シジ ノ ユウコウセイ オ メグッテ

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Advance directives are statements made beforehand by a person who was competent at the time about the care he/she wishes to receive if he/she were to become incompetent in the future. They are thus means of determining the patient's will when surrogate decision-making is needed. However, difficult problems may arise if advance directives conflict with the interests of the patient as judged by the people around him/her. This paper will explore this issue, focusing on advance directives of dementia patients. Theorists have varying opinions on the advance directives provided by dementia patients when they were competent. R. Dworkin argues that if someone has made a prior expression that "I will refuse any medical treatment at the terminal stage of dementia", we should not give the person any treatment at all. In contrast, R. Dresser asserts that "a dementia patient is a 'different person' from the person who made the advance directive", so that advance directives should be overridden if the current benefits of treatment the dementia patient may obtain are greater than the burden resulting from it. M. Quante asserts that advance directives should be respected as long as they do not cause actual pain or harm to dementia patients. The differences between these assertions are, in my view, based on differing views regarding the "personality" of incompetent dementia patients. Dementia patients have lost their personalities, according to Dworkin and Quante, while they have a "different personality" according to Dresser. However, a dementia patient and the person he/she used to be cannot be completely severed, for he/she is a being who lives one human life. Therefore, in order to make decisions on behalf of the patient, I suggest the need to distinguish him/her from the person who he/she used to be while at the same time regarding him/her as a person who lives one human life.


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