Advertisement

Medicine, Health Care and Philosophy

, Volume 21, Issue 2, pp 255–264 | Cite as

Dementia, identity and the role of friends

  • Christopher Cowley
Scientific Contribution
  • 156 Downloads

Abstract

Ronald Dworkin (1993) introduced the example of Margo, who was so severely demented that she could not recognise any family or friends, and could not remember anything of her life. At the same time, however, she seemed full of childish delight. Dworkin also imagines that, before her dementia, Margo signed an advance refusal of life-saving treatment. Now severely demented, she develops pneumonia, easy to treat, but lethal if untreated. Dworkin argues that the advance refusal ought to be heeded and Margo be allowed to die of that pneumonia, on the basis that the prior refusal expresses her true wishes (her ‘critical interests’). In this paper I want to challenge Dworkin’s understanding of identity and his conclusion about advance refusals, and I develop my argument in two directions. First, I argue that the demented Margo is not some ‘lesser’ version of the ‘true’ Margo, but instead that the present Margo’s wishes should take precedence over those of the past Margo, on the grounds that all of us are entitled to change our minds. Second, I argue for a stronger role for friends and family members in sustaining the demented Margo’s identity through her years of decline. Based on this, I argue for a presumption against the advance refusal, but I allow that in extreme cases (which I describe), a friend might have the authority to demand that it be heeded.

Keywords

Dementia Personal identity Friendship Advance directives 

References

  1. De Grazia, D. 1999. Advance directives, dementia, and ‘the someone else problem’. Bioethics 13 (5): 373–391.CrossRefGoogle Scholar
  2. Dresser, R. 1995. Dworkin on dementia: Elegant theory, questionable policy. Hastings Center Report 25 (6): 32–38.CrossRefGoogle Scholar
  3. Dresser, R. 2014. Toward a humane death with dementia. Hastings Center Report 44 (3): 38–40.CrossRefGoogle Scholar
  4. Dworkin, R. 1993. Life’s Dominion. New York: Vintage.Google Scholar
  5. Firlik, A. 1991. ‘Margo’s Logo’. Journal of the American Medical Association 265: 201.CrossRefGoogle Scholar
  6. Gaita, R. 2000. A Common Humanity. Thinking about Love and Truth and Justice. London: Routledge.Google Scholar
  7. Gedge, E. 2004. Collective moral imagination: Making decisions for persons with dementia. Journal of Medicine and Philosophy 29 (4): 435–450.CrossRefGoogle Scholar
  8. Lindemann, H. 2009. Holding one another (well, wrongly, clumsily) in a time of dementia. Metaphilosophy 40 (3–4): 416–424.CrossRefGoogle Scholar
  9. Lovibond, S. 1998. Wittgensteinian Ethics, Routledge Encyclopedia of Philosophy, London: Taylor and Francis.Google Scholar
  10. Mackenzie, C., ed. 2000. Relational Autonomy: Feminist Essays on Autonomy, Agency and Social Self. Oxford: Oxford University Press.Google Scholar
  11. Matthews, E. 2006. Dementia and the identity of the person. In Dementia: Mind, Meaning and the Person, ed. Hughes J. et al. Oxford: Oxford University Press.Google Scholar
  12. Menzel, P., B. Steinbock. 2013. Advance directives, dementia, and physician-assisted death. Journal of Law, Medicine and Ethics 41.2: 484–500.CrossRefGoogle Scholar
  13. Muramoto, O. 2011. Socially and temporally extended end-of-life decision-making process for dementia patients. Journal of Medical Ethics 37 (6): 339–343.CrossRefGoogle Scholar
  14. Parfit, D. 1984. Reasons and Persons. Oxford: Oxford University Press.Google Scholar
  15. Savulescu, J. 2006. Conscientious objection in medicine. British Medical Journal 332: 294–297.CrossRefGoogle Scholar
  16. Ter Meulen, R., K. Wright. 2012. Family solidarity and informal care: The case of care for people with dementia. Bioethics 26 (7): 361–368.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2017

Authors and Affiliations

  1. 1.School of PhilosophyUniversity College DublinDublin 4Ireland

Personalised recommendations