Cookies on this website
We use cookies to ensure that we give you the best experience on our website. If you click 'Continue' we'll assume that you are happy to receive all cookies and you won't see this message again. Click 'Find out more' for information on how to change your cookie settings.

It is accepted that treatment of previously competent, now incompetent patients can be limited if that is what the patient would desire, if she were now competent. Expressed past preferences or an advance directive are often taken to constitute sufficient evidence of what a patient would now desire. I distinguish between desires and rational desires. I argue that for a desire to be an expression of a person's autonomy, it must be or satisfy that person's rational desires. A person rationally desires a course of action if that person desires it while being in possession of all available relevant facts, without committing relevant error of logic, and "vividly imagining" what its consequences would be like for her. I argue that some competent, expressed desires obstruct autonomy. I show that several psychological mechanisms operate to prevent a person rationally evaluating what future life in a disabled state would be like. Rational evaluation is difficult. However, treatment limitation, if it is to respect autonomy, must be in accord with a patient's rational desires, and not merely her expressed desires. I illustrate the implications of these arguments for the use of advance directives and for the treatment of competent patients.

Type

Journal article

Journal

Bioethics

Publication Date

07/1994

Volume

8

Pages

191 - 222

Keywords

Analytical Approach, Death and Euthanasia, Philosophical Approach, President's Commission for the Study of Ethical Problems, Advance Directive Adherence, Advance Directives, Advisory Committees, Cognition, Comprehension, Decision Making, Disabled Persons, Euthanasia, Passive, Freedom, Health Personnel, Humans, Mental Competency, Paternalism, Patients, Personal Autonomy, Philosophy, Psychology, Public Policy, Quality of Life, Social Values, Third-Party Consent, Treatment Refusal, Withholding Treatment