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The New St Cross Special Ethics Seminars are jointly arranged by the Oxford Uehiro Centre for Practical Ethics and the Wellcome Centre for Ethics and Humanities (WEH).


Patients with disorders of consciousness after severe brain injury need surrogate decision-makers to guide treatment decisions on their behalf. Formal guidelines for surrogate decision-making generally instruct decision-makers to first appeal to a patient’s written advance directive, followed by making a substituted judgement of what the patient would have chosen, and lastly, to make decisions according to what seems to be in the patient’s best medical interests. The basic idea is that past values begin to matter when global incompetence sets in. In this paper, I challenge this rationale, using patients with ‘covert awareness’ as a case study. Patients with ‘covert awareness’ may continue to have values and an authentic sense of self, which may differ from their past values and wishes, despite lacking decision-making capacity in the present. Accordingly, surrogate decision-makers should make decisions based on how the patient is likely to experience their condition in the present, rather than their past wishes and values.

speaker bio

Mackenzie Graham is a Senior Research Fellow at the Ethox Centre and Wellcome Centre for Ethics and Humanities. He is currently part of the National Consortium of Intelligent Medical Imaging (NCIMI), investigating ethical issues arising from the collection, storage, and sharing of digitalized medical images. This project aims to facilitate the ethical integration of clinical imaging enhanced by artificial intelligence (AI), into medical practice. Mackenzie received a PhD in Philosophy from Western University, Canada, in 2016, where he specialised in moral philosophy and bioethics



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