Advance Directives and the Happy Demented Patient

ABSTRACT 

In this talk I will argue that advance directives, while they should be regarded as authoritative in cases of permanent unconsciousness, are not authoritative in cases involving dementia; and that in dementia cases a “best-interest” standard should be applied, instead. I argue that the case against advance directives in dementia is in fact over-determined: they should be disregarded both because the dementia patient’s current interests should take priority over her prior expressed wishes, and because the patient, pre-dementia, was unqualified to make decisions regarding her future self. This is true even if we accept that dementia does not affect personal identity.

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