PHIL276 Language in Society
so long as the demented patient at that present moment has values , we can still respect their autonomy by helping them act on these very values . As a result , we can discount the advanced directive of what is essentially another person .
Margo ’ s Advanced Directive
To summarise how I intend to use the Margo case in this essay- Margo , at t1 , issued a directive saying she wished to die if she ever had dementia in the future ( be that through withholding medical treatment or engaging in assisted suicide of some form ). At t2 , Margo is demented but happily reads , paints and eats peanut butter-jelly sandwiches day to day . Do we respect the advanced directive at t1 ? ( Dworkin , 1993 : 221 ).
Taking the Margo case , it is understandable why Dworkin supports the integrity view ; he believes it ‘ supports a genuine doctrine of precedent autonomy . A competent person ’ s right to autonomy requires that his past decisions about how he is to be treated if he becomes demented be respected even if they contradict the desires he has at that later point ’ ( Dworkin , 1993 : 228 ). After all , Margo , when competent , wished that if she were to become demented , she would prefer to die .
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If the last semblance of rationality of Margo that we have was in the past in which she made this advanced directive , then it would follow that , in virtue of her rational capacities being fully functional at that time , dying now that she is demented is what she genuinely wants , to retain her sense of self . Retaining a sense of self is important in most cases- typically ‘ we ’ want to be the arbiter of our life , and of our decisions , we want authenticity in our choices and to know we lived our life as closely as we could to our wishes . The problem I wish to uncover here is that , in t1 and t2 , there are different ‘ versions ’ of self that must have different levels of autonomy .
The initial reaction , as Dworkin remarks , is to question whether ‘ we ever conceivably kill her ?’ ( Ibid .). The intuitive answer here is ‘ no ’. In most readily available scenarios , seeing Margo living out her days eating sandwiches in contentment would be too much to overcome when taking out the task of killing her . At least , as far as one is a moral agent , one would struggle with actually carrying out the assisted suicide or withholding of medicine of such an innocent and blissfully unaware woman . For example , when one decides to turn off the life support machine ( which is no easy decision to make ) of