should Dementia Margo be forced to die based on the wishes of an entirely different person mentally speaking ? Intuitively , this may be hard for some to accept . It is hard for family and friends to perhaps view it this way ; Margo just looks like the same Margo before dementia struck , and our stream of consciousness perceived her changes in mental capacity over time . However , it is because internally that Margo has lost her own stream of consciousness , that psychological continuity has been lost , that we must admit that there is a new self that now exists . As Ott notes , ‘ what , if anything could possibly justify following an advance directive drawn up by an individual with whom you are no longer psychologically continuous ?’ ( Ott , 2009 : 44 ). I agree with Ott ’ s implied answer to his rhetorical question . If there is no psychological continuity between physical entities , then one is hard pressed to find a reason why an advanced directive should be adhered to . Dworkin argues that showing ‘ dignity ’, presumably in adhering to these advanced directives , shows respect for the demented person ’ s life ‘ as a whole ’ ( Dworkin , 1993 : 221-2 ). On Dworkin ’ s integrity view then , respecting Margo ’ s life as a whole means that we ought to grant her advanced directive the higher normative status when coming to
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a decision on Margo ’ s future . If anything , Dworkin ’ s assertion could be read as not respecting Margo ’ s life as a whole . On this view , we are respecting the prior part of Margo ’ s life - we ignore her contemporaneous wishes , current interests , and focus on one section in which she made this directive . This , I argue , is the antithesis of respecting the integrity of a person as a whole . However , this point need not be made , since there are two different senses in which we refer to Margo . Respecting Margo as a whole is respecting that Margo now has no continuity with the person who made the advanced directive , and now we must reach a decision on her future in another way . As Ott also comments , the problem remains ; the nature of the weakened connection between pre-demented and demented agent undermines any authority of an advanced directive ( Ott , 2009 : 44-5 ).
As a result of accepting this account of personal identity , it is not the case that the past directives of Margo must be adhered to , as Dworkin argued . In the Margo case , demented Margo is a new self , a new person , and as such should not die on the basis on what a different ‘ person ’ wanted to happen in certain circumstances . The choice to keep demented Margo alive does not rest on the shoulders of a completely