PHIL276 Language in Society
different Margo from the past . Some may disagree . Looking at the Ulysses case as Oliver Hallich characterised , Ulysses at t1 authorised his shipmates to be tied to the mast at t2 and to restrict his liberty at t2 , even though he will be incompetent and possibly suffer at t2 ( Hallich , 2019 : 3 ). Most would say that Ulysses ’ past directives should enforce the decision to allow him to suffer ; he cannot make a rational decision now ( just like sandwich eating Margo cannot ), so why can we not accept predementia Margo ’ s request ? The difference is that , whilst we assume Ulysses ’ pain , and his irrationality to be temporary , the stream of consciousness , or capacity for a stream of consciousness , still exists . When this pain eventually finishes , Ulysses will still be Ulysses because of the continuous conscious experience , and he will be happy that we adhered to his wishes . Even if he passed out or went into a crazed state where consciousness was lost , this would only be a temporary consequence of tying himself to the mast , the c-system , the potential for continuous conscious experience would persist . Dementia patients are different selves exactly because this potential does not exist . This is not a temporary illness ( yet ); over time brain degradation increases , totalling a new self once the capacity for consistent conscious
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experience has vanished ; one which will not return after some temporary pain and be thankful that we adhered to her wishes . Giving substantial weight to respecting advanced directives works in scenarios where rationality is temporarily ceded ( be it through a coma which is expected to be temporary for example ), but a permanent change in one ’ s stream of consciousness is tantamount to a new self . Margo at t1 , is not Margo at t2 . As Brock argues , ‘ If the cognitive changes in the patient are so profound as to call into question whether personal identity is maintained between the earlier and later selves , this challenge may seem even more worrisome [ for respecting advanced directives ]’ ( Brock , 1994 : 10 ).
Some may reject this line of enquiry altogether ; issues of autonomy and advanced directives in dementia patients are inherently ethical issues , theories of personal identity are an inherently metaphysical issue and such the two should be kept separate . This sort of response skirts around the issue . The metaphysical is important because it can inform the physical everyday reality that we exist in . The very notion of the boundaries of autonomy and patient care are hard to discuss without defining the self . For us to judge the importance