of advanced directives , current wishes or potential breaches of autonomy we need to know who is making these assertions , these demands and wishes . The problem is that , without grounding the necessary and sufficient conditions for the self , we cannot determine whether we should adhere to these demands in the first place . Ultimately , we need to engage in metaphysical discussion about the nature of the self in order to inform our practice in ethical cases of paternalism , care and medical ethics .
There is perhaps one strong objection to this line of enquiry . As Buchanan argues , there is an argument to suggest that such a cognitively debilitating illness such as dementia leaves no person in its place whatsoever ; the living being is not a person , so a fortiori , is not a different person ( Buchanan , 1988 : 283 ). As a result , our argument would break down because I have assumed that since we have Margo at t1 , and a new Margo at t2 , the advanced directives of t1 Margo cannot enforce decisions on t2 Margo . This of course would depend upon your persistence conditions imposed . I have opted for Dainton ’ s ‘ stream of consciousness ’. This aligns closest to the first of Buchannan ’ s options for necessary persistence conditions and the one I will look
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closest at - ‘( a ) the ability to be conscious of oneself as existing over time-as having a past and a future , as well as a present .’ Buchannan argues that since demented people cannot do this , they are not persons ( which would be counterintuitive )’ ( Buchanan , 1988 : 284 ).
Buchannan ’ s account for condition ( a ) is left open to interpretation what amount of ‘ time ’ a person must be conscious of oneself to be labelled as a person . On Dainton ’ s view , we can make the argument that Margo at t1 and at t2 are different selves . A self is defined by its capacity for continual streams of consciousness on Dainton ’ s account . The salient feature however is that this does not have to be a continual , permanent stream ; of course , people sleep and lose consciousness for example . What binds the self is what are called ‘ overlapping c-phases ’ where ‘ earlier and later c-phases have a common part ’ ( Dainton , 2014 : 92 ). T1 and t2 Margo do not share this ; this is accepted by most I would believe . Perhaps dementia patients have strong memories of the past , but not in any coherent timeline that they can rationalise . The argument that Buchannan is seemingly trying to make is that there is no ‘ person ’ at t2 on this account because demented