Euthanasia and dementia : Handling advance directives in the light of the someone else problem

Abstract

In this thesis I’ll focus on the handling of advance euthanasia directives and consider if it is morally acceptable to euthanize patients suffering from dementia based on an advance directive in the light of the someone else problem. This problem will have a prominent role throughout this research for it is feared that patients completely change into someone else due to the radical psychological change they undergo in the context of dementia and it is deemed to be unacceptable that the request of one person would lead to the death of another. An overview of the current practice, in which legal regulations, the physician’s and patient’s perspectives are discussed, will be provided. Hereafter the someone else problem is approached from the theoretical perspectives of the psychological, biological and narrative approaches of personal identity. Even though a charitable interpretation of the psychological approach will expose a fracture in persistence of personal identity over time, this approach will turn out to rest on a faulty conception of the human essence and the biological approach will restore continued existence over time. But despite numerical continuity of persons as biological beings, the narrative approach of personal identity will expose the qualitative changes that patients undergo due to their suffering from dementia. Hereto I’ll consider whether an appeal to precedent autonomy can resolve the handling of advance directives in the context of narrative identity. It will however become evident that patients remain to possess a degree of autonomy in the initial stages of their disease and can hold values throughout the development of their illness despite their qualitatively changed identity. Hereto I’ll conclude that the someone else problem does impede the euthanizing of demented patients based on an advance directive and that one can only adhere to one’s predetermined directive if this is not in conflict with one’s current values and if one’s final degree of autonomy, and thus his capacity to value, has disappeared completely.