Advance directives permit competent adult patients to provide guidance regarding their care in the event that they lose the capacity to make medical decisions. One concern about the use of advance directives is the possibility that, in certain cases in which a patient undergoes massive psychological change, the individual who exists after such change is literally a (numerically) distinct individual from the person who completed the directive. If this is true, there is good reason to question the authority of the (...) directive Ð which is supposed to apply to the individual who completed it, not to someone else. This is `the someone else problem'. After briefly introducing advance directives as a basis for medical decision-making, this paper elaborates `the someone else problem' in the context of severe dementia. The paper then reconstructs the reasoning that leads to this putative problem and exposes the important underlying assumption that we are essentially persons. An alternative view of what we are, one that regards personhood as inessential, is then considered, before several arguments are advanced in favor of that alternative view. The paper next explores implications for advance directives: `The someone else problem' is effectively dissolved, while it is noted that a related problem (one beyond the paper's scope) may persist. A few implications beyond advance directives are also identified. (shrink)

Does respect for autonomy imply respect for precedent autonomy? The principle of respect for autonomy requires us to respect a competent patient’s treatment preference, but not everyone agrees that it requires us to respect preferences formed earlier by a now‐incapacitated patient, such as those expressed in an advance directive. The concept of precedent autonomy, which concerns just such preferences, is problematic because it is not clear that we can still attribute to a now‐incapacitated patient a preference which that patient never (...) disaffirmed but can no longer understand. If we cannot make that attribution, then perhaps we should not respect precedent autonomy – after all, how can you respect patient autonomy by giving patients what they no longer want, even if they never disaffirmed those wants? I argue that whether an earlier preference can still be attributed to a now‐incapacitated patient depends on the reasons behind the preference, for a preference includes (and is not merely supported by) the reasons behind it. When the considerations that served as reasons no longer exist, neither does the preference which included those reasons. In particular, if the considerations that served as reasons for the patient exist only under conditions where the patient retains full mental capacity, then once that capacity is lost, so are those reasons and the preference based upon them. I use this analysis of precedent autonomy to ascertain the merits of various approaches to advance medical decisionmaking, including Nancy Rhoden’s approach, approaches based on a Parfitian personal identity analysis, approaches based on soft paternalism, and approaches based on the stability and longevity of preferences. Despite the apparent absurdity of respecting patient autonomy by giving patients what they no longer prefer but have never disaffirmed, I conclude with some programmatic remarks on when and why respect for (precedent) autonomy nonetheless requires us to respect former preferences. (shrink)

Eric Olsen argues from the fact that we once existed as fetal individuals to the conclusion that the Standard View of personal identity is mistaken. I shall establish that a similar argument focusing upon dead people opposes Olson’s favored Biological View of personal identity.

We defend the view that we are not identical to organisms against the objection that it implies that there are two subjects of every conscious state one experiences: oneself and one’s organism. We then criticize animalism —the view that each of us is identical to a human organism—by showing that it has unacceptable implications for a range of actual and hypothetical cases of conjoined twinning : dicephalus, craniopagus parasiticus, and cephalopagus.

In this paper we propose an approach to vagueness characterised by two features. The first one is philosophical: we move along a Kantian path emphasizing the knowing subject’s conceptual apparatus. The second one is formal: to face vagueness, and our philosophical view on it, we propose to use topology and formal topology. We show that the Kantian and the topological features joined together allow us an atypical, but promising, way of considering vagueness.

Two problems related to the biological identity of living beings are faced: the who-problem (which are the biological properties making that living being unique and different from the others?); the persistence-problem (what does it take for a living being to persist from a time to another?). They are discussed inside a molecular biology framework, which shows how epigenetics can be a good ground to provide plausible answers. That is, we propose an empirical solution to the who-problem and to the persistence-problem (...) on the basis of the new perspectives opened by a molecular understanding of epigenetic processes. In particular, concerning the former, we argue that any living being is the result of the epigenetic processes that have regulated the expression of its genome; concerning the latter, we defend the idea that the criterion for the persistence of its identity is to be indicated in the continuity of those epigenetic processes. We also counteract possible objections, in particular (1) whether our approach has something to say at a metaphysical level; (2) how it could account for the passage from the two phenotypes of the parental gametes to the single phenotype of the zygote; (3) how it could account for the identity of derivatives of one living being that continue to live disjoined from that original living being; (4) how it could account for higher mental functions. (shrink)

In this paper, the ontological, terminological, epistemological, and ethical aspects of omission are considered in a coherent and balanced framework, based on the idea that there are omissions which are actions and omissions which are non-actions. In particular, we suggest that the approach to causation which best deals with omission is Mackie's INUS conditional proposal. We argue that omissions are determined partly by the ontological conditional structure of reality, and partly by the interests, beliefs, and values of observers. The final (...) upshot is that moral judgments involved in cases of omissions cannot be grounded on, but are the ground for judgments about what INUS conditions count as omissions. (shrink)

In this paper we will propose an empirical analysis of spatial and temporal boundaries. Unlike other proposals, which deal mainly with the commonsense level of the subject, we will ground our explication on well-established scientific practice and language. In this way we show how to reconsider in an innovative way questions such as the distinction between the bona fide boundaries and the fiat boundaries, the thickness and the ownership of the boundaries. At the same time we propose a division between (...) ex mensura boundaries and qui vulgo dicuntur boundaries. What is it, therefore,that divides the atmosphere from the water?[Leonardo da Vinci, Notebooks]. (shrink)

In this paper I will compare the concept of explication à la Carnap and the concept of explication à la Kant. This essay should primarily be seen as a comparison of two different philosophical styles, but it is also intended as a vindication of what Kant wrote and what Carnap forgot to read.

The purpose of this paper is methodological. I begin by showing the methodological frailties of both the heart and brain approach to the criteria of death used in connection with organ transplantation. I then clarify what a definition is. Finally, I propose to abandon the definition of death, and suggest a pragmatic definition of ‘explantability window’.

We discuss the meaning of “being alive” and “being dead.” Our primary aim is to pave the way for a sound and accurate ethical debate concerning these two concepts. In particular, we analyze a metabolic approach and a genetic one and discuss the reasons for their failure to constitute a good starting point for successive debates. We argue that any ethical or social discussion of topics involving life and death must introduce cultural constructs such as, on the one hand, the (...) concept of clinical death and, on the other hand, the concept of existence. We argue that these two cultural constructs, although consistent with biomedical knowledge, cannot be ontologically grounded in it. To conclude, we apply our findings to the case of human embryos. (shrink)

The rare condition known as dicephalus occurs when (prior to implantation) a zygote fails to divide completely, resulting in twins who are conjoined below the neck. Human dicephalic twins look like a two-headed person, with each brain supporting a distinct mental life. Jeff McMahan has recently argued that, because they instance two of us but only one animal, dicephalic twins provide a counterexample to the animalist's claim that each of us is identical with a human animal. To the contrary, I (...) argue that in cases of dicephalus it is obvious neither that there is one animal nor that there are two of us. Consequently, the animalist criterion does not straightforwardly apply to cases of dicephalus. I defend an account of dicephalus that is both sensitive to the complexity of twinning phenomena and not inconsistent with animalism. In my view, dicephalic twins are a borderline case of the concept HUMAN ANIMAL. I conclude with some speculative remarks concerning the normative import (if any) of my claim that dicephalic twins are a borderline case. (shrink)

It has long been thought that certain key bioethical views depend heavily on work in personal identity theory, regarding questions of either our essence or the conditions of our numerical identity across time. In this paper I argue to the contrary, that personal identity is actually not significant at all in this arena. Specifically, I explore three topics where considerations of identity are thought to be essential – abortion, definition of death, and advance directives – and I show in each (...) case that the significant work is being done by a relation other than identity. (shrink)

Many philosophers have taken there to be an important relation between personal identity and several of our practical concerns (among them moral responsibility, compensation, and self-concern). I articulate four natural methodological assumptions made by those wanting to construct a theory of the relation between identity and practical concerns, and I point out powerful objections to each assumption, objections constituting serious methodological obstacles to the overall project. I then attempt to offer replies to each general objection in a way that leaves (...) the project intact, albeit significantly changed. Perhaps the most important change stems from the recognition that the practical concerns motivating investigation into personal identity turn out to be not univocal, as is typically thought, such that each of the different practical concerns may actually be related to personal identity in very different ways. (shrink)

In this introduction to the special issue of Theoretical Medicine and Bioethics on the topic of personal identity and bioethics, I provide a background for the topic and then discuss the contributions in the special issue by Eric Olson, Marya Schechtman, Tim Campbell and Jeff McMahan, James Delaney and David Hershenov, and David DeGrazia.

: Debates on precedent autonomy and some forms of paternalistic interventions, which are related to questions of personal identity, are analyzed. The discussion is based on the distinction between personal identity as persistence and as biographical identity. It first is shown that categorical objections to advance directives and "Ulysses contracts" are based on false assumptions about personal identity that conflate persistence and biographical identity. Therefore, advance directives and "Ulysses contracts" are ethically acceptable tools for prolonging one's autonomy. The notions of (...) personality and biographical identity are used to analyze the ethically relevant features. Thereby, it is shown that these concepts are operative in and useful for thinking in biomedical ethics. The overall conclusion is that categorical arguments against precedent autonomy or "Ulysses contracts" are based on misleading theories of personal identity and that advance directives are an ethically respectable tool for prolonging individuals' autonomy in cases of dementia and mental illness. (shrink)

[A] man does not consist of memory alone. He has feeling, will, sensibilities, moral being…. And it is here … that you may find ways to touch him.—A. R. Luria1.

After motivating the general problem of personal identity and considering several possible accounts, this entry reviews a variety of arguments for and against the animalist criterion of personal identity.