This book is the most comprehensive treatment available of one of the most urgent - and yet in some respects most neglected - problems in bioethics: decision-making for incompetents. Part I develops a general theory for making treatment and care decisions for patients who are not competent to decide for themselves. It provides an in-depth analysis of competence, articulates and defends a coherent set of principles to specify suitable surrogate decisionmakers and to guide their choices, examines the value of advance (...) directives, and investigates the role that considerations of cost ought to play in decisions concerning incompetents. Part II applies this theoretical framework to the distinctive problems of three important classes of individuals, many of whom are incompetent: minors, the elderly and psychiatric patients. The authors' approach combines a probing analysis of fundamental issues in ethical theory with a sensitive awareness of the concrete realities of health care institutions and the highly personal and individual character of difficult practical problems. Its broad scope will appeal to health professionals, moral philosophers and lawyers alike. (shrink)

Might something I do now make something have happened earlier? This paper is about an argument which concludes that I might. Some arguments about “backward causation” conclude that the world could have been the kind of place in which actions make things have happened earlier. The present argument says that it is that kind of place: that we actually are continually doing things that really make earlier things have happened. The argument is not new. It sees temporal direction as logically (...) independent of any direction which necessary and sufficient conditions may have and it sees causal direction as properly deriving from the latter. Thus the directions of time and of making things happen need not coincide and, as it turns out, do not actually coincide in fact. There are examples of events which are sufficient, in a suitably rich sense, for the occurrence of earlier events; hence they make the earlier events happen. My purpose in this paper is to lend support to the argument by filling in some details which ‘backward sufficient conditions’ may lay claim to. (shrink)