Dementia patients in the moderate-late stage of the disease can, and often do, express different preferences than they did at the onset of their condition. The received view in the philosophical literature argues that advance directives which prioritize the patient’s preferences at onset ought to be given decisive moral weight in medical decision-making. Clinical practice, on the other hand, favors giving moral weight to the preferences expressed by dementia patients after onset. The purpose of this article is to show that (...) the received view in the philosophical literature is inadequate and is out of touch with real clinical practice. I argue that having dementia is a cognitive transformative experience and that preference changes which result from this are legitimate and ought to be given moral weight in medical decision-making. This argument ought to encourage us to reduce our confidence in the moral weight of advance directives for dementia patients. (shrink)

This paper is part of a book symposium for L. A. Paul (2014) Transformative Experience (OUP).

In “What you can’t expect when you’re expecting,” I argue that, if you don’t know what it’s like to be a parent, you cannot make this decision rationally—at least, not if your decision is based on what you think it would be like for you to become a parent. My argument hinges on the idea that becoming a parent is a transformative experience. This unique type of experience often transforms people in a deep and personal sense, and in the process, (...) changes their preferences. In section 1, I will explain transformative experience in terms of radical first-personal epistemic and self change. In section 2, I’ll explain the notion of subjective value that I use to develop the decision problem. In section 3, I will discuss the way we ordinarily combine our introspective assessments with testimony and evidence. In section 4, I will discuss the problems for rational decision-making. In section 5, I will explore the problem of first-personally transformed future selves. In section 6, I will engage with the main themes and arguments and ideas of the authors of the papers contributed to this volume. (shrink)

In the real world, there can be constraints on rational decision-making: there can be limitations on what I can know and on what you can know. There can also be constraints on my ability to deliberate or on your ability to deliberate. It is useful to know what the norms of rational deliberation should be in ideal contexts, for fully informed agents, in an ideal world. But it is also useful to know what the norms of rational deliberation should be (...) in the actual world, in non-ideal contexts, for imperfectly informed agents, especially for big, life-changing decisions. That is, we want to know how to deliberate as best we can, given the real-world limitations on what we can know, and given real-world limitations on how we are able to deliberate. In this paper, our concern is with the norms of rational deliberation in certain, important, non-ideal contexts, where the reasoning occurs from the agent’s first person, subjective point of view. The norms governing the process of deliberation for real people in the sorts of non-ideal contexts we’ll consider need to reflect the way that real agents, with an incomplete grasp on the facts and an imperfect ability to deliberate, can be expected to proceed. Our central contention is that framing and exploring the deliberative process from the first person perspective allows us to uncover and explore important, real-world constraints on boundedly rational agents deliberating from the subjective perspective. (shrink)

I summarize the main argument of Transformative Experience (OUP 2014). The book develops familiar examples from classical philosophical debates, as well as original examples, to argue that an agent’s decision to undergo a transformative experience—an experience constituted by radical personal and epistemic change for the agent—must either be authentic or irrational, but not both. The Precis of Transformative Experience walks the reader through the main ideas involved in epistemically and personally transformative experiences, the problems they pose for rational decision-making, and (...) discusses a number of key original examples of transformative experiences. (shrink)

How should we make choices when we know so little about our futures? L. A. Paul argues that we must view life decisions as choices to make discoveries about the nature of experience. Her account of transformative experience holds that part of the value of living authentically is to experience our lives and preferences in whatever ways they evolve.

We propose that certain forms of chronic illness can be transformative experiences, in the sense described by L.A. Paul.