Many people, including many egalitarian political philosophers, professa belief in equality while enjoying high incomes of which they devotevery little to egalitarian purposes. The article critically examinesways of resolving the putative inconsistency in the stance of thesepeople, in particular, that favouring an egalitarian society has noimplications for behaviour in an unequal one; that what''s bad aboutinequality is a social division that philanthropy cannot reduce; thatprivate action cannot ensure that others have good lives; that privateaction can only achieve a ``drop in (...) the ocean''''; that private effortis not called for, since justice is a matter for the state to enforce;that private effort cannot remove the fundamental injustice, whichis inequality of power; and that private effort involves an unreasonablylarge psychological burden. (shrink)

ZusammenfassungPatientenverfügungen für spätere Zustände schwerer kognitiver Beeinträchtigungen, wie sie für Spätphasen der Demenz typisch sind, stoßen auf weitergehende Vorbehalte als Patientenverfügungen für anderweitige Zustände eingeschränkter Einwilligungsfähigkeit. Einer der Gründe dafür scheinen die ethischen und psychologischen Konflikte im Gefolge von Patientenverfügungen zu sein, mit denen Patienten in gesunden Tagen für bestimmte Phasen der Erkrankung die Nichtbehandlung interkurrenter Erkrankungen oder die Unterlassung künstlicher Ernährung verfügt haben, während sich unter den in der Patientenverfügung gemeinten Bedingungen keine Anzeichen finden, dass sie unter ihrer Situation (...) leiden. Der Beitrag argumentiert für diese Situation für eine „gemischte“ ethische Strategie: Patientenverfügungen im rechtlichen Sinne sollten insbesondere dann, wenn sie im Rahmen eines Advance Care Planning erstellt sind, befolgt werden, um zu verhindern, dass den Vorausverfügenden das Vertrauen in die spätere Befolgung ihres Wunsches nach Abbruch oder Nichtaufnahme medizinischer Behandlungen genommen wird. Dagegen sollten darüber hinausgehende „Pflegeverfügungen“ ohne rechtlich verbindlichen Status nur in Fällen beachtet werden, in denen zwischen vorausverfügtem und „natürlichem“ Willen Konkordanz besteht. (shrink)

Hud Hudson presents an innovative view of the metaphysics of human persons according to which human persons are material objects but not human organisms. In developing his account, he formulates and defends a unique collection of positions on parthood, persistence, vagueness, composition, identity, and various puzzles of material constitution. The author also applies his materialist metaphysics to issues in ethics and in the philosophy of religion. He examines the implications for ethics of his metaphysical views for standard arguments addressing the (...) moral permissibility of our treatment of human persons and their parts, fetuses and infants, the irreversibly comatose, and corpses. He argues that his metaphysics provides the best foundation in the philosophy of religion for the Christian doctrine of the resurrection of the body. Hudson addresses a broad range of metaphysical issues, but among his most strikingly original contributions are his defense of the "Partist" view and his argument for the compatibility of Christianity with a materialistic theory of human persons. (shrink)

Recent legal rulings concerning the status of advance statements have raised interest in the topic but failed to provide any definitive general guidelines for their enforcement. I examine arguments used to justify the moral authority of such statements. The fundamental ethical issue I am concerned with is how accounts of personal identity underpin our account of moral authority through the connection between personal identity and autonomy. I focus on how recent Animalist accounts of personal identity initially appear to provide a (...) sound basis for extending the moral autonomy of an individual - and hence their autonomous wishes expressed through an advance directive - past the point of severe psychological decline. I argue that neither the traditional psychological account nor the more recent Animalist account of personal identity manage to provide a sufficient basis for extending our moral autonomy past the point of incapacity or incompetence. I briefly explore how analogies to similar areas in law designed to facilitate autonomous decision, such as wills and trusts, provide at best only very limited scope for an alternative justification for granting advance statements any legal or moral authority. I conclude that whilst advance statements play a useful role in formulating what treatment is in a patient’s best interests, such statements do not ultimately have sufficient moral force to take precedence over paternalistic best interest judgements concerning an individual’s care or treatment. (shrink)

In this quite modestly ambitious essay, I'll generally just assume that, for the most part, our "scientifically informed" commonsense view of the world is true. Just as it is with such unthinking things as planets, plates and, I suppose, plants, too, so it also is with all earthly thinking beings, from people to pigs and pigeons; each occupies a region of space, however large or small, in which all are spatially related to each other. Or, at least, so it is (...) with the bodies of these beings. And, even as each of these ordinary entities extends through some space, so, also, each endures through some time. In line with that, each ordinary entity is at least very largely, and is perhaps entirely, an enduring physical entity (which allows that many might have certain properties that aren't purely physical properties.) Further, each ordinary enduring entity is a physically complex entity: Not only is each composed of parts, but many of these parts, whether or not absolutely all of them, are themselves enduring physical entities, and many of them also are such physically complex continuing entities. When an ordinary entity undergoes a significant change, then, at least generally, this change will involve changes concerning that entity's constituting physical parts, whether it be a rearrangement of (some of) these parts, or a loss of parts, or a gain of parts, or whatever. Often, the entity will still exist even after the change occurs. As we may well suppose, this happens when, from two strokes of an ax, an ordinary log loses just a chip of wood. As we may then say, such a change conforms with the log's "persistence conditions." Somewhat less often, such an ordinary entity undergoes a change that means an end to it: When a bomb's explosion makes our log become just so many widely scattered motes of dust, the log will no longer exist. Such a momentous change doesn't conform with the log's persistence conditions. (shrink)

The question of when we have justification for overriding ordinary, everyday decisions of persons with dementia is considered. It is argued that no single criterion for competent decision-making is able to distinguish reliably between decisions we can legitimately override and decisions we cannot legitimately override.

This article evaluates whether personal identity should be sought only in the biological or embodied existence of the person or exclusively in psychological existence. It suggests that whatever the answer turns out to be, it would involve causality. It argues against the animalist view of personal identity and defends the classical neo-Lockean view by arguing that the thick properties of person are psychological or mental ones. The author's answer to the question of what we are is in part that we (...) are creatures having certain kinds of mental properties as the thick properties whose causal profiles determine their persistence conditions. (shrink)

: 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)

We can start with some science fiction. Here on Earth, I enter the Teletransporter. When I press some button, a machine destroys my body, while recording the exact states of all my cells. This information is sent by radio to Mars, where another machine makes, out of organic materials, a perfect copy of my body. The person who wakes up on Mars seems to remember living my life up to the moment when I pressed the button, and is in every (...) other way just like me. (shrink)

This paper is about the neglected question of what sort of things we are metaphysically speaking. It is different from the mind-body problem and from familiar questions of personal identity. After explaining what the question means and how it differs from others, the paper tries to show how difficult it is to give a satisfying answer.

According to a view attractive to both metaphysicians and ethicists, every period in a person’s life is the life of a being just like that person except that it exists only during that period. These “subpeople” appear to have moral status, and their interests seem to clash with ours: though it may be in some person’s interests to sacrifice for tomorrow, it is not in the interests of a subperson coinciding with him only today, who will never benefit from it. (...) Or perhaps there is no clash, and a subperson’s interests derive from those of the person it coincides with. But this makes it likely that our own interests derive from those of other beings coinciding with us. (shrink)

In his book, Eric Olson (2007) makes some criticisms of a response to the problem of the thinking animal (also called the ‘too many minds’ or ‘too many thinkers’ problem) which I have offered, on behalf of the neo-Lockean psychological continuity theorist. Olson calls my proposal ‘personal pronoun revisionism’ (though I am not suggesting any revision). In what follows I shall say what my proposal actually is, defend it and briefly respond to Olson's criticism.

Physician-assisted suicide laws in Oregon and Washington require the person's current competency and a prognosis of terminal illness. In The Netherlands voluntariness and unbearable suffering are required for euthanasia. Many people are more concerned about the loss of autonomy and independence in years of severe dementia than about pain and suffering in their last months. To address this concern, people could write advance directives for physician-assisted death in dementia. Should such directives be implemented even though, at the time, the person (...) is no longer competent and would not be either terminally ill or suffering unbearably? We argue that in many cases they should be, and that a sliding scale which considers both autonomy and the capacity for enjoyment provides the best justification for determining when: when written by a previously well-informed and competent person, such a directive gains in authority as the later person's capacities to generate new critical interests and to enjoy life decrease. Such an extension of legalized death assistance is grounded in the same central value of voluntariness that undergirds the current more limited legalization. (shrink)

Almost all jurisdictions where physician-assisted death is legal require that the requesting individual be competent to make medical decisions at time of assistance. The requirement of contemporary competence is intended to ensure that PAD is limited to people who really want to die and have the cognitive ability to make a final choice of such enormous import. Along with terminal illness, defined as prognosis of death within six months, contemporary competence is regarded as an important safeguard against mistake and abuse, (...) arguably the strongest objections to legalizing PAD.The insistence on contemporary competence is problematic. It means that someone who has dementia is ruled out as a candidate for PAD, even if she is terminally ill and suffering terrible and unrelievable pain. It also rules out individuals with strong and unwavering desires not to end their life in dementia. (shrink)

: In this paper, I consider objections to advance directives based on the claim that there is a discontinuity of interests, and of personal identity, between the time a person executes an advance directive and the time when the patient has become severely demented. Focusing narrowly on refusals of life-sustaining treatment for severely demented patients, I argue that acceptance of the psychological view of personal identity does not entail that treatment refusals should be overridden. Although severely demented patients are morally (...) considerable beings, and must be kept comfortable whilst alive, they no longer have an interest in receiving life-sustaining treatment. (shrink)

The conventional wisdom about advance care planning holds that the normative force of my prior wishes is simply that they are mine. It is their connection to me that matters. This paper challenges conventional thinking. I propose that the normative force of prior wishes does not depend exclusively on personal identity. Instead, it sometimes depends on a special relationship that exists between a prior, capacitated person and a now incapacitated person. I consider what normative guidance governs persons who stand in (...) a special relationship, and contrast these with the standard model of respect for autonomy. My conclusion is that advance care planning for individuals who have lost decision-making capacity should incorporate the virtues of prudence and integrity, even when one and the same person ceases to exist, and respect for personal autonomy is no longer relevant. (shrink)

Shoemaker maintains that when a functionalist theory of mind is combined with his belief about individuating properties and the well-known cerebrumtransplant thought experiment, the resulting position will be a version of the psychological approach to personal identity that can avoid The Problem of Too Many Thinkers. I maintain that the costs of his solution—that the human animal is incapable of thought—are too high. Shoemaker also has not provided an argumentagainst there existing a merely conscious being that is not essentially self-conscious (...) but is spatially coincident with a person who is essentially self-conscious. Both the person and the merely sentient being will be transplanted when the cerebrum is. And another thought experiment will make it impossible for Shoemaker to identify the person and the merely conscious being. (shrink)

We argue that animalism is the only materialist account of personal identity that can account for the autonomy that we typically think of ourselves as possessing. All the rival materialist theories suffer from a moral version of the problem of too many thinkers when they posit a human person that overlaps a numerically distinct human animal. The different persistence conditions of overlapping thinkers will lead them to have interests that conflict, which in many cases prevents them both from autonomously forming (...) and acting on the same intentions. These problems are exacerbated by problems of self-reference plaguing the overlapping thinkers. We contend that the impossibility of simultaneous autonomous action by animals and persons provides a reason to favor animalism over Neo-Lockeanism, Four-Dimensionalism, Constitution theory, and brain-size views of the person. We anticipate and reject arguments that the autonomy of the person and the animal can be shown to be compatible by relying upon either the Parfitian thesis that identity isn’t what matters or claiming that animals acquire the interests of the person they constitute. (shrink)

Should advance directives (ADs) such as living wills be employed to direct the care of the severely demented? In considering this question, I focus primarily on the claims of Rebecca Dresser who objects in principle to the use of ADs in this context. Dresser has persuasively argued that ADs are both theoretically incoherent and ethically dangerous. She proceeds to advocate a Best Interest Standard as the best way for deciding when and how the demented ought to be treated. I put (...) forth a compromise position: both ADs and the Best Interest Standard have roles to play in guiding the care of the severely demented. (shrink)

Book reviewed in this article: Principles of Biomedical Ethics. By Tom L. Beauchamp and James F. Childress.

When patients have progressive and incurable dementia, should their advance directives always be followed? Contra Dworkin, Dresser argues that when patients remain able to enjoy and participate in their lives, directives to hasten death should sometimes be disregarded.