Citation

Dowie SE. Camb. Q. Healthc. Ethics 2024; ePub(ePub): ePub.

Copyright

(Copyright © 2024, Cambridge University Press)

DOI

10.1017/S0963180124000239

PMID

38720656

Abstract

Derek Parfit's view of personal identity raises questions about whether advance decisions refusing life-saving treatment should be honored in cases where a patient loses psychological continuity; it implies that these advance decisions would not be self-determining at all. However, rather than accepting that an unknown metaphysical 'further fact' underpins agential unity, one can accept Parfit's view but offer a different account of what it implies morally. Part II of this article argues that contractual obligations provide a moral basis for honoring advance decisions refusing life-saving and/or life-sustaining medical treatment; advance decisions have similarities to contracts, such as life insurance policies and will-contracts, that come into effect when the psychological discontinuity is through death.

Language: en

Keywords

advance decisions; consent; contracts; Parfit; psychological continuity