Advance directives and knowledge of future selves

Abstract

A number of concerns have been raised with respect to advance directives. Advance directives are intended to allow a person who is currently capable of giving informed consent to determine how they are to be treated at a later time at which they are not competent to give such consent. For example, an advance directive such as a living will might specify that should a patient face severe dementia, certain forms of treatment should not be provided if needed to prolong life. Or an individual might fill out a do-not-resuscitate order asking not to be revived in the event of a heart attack. This article discusses three distinct arguments that have been offered against the legitimacy of some or all advance directives. After laying out each argument, focus is given to a potential response to one of the arguments in particular, an argument labelled the “Ignorance Argument”. The argument contends that the potential application of any advance directive is plagued by a host of epistemic issues that are serious enough to hamper the very expression of autonomy advance directives are designed to allow for. A possible response to the argument is developed. The response suggests that the argument may place unduly severe constraints on the type of self-knowledge needed to underwrite the expression of a person’s autonomy through the creation of an advance directive. The response identifies some connections between the different arguments. An answer is also given to a recent criticism, offered by Eric Vogelstein (2016), which questions the existence of the type of autonomy needed to underwrite advance directives.