Advance directives are widely embraced as a morally and legally legitimate means through which people can exercise self-determination and personal autonomy in medical care. \; Nonetheless\, they face an inherent and fundamental challenge\, the &ldquo\;then-self vs. now-self&rdquo\; problem: \; why should the earlier self who wrote the directive have authority over the current incompetent self who does not care about the directive and no longer values autonomy? \;The seminar will clarify the challenge itself and critically probe several defenses that have been offered: \; self-ownership\, the reality of an enduring narrative self\, and the moral need to treat previously competent patients differently from never-competent patients. \; More yet may be needed to make these intuitively compelling defenses work &ndash\; a richer understanding of patients&rsquo\; current interests\, refinement of the subjective value of survival\, or clarification of what constitutes a &ldquo\;change of mind.&rdquo\; \;Individual cases will be used to illustrate the problem and its potential resolution. \; Some will involve severe dementia\, and some will involve directives to forego oral feeding. \; \;
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\n\n\nPaul T. Menzel\, PhD\, is Professor of Philosophy emeritus at Pacific Lutheran University. He has published widely on moral questions in health economics and health policy\, including Strong Medicine: The Ethical Rationing of Health Care and (as co-editor) Prevention vs. Treatment: What&rsquo\;s the Right Balance? \; Most recently he has written on end of life issues\, including advance directives for dementia and voluntarily stopping eating and drinking. \; He has been a visiting scholar at Kennedy Institute of Ethics\, Rockefeller Center-Bellagio\, Brocher Foundation\, and Chinese University of Hong Kong. \; \; \; \;
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