Precedent autonomy and personal identity
pp. 253-263
in: , Personhood and health care, Berlin, Springer, 2001Abstract
As Stephen Post (1995:307) notes, "it is now a common bioethical assumption that the extension of patient autonomy through advance directives is in principle correct, even if its implementation may be complex." But things are less clear when it comes to the question of whether advance directives should be respected in cases of Alzheimer's disease, and other progressive and irreversible dementia, or in psychiatry. In these contexts our understanding of personal identity through time interferes with our understanding of autonomy. In addition, two conceptions of personal identity are conflated in such cases. On one hand, there is the persistence sense of personal identity, which addresses the question of what the constitutive criteria for a person's persistence are. On the other hand, there is the sense of personal identity as personality or biographical identity (Quante 1995a). In this sense, a person's personality is the complex pattern of values, preferences, and beliefs, in which a person manifests who she is and wants to be. It is personal identity in the sense of biographical identity and personality that matters most in bioethical contexts. We are mainly concerned with our values and our personality when we plan for our own future. Certainly, there are contexts in bioethics in which the question of persistence is relevant (like birth and death), but personality and biographical identity are directly connected with our notion of autonomy (Feinberg 1986: 27–51) and the principle of respect for autonomy (Beauchamp and Childress 1994).