Journal Article

Dementia and Dignity: Towards a New Method of Surrogate Decision Making

Elysa R. Koppelman

in The Journal of Medicine and Philosophy: A Forum for Bioethics and Philosophy of Medicine

Published on behalf of The Journal of Medicine and Philosophy Inc.

Volume 27, issue 1, pages 65-85
Published in print January 2002 | ISSN: 0360-5310
Published online January 2002 | e-ISSN: 1744-5019 | DOI:
Dementia and Dignity: Towards a New Method of Surrogate Decision Making

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Autonomous decisions are decisions that reflect the self who makes them. Since patients in need of surrogate decision making can no longer enjoy the dignity of being free to express who they are through choice and action, surrogates should strive to, at least, make sure that decisions on behalf of the patient reflects that patient's self. Concepts of the self, then, underlie views about the role autonomy should play in surrogate decision making. Alzheimer's disease (AD) complicates the situation because it is a disease which effects the self and theorists disagree about which aspect of the AD self the decision should reflect. This disagreement has led to a seemingly irresolvable split between those who favor the then self and those who favor the now self. The debate has stalled because while both of these views are attractive, neither seems adequate. That is, neither view is complete because each focuses only on one aspect of a whole self. In this paper, I argue that a good mode of surrogate decision making is one that focuses on the whole self and I offer practical advice concerning how we can begin to think about how such a decision might be made.

Keywords: autonomy; dignity; now self; surrogate decision making; then self

Journal Article.  0 words. 

Subjects: Philosophy ; Medical Ethics ; Bioethics ; Public Policy

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