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Rethinking the Precedent Autonomy, Current Minimal Autonomy, and Current Well-Being in Medical Decisions for Persons with Dementia

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Abstract

As patient autonomy expands, a highly controversial issue has emerged. Should the advance directives (ADs) of refusing life-saving treatments or requesting euthanasia of persons with dementia (PWDs) who express changed minds or are often in a happy state be fulfilled? There are two autonomy-related positions. The mainstream position in philosophical discussions supports the priority of ADs based on precedent autonomy. Buchanan and Brock, and Dworkin represent this view. The other position supports the priority of PWDs’ current wishes based on minimal autonomy represented by Jaworska. By rethinking the theoretical and practical challenges of the two positions and their arguments respectively, the paper concludes that in such a scenario, the priority of ADs is morally indefensible, and it is also challenging to establish minimal autonomy defend the moral priority of PWDs’ current wishes. For PWDs whose past values, beliefs, and preferences fade away but who retain apparent intrinsic sentience of well-being, a modified defined quality-of-life (QoL) approach serves as another reasonable basis in their medical decision-making, and the ADs and the QoL should be further merged to reduce the uncertainty of the grey zone.

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Acknowledgments

We appreciate the reviewers for their constructive comments and helpful suggestions.

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Authors and Affiliations

  1. Institute of Medical Information, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100020, China

    Yuanyuan Huang

  2. School of Public Health, Peking University Health Science Center, Beijing, 100191, China

    Yuanyuan Huang & Zhifeng Wang

  3. The Department of Medical Ethics and Law, Peking University Health Science Center, Beijing, 100191, China

    Yali Cong

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  1. Yuanyuan Huang
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Correspondence to Zhifeng Wang.

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Huang, Y., Cong, Y. & Wang, Z. Rethinking the Precedent Autonomy, Current Minimal Autonomy, and Current Well-Being in Medical Decisions for Persons with Dementia. Bioethical Inquiry 19, 163–175 (2022). https://doi.org/10.1007/s11673-021-10159-3

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