J Med Ethics. 2019 Mar;45(3):204-208. doi: 10.1136/medethics-2018-104919. Epub 2018 Jul 9.
As the prevalence of dementia increases across the Western world, there is a growing interest in advance care planning, by which patients may make decisions on behalf of their future selves. Under which ethical principles is this practice justified? I assess the justification for advance care planning put forward by the philosopher Ronald Dworkin, which he rationalises through an integrity-based conception of autonomy. I suggest his judgement is misguided by arguing in favour of two claims. First, that patients with dementia qualify for some right to contemporary autonomy conceptualised under the 'sense of liberty' it provides. Second, that respecting precedent autonomy, such as an advance care plan, is not essential to Dworkin's integrity-based account of autonomy. Together, my claims problematise the practice of using advance decisions in the context of dementia.
随着痴呆症在西方世界的患病率不断上升，人们对预先护理计划越来越感兴趣，通过这种计划，患者可以代表未来的自己做出决策。这种做法是基于哪些伦理原则的呢？我评估了哲学家罗纳德·德沃金提出的预先护理计划的正当性，他通过自主性的完整性概念使其合理化。我通过支持两个主张来表明他的判断是有误导性的。首先，患有痴呆症的患者有资格享有某种当代自主性的权利，这种自主性是通过它提供的“自由感”来概念化的。其次，尊重先前的自主性，如预先护理计划，对于德沃金基于完整性的自主性解释并不是必不可少的。总的来说，我的主张使在痴呆症背景下使用预先决定的做法变得复杂起来。
