J Med Ethics. 2019 Apr;45(4):249-256. doi: 10.1136/medethics-2018-104971. Epub 2018 Dec 22.
This paper takes a novel approach to the active bioethical debate over whether advance medical directives have moral authority in dementia cases. Many have assumed that advance directives would lack moral authority if dementia truly produced a complete discontinuity in personal identity, such that the predementia individual is a separate individual from the postdementia individual. I argue that even if dementia were to undermine personal identity, the continuity of the body and the predementia individual's rights over that body can support the moral authority of advance directives. I propose that the predementia individual retains posthumous rights over her body that she acquired through historical embodiment in that body, and further argue that claims grounded in historical embodiment can sometimes override or exclude moral claims grounded in current embodiment. I close by considering how advance directives grounded in historical embodiment might be employed in practice and what they would and would not justify.
本文针对在痴呆病例中，预先医疗指示是否具有道德权威这一活跃的生物伦理争议，提出了一种新颖的方法。许多人认为，如果痴呆症确实导致了个人身份的完全中断，即痴呆前的个体与痴呆后的个体是两个不同的个体，那么预先医疗指示将缺乏道德权威。我认为，即使痴呆症破坏了个人身份，身体的连续性以及痴呆前个体对该身体的权利仍可以支持预先医疗指示的道德权威。我提出，痴呆前的个体通过在该身体中的历史体现获得了对该身体的死后权利，并且进一步认为，基于历史体现的主张有时可以推翻或排除基于当前体现的道德主张。最后，我考虑了基于历史体现的预先医疗指示如何在实践中得到运用，以及它们将证明什么或不证明什么。
