Plunkett Centre for Ethics, St Vincent's Hospital Sydney and Australian Catholic University, Darlinghurst, NSW, Australia.
Theor Med Bioeth. 2020 Feb;41(1):23-37. doi: 10.1007/s11017-020-09517-w.
This paper revisits Ronald Dworkin's influential position that a person's advance directive for future health care and medical treatment retains its moral authority beyond the onset of dementia, even when respecting this authority involves foreshortening the life of someone who is happy and content and who no longer remembers or identifies with instructions included within the advance directive. The analysis distils a eudaimonist perspective from Dworkin's argument and traces variations of this perspective in further arguments for the moral authority of advance directives by other authors. It then critiques a feature of the eudaimonist perspectives within these arguments-namely, the position that dementia has a retroactive negative impact on what a person has previously valued-and challenges the commonly held assumption underlying them that a person's life and well-being have relatively low value beyond the onset of dementia. Although advance directives have moral authority as a means of guiding one's future health care, accounts that dismiss the value of the lives and well-being of people living with dementia should be questioned to the extent that such accounts are used to support the moral authority of advance directives stipulating measures to foreshorten individuals' lives.
本文重新审视了罗纳德·德沃金（Ronald Dworkin）颇具影响力的观点，即一个人未来的医疗保健和治疗的预先指示在痴呆症发作后仍然保留其道德权威，即使尊重这一权威会缩短一个快乐满足的人的生命，而这个人已经不再记得或认同预先指示中包含的指令。该分析从德沃金的论点中提炼出一种幸福论观点，并追溯了其他作者为预先指示的道德权威进一步论证的这一观点的变化。然后，本文批评了这些论点中幸福论观点的一个特征——即痴呆症对一个人以前重视的东西具有追溯性的负面影响——并挑战了这些论点所隐含的一个常见假设，即痴呆症发作后，一个人的生命和福祉的价值相对较低。尽管预先指示作为指导未来医疗保健的一种手段具有道德权威，但在一定程度上，应该对那些轻视痴呆症患者的生命和福祉价值的说法提出质疑，因为这些说法被用来支持预先指示的道德权威，规定缩短个人生命的措施。
