Dowie Suzanne E
University of Glasgow, Glasgow, UK.
Camb Q Healthc Ethics. 2024 May 9:1-12. doi: 10.1017/S0963180124000239.
Derek Parfit's view of personal identity raises questions about whether advance decisions refusing life-saving treatment should be honored in cases where a patient loses psychological continuity; it implies that these advance decisions would not be -determining at all. However, rather than accepting that an unknown metaphysical 'further fact' underpins agential unity, one can accept Parfit's view but offer a different account of what it implies morally. Part II of this article argues that contractual obligations provide a moral basis for honoring advance decisions refusing life-saving and/or life-sustaining medical treatment; advance decisions have similarities to contracts, such as life insurance policies and will-contracts, that come into effect when the psychological discontinuity is through death.
德里克·帕菲特关于个人同一性的观点引发了一些问题，即在患者失去心理连续性的情况下，拒绝接受挽救生命治疗的预先决定是否应该得到尊重；这意味着这些预先决定根本不会起决定性作用。然而，与其接受某种未知的形而上学“进一步事实”是行动统一性的基础，人们可以接受帕菲特的观点，但对其道德含义给出不同的解释。本文第二部分认为，契约义务为尊重拒绝挽救生命和/或维持生命的医疗治疗的预先决定提供了道德基础；预先决定与诸如人寿保险单和遗嘱契约等合同有相似之处，当心理连续性因死亡而中断时，这些合同就会生效。
