Eudaimonia and well-being : Questioning the moral authority of advance directives in dementia

Journal article

Byers, Philippa. (2020). Eudaimonia and well-being : Questioning the moral authority of advance directives in dementia. Theoretical Medicine and Bioethics. 41(1), pp. 23-37.
AuthorsByers, Philippa

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.

Keywordsdementia; advance directives; eudaimonia; well-being; Ronald Dworkin
JournalTheoretical Medicine and Bioethics
Journal citation41 (1), pp. 23-37
Digital Object Identifier (DOI)
PubMed ID32034586
Scopus EID2-s2.0-85079184525
PubMed Central IDPMC7192877
Open accessPublished as ‘gold’ (paid) open access
Page range23-37
FunderAustralian Research Council (ARC)
Publisher's version
File Access Level
Output statusPublished
Publication dates
Online07 Feb 2020
Publication process dates
Deposited20 Jan 2023
ARC Funded ResearchThis output has been funded, wholly or partially, under the Australian Research Council Act 2001
Grant IDDP180103262
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License: CC BY 4.0
File access level: Open

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