从人格同一性思考老年痴呆症预嘱中的伦理困境

Ethical Dilemma of Advance Directives for Senile Dementia Patients from the Perspective of Personal Identity

基于心理连续性的人格同一性问题挑战了预嘱的道德合理性,布坎南尝试通过降低保留人格同一性的心理连续性阈值来化解这一挑战。在此基础上,分析老年痴呆症预嘱所面临的伦理困境,认为人格同一性并非论证预嘱道德合理性的充分条件。处于老年痴呆症早期阶段的患者能否修改预嘱中的决定取决于其当前的行为能力,而非他们与预立预嘱时自己的心理连续性程度;对于失去行为能力的人格个体与后人格个体,他们当前改变的意愿或利益仍然具有道德意义,对预嘱有效性的论证还需进一步探讨患者在不同阶段的道德地位。

Personal identity problem based on psychological continuity challenges the moral authority of advance directives.Allen Buchanan attempts to solve this problem by reducing psychological continuity threshold which retain personal identity.On this basis,this paper analyzes the ethical dilemma of advance directives for senile dementia patients.It addresses that personal identity is not a sufficient condition to argue the moral authority of advance directives.Whether a senile dementia patient at an early stage can modify his/her decisions in the advance directives depends on his/her current competence rather than the degree of his/her psychological continuity with his/her former self who wrote the advance directives.For those who lose competence or personality,their current changed interests or desires also have moral significance,the argument for validity of advance directives need further explore the moral status of senile dementia patients at different stages.