Bioethics
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This paper examines how decisions to limit treatment to critically ill patients under uncertainty can be made rationally. Expected utility theory offers one way of making rational decisions under uncertainty. One problem with using this approach is that we may not know the value of each option. ⋯ Critically ill patients are allowed to die because it is believed that their lives will be not worth living. It is likely that some patients are allowed to die when there is some objective chance of worthwhile future life. This paper argues that a policy of treating critically ill patients until the nature of future options can be better evaluated, in company with an offer of subsequent euthanasia where appropriate, allows a more rational and humane approach to treatment limitation decisions under uncertainty.
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I consider objections to the use of living wills based upon the discontinuity of personal identity between the time of the execution of the directive and the time the person becomes incompetent. Recent authors, following Derek Parfit's "Complex View" of personal identity, have argued that there is often not sufficient identity of interests between the competent person who executes the living will and the incompetent patient to warrant the use of the advance directive. ⋯ By exploring Buchanan and Brock's concept of "surviving interests", an argument is developed that certain future-oriented acts have a normative force that contributes to the narrative unity which is constitutive of personal identity. This narrative concept of the self is entailed by many of our ordinary practices and challenges the philosophical consensus to view the self in a more dynamic and communitarian manner.