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Dementia, death and advance directives

Published online by Cambridge University Press:  19 October 2012

Professor, Department of Philosophy, University College London, London, UK
*Correspondence to: Professor Jonathan Wolff, Professor of Philosophy, University College London, Gower Street, London WC1E 6BT, UK. Email:


This article considers the ethics of advance directives, especially in relation to conditions such as dementia. For some choices, such as over whether one's life should end at home or in a hospice, advance directives can be very enlightened and helpful. For others, such as those to end the life of an autonomous subject, against their will, have no moral appeal and would rightly be ignored. In a wide range of intermediate cases, given our typical lack of insight into how changes in our health condition will affect us in other ways, we should be very cautious indeed in promoting the use of advance directives in end-of-life decisions, at least where a reasonable quality of life remains. There may be some reasons for giving priority to the earlier autonomous self over a later, contented but non-autonomous self, but these reasons seem far from compelling.

Copyright © Cambridge University Press 2012

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