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Dresser – respecting a person’s current subjective experience

2009: Advance directives and personhood

Dresser (1995) agrees with Parfit in the sense that the person with dementia could be considered as a different person to their former self and that in such cases, one might ask why the wishes of the former self (someone else) should take precedence over those of the current self.

Dresser takes the stance that a care and treatment policy should be centered on the conscious incompetent patient’s subjective reality. She does not seem to be against respecting a wish which could lead to death provided that the experiential burden of continued life seems to be too heavy or the benefits too minimum but that when a person’s subjective experience seems positive, attempts should be made to delay death. Such an approach is clearly dependent on the ability to accurately assess the experiential benefits and burdens of people in the advance stages of dementia, which incidentally Dresser thinks possible. She concludes, “Their loss of higher-level intellectual capacities ought not to exclude people … from the law’s protective reach, even when the threats to their well-being emanate from their own former preferences.” She summarises Dworkin’s approach as “an elegant theory that may lead to a questionable policy”.

Nevertheless, such an approach might not be possible in all countries. In Germany, for example, two of the three propositions laid down in the Principles of the German Medical Association concerning terminal care (1998), are the refusal of any medical assessment of the value of life or the quality of life by doctors and the respect for patients’ wishes, including those made in an advance declaration (in Wegener, 2000)



Last Updated: Friday 09 October 2009


  • Acknowledgements

    Alzheimer Europe gratefully acknowledges the support of the German Ministry of Health for the implementation of the Dementia Ethics Network.
  • Bundesministerium für Gesundheit