Animals, advance directives, and prudence: Should we let the cheerfully demented die?

Abstract

Summary This paper argues that the animalist—someone who believes we are no more than human organisms—should not be highly confident that advance directives are properly applied to patients who are cheerful and yet severely demented. Pretend that I have suffered from severe dementia for some time. Though I am cheerful and well off considering the circumstances, I live with minimal psychological continuity. Currently I am sitting in a chair gazing out a window. Question: is the individual sitting in the chair actually me? My memories, hopes, fears, interests, and ability to project myself into the future are gone. Am I also gone? Now let's imagine that the individual in the chair has been diagnosed with pneumonia. I signed an advance directive refusing treatment in such a scenario. Has the individual in the chair signed an advance directive? The answer to this question depends on what you think I am and what it takes for such a thing to persist. The animalist, who tells us we are nothing more than human organisms, says that I persist if the organism persists. I survive as long as the organism survives, and that survival has nothing to do with psychology (memories, beliefs, etc.), only with biology. So, me-last-night is identical to me-this-morning if the organism is the same as it was last night. This will be true if the organism survived (remained alive) through the night. Now, I—as the signee —sign an advance directive in the interest of consenting in advance in case there is a time when I—as the patient— cannot speak for myself in terms of medical treatment. I assume that the consent in this case is binding only if I am in fact speaking for myself in the future and not someone else. That is, I must be both the signee and the patient for the advance directive to be binding. The advocate of animalism contends that her view gives the obvious answer. That the patient and signee are identical. There is no clinical case where one would be remotely tempted to apply an advance directive where the signee and patient do not share a life. If the signee and patient share a life, then they are the same organism, and according to animalism the signee has survived and is thus identical to the patient. So, if animalism is true, then in the case of severe dementia or Alzheimer's, the organism continues to persist, which means I continue to persist. Were this problem merely theoretical, then perhaps the above argument would be satisfying, assuming the truth of animalism. However, in practice, we need more than the assumed truth of animalism. To overcome this problem of identity, we need enough justification in animalism to warrant a lethal omission of action towards a cheerful patient who cannot express her own wishes. That is, animalism is only helpful in telling you when to honor an advance directive in so much as you are confident enough in its truth to allow for the consequences of a mistake. I assume that when it comes to the risk of allowing the wrong individual to die, we should have a high level of confidence in the success of our actions before proceeding, ceteris paribus . I argue that we should not have a high level of confidence that we persist according to animalism, and thus, we should not apply lethal advance directives to the cheerfully demented. My argument is that animalism is undermined by its attempts to overcome objections. For instance, the animalist must be able to principally exclude the brain, as opposed to the animal, as what is the thinker. There is consensus among animalist that the best way to avoid the brain as the thinker is to adopt a sparse ontology denying the existence of brains, hands, tables, and chairs. However, the adoption of such an ontology reduces the justificatory force of commonsense, which is key in arguing for animalism and that we persist as long as our animal is biologically alive. This is also a loss of justification that I am the signee and the patient, that the advance directive applies to the individual in the chair, and that the directive is sufficient to let that individual die.