Personal Capacity to Anticipate Future Illness and Treatment Preferences

Abstract

Since advance directives could potentially play a decisive role when a patient comes to lack decisional capacity (e.g. in coma, severe dementia), certain issues may arise due to the gap between the original statement and the actual decision, to which great weight is attached in the modern world given the importance of autonomy. Is a healthy person able to anticipate? Is it even reasonable to suppose that wishes can be accurately predicted when modern medicine consistently enables real progress in the management of currently fatal diseases? More than ever, personal capacity rests on the historical, situational and philosophical context that increases or decreases the ability to anticipate future illness. It also rests on personal identity and capacity of judgment, which will not be highlighted in this chapter, although it is important to emphasize them insofar as they influence personal capacity for anticipation. This chapter briefly discusses the role of context and requests in relation to personal capacity. We will examine two examples and finally consider the usefulness of a learning process around advance directives.