The article addresses the issue of advance care directives. It turns out they might not always be the ideal solution they might seem at first glance:
"It might be possible to deal with the problem of lying and dementia by means of advance directives. People already specify what sorts of medical treatment they want and
don’t want in the future, in case they later lose the capacity to make those decisions; could they not also specify how they want to be treated in other ways? Someone who
most values happiness, however simple, might choose lies and medicine; someone who feels that life with late-stage dementia, without a certain degree of awareness, is not
worth living might choose truth and death. The trouble is, advance directives themselves bring up all kinds of problems in the context of dementia. Suppose a woman signs a
directive that she is not to be lied to but, at a later stage of the disease, suffers terrible bereavement each day as a consequence--should her family feel obliged to
respect her wishes? Or suppose a man believes that life with late-stage dementia is not worth living, and signs an advance directive to have all medical treatment
withheld, even antibiotics, once he reaches that point; but then, when he does reach it, he seems very happy with his life--he still enjoys visits (even if he can’t
identify the visitor), his meals, beloved music, walks in the sun. Should his directive be respected, ending his life?
"The late philosopher Ronald Dworkin believed such advance directives should be respected. People don’t just live for pleasure, he argued; they also want to preserve their
dignity, and to feel that their life as a whole has integrity and coherence. When people dread the total dependency of late-stage dementia, they don’t just dread its
effect on others; they dread the way it warps the shape and story of their life. For some, the prospect that they might live their last years content with childlike
pleasures, kept happy with benevolent lies, would not be a relief but a horror. In the case of such a person, Dworkin believed, it is no more legitimate or kind to
contradict their advance directive in late-stage dementia than it would be if they were in a permanent vegetative state.
"Dworkin assumed that the man who dreaded late-stage dementia and the one who is perfectly happy are the same person. But what if the happy person can no longer remember
anything about the man he once was--is he still the same person in any meaningful sense? And, if not, is it right to end his happy life in order to preserve the dignity of,
in effect, somebody else? Also, does it make a difference what his family thinks about this? Whether they feel, in the later stages, that the person they loved is gone; or
whether they feel that that person, though much changed, is still there--still recognizable in his body, in his smell, in his eyes, in his hands when held, in some of the
things he appears still to delight in? Why should a person be defined by thoughts and memories? Aren’t emotions and bodies enough?"