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30 HEC F. 1 (2018)

handle is hein.journals/hecforum30 and id is 1 raw text is: HEC Forum (2018) 30:1-11 CrssMark https://doi.org/10.1007/s10730-017-9334-3 Advance Directives and the Descendant Argument Jukka Varelius Published online: 16 August 2017 © Springer Science+Business Media B.V. 2017 Abstract By issuing an advance treatment directive, an autonomous person can for- mally express what kinds of treatment she wishes and does not wish to receive in case she becomes ill or injured and unable to autonomously decide about her treatment. While many jurisdictions and medical associations endorse them, advance treatment directives have also been criticized. According to an important criticism, when a person irre- versibly loses her autonomy what she formerly autonomously desired ceases to be of (central) importance in deciding about her treatment. The medical ethical debate regarding different possible ways of solving the problem on which the criticism is based has grown exceedingly intricate. Instead of assessing the developments made in the debate so far, I present a thought experiment-built around a suicide case-which suggests that the problem is not as intractable as it has generally been deemed to be. Keywords Advance directives - Autonomy - Happiness - Patient - Personality change - Wellbeing Introduction By issuing an advance treatment directive, an autonomous person can formally express what kinds of treatment she wishes and does not wish to receive in case she becomes ill or injured and unable to autonomously decide about her treatment.1 The choice is typically made within certain preordained limits that in practice may, to an extent, vary from one case to another. For instance, a wealthy patient may sometimes have options that are not open to a destitute patient. Besides in connection with making treatment decisions, it has been suggested that ® Jukka Varelius jukka.varelius@utu.fi Department of Philosophy, Contemporary History, and Political Science, University of Turku, 20014 Turku, Finland I_ Springer

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