"PHILOSOPHICALLY SPEAKING...":

When people change because of dementia or brain damage, for example, should their new wishes be respected, even if they fly in the face of their earlier stated preferences? This article from The New York Times Magazine is a case study, a cautionary tale, and a philosophical thought experiment all rolled into one: www.nytimes.com/2023/05/09/magazine/dementia-mother.html

"In the philosophical literature on dementia, scholars speak of a contest between the “then-self” before the disease and the “now-self” after it: between how a person with dementia seems to want to live and how she previously said she would have wanted to live. Many academic papers on the question begin in the same way: by telling the story of a woman named Margo, who was the subject of a 1991 article in The Journal of the American Medical Association (JAMA), by a physician named Andrew Firlik. Margo, according to the article, was 55 and had early-onset Alzheimer’s disease and couldn’t recognize anyone around her, but she was very happy. She spent her days painting and listening to music. She read mystery novels too: often the same book day after day, the mystery remaining mysterious because she would forget it. “Despite her illness, or maybe somehow because of it,” Firlik wrote, “Margo is undeniably one of the happiest people I have known.” A couple of years after the JAMA article was published, the philosopher and constitutional jurist Ronald Dworkin revisited the happy Margo in his 1993 book, “Life’s Dominion.” Imagine, he asked readers, that years ago, when she was fully competent, Margo had written a formal document explaining that if she ever developed Alzheimer’s disease, she should not be given lifesaving medical treatment. “Or even that in that event she should be killed as soon and as painlessly as possible?” What was an ethical doctor to do? Should he kill now-Margo, even though she was happy, because then-Margo would have wanted to be dead?"