Advance Directives: The Principle of Determining Authenticity

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4 Citations (Scopus)


In medical ethics, there is a well-established debate about the authority of advance directives over people living with dementia, a dispute often cast as a clash between two principles: respecting autonomy and beneficence toward patients. In this article, I argue that there need be only one principle in substitute decision-making: determining authenticity. This principle favors a substituted judgment standard in all cases and instructs decision-makers to determine what the patient would authentically prefer to happen—based not merely on the patient’s decisions but also on their present settled dispositions. Adhering to this principle entails that, in a significant range of cases, an advance directive can (and indeed ought to) be overruled.

Original languageEnglish
Pages (from-to)32-41
Number of pages10
JournalHastings Center Report
Issue number1
Publication statusPublished - 10 Feb 2022


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