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Jaworska, Agnieszka. Respecting the Margins of Agency: Alzheimer’s Patients and the Capacity to Value
1999, Philosophy and Public Affairs 28(2): 105–138.
Added by: Simon Fokt
Introduction: Dworkin puts forth two main arguments to justify adhering to the wishes the patient expressed before becoming demented. As he sees it, this course of action both promotes the patient’s well-being and is required in order to respect the patient’s autonomy. In each argument, while I consider most of the ideas well-founded, I challenge the crucial premise. In the argument focused on the patient’s well-being, I dispute the claim that demented patients are no longer capable of generating what Dworkin calls “critical interests.” In the argument concerning autonomy, I question the premise that demented patients no longer possess the “capacity for autonomy.”7 In each case, I will trace how the problematic premise arises within Dworkin’s argument and then develop an alternative account of the relevant capacity.

Comment: Jaworska asks: 'Should we, in our efforts to best respect a patient with dementia, give priority to the preferences and attitudes this person held before becoming demented, or should we follow the person’s present preferences?' (p. 108). The article offers a useful critical overview of the views expressed by Rebecca Dresser and Ronald Dworkin. It is best used as a primary reading in ethics classes focusing directly on medical ethics or autonomy, or as further reading in general ethics teaching on autonomy.

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0 thoughts on “Respecting the Margins of Agency: Alzheimer’s Patients and the Capacity to Value

  1. My mother has dementia, she was transferred from a psychiatric ward and is detained in a secure residential facility. She still maintains the preference to be cared for by her daughters when she could not care for herself. She gave this verbal directive to me in 2005 and inspite of a clinical opinion
    that she should remain in the facility she is adimant that she would prefer her daughters to care for her. If her daughters are capable and have access to resources, should her preference be taken into account by the clinicians and allowed ?.

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