Advance Directives, Future Selves and Decision-Making

The Liberal ideal of self-determination is a well-established principle of Anglo-American law.1 For competent patients, the law2 protects their right to decide irrespective of how irrational or harmful to themselves their decisions may be.3 This works passably well for much of the competent person's life as the torts of battery and negligence make the lawfulness of medical treatment subject to the patient's consent. The problem is, as a moment's reflection will reveal, that there are likely to be times when we lack the requisite capacity. If being in control of one's own life is important, this loss of decisional-competence, whether temporary or permanent, will raise concerns as to how best to retain that control despite the envisaged period of incompetence. The desire to retain this control may be amplified by the current state of medical science, which is often capable of prolonging our survival in severely...