Campbell, Tim | 2026
Transformative Ethics. Preprint series vol. 1. Working paper 2026:16
Advance directives (ADs) are commonly defended as a way for individuals to extend their autonomy into periods of incapacity, such as advanced dementia. Yet in some cases, the person who signs the directive and the later patient with severe dementia appear to be “different people”, in a way that challenges the claim that the directive has any authority with regard to the patient’s care. This is known as “the someone else problem.” In this paper, I distinguish two different versions of the someone else problem and respond to each, arguing that the authority of ADs can be preserved, even in cases involving “different people” in either of the two senses considered. Moreover, I present a thought experiment—a case of “reversed dementia”—to show that the signatory’s preferences continue to have normative weight, even when they conflict with those of her demented future self.
