Publication Type
Journal Article
Version
publishedVersion
Publication Date
1-2026
Abstract
This paper contributes to the ongoing debate over the authority of advance directives in cases where patients with dementia express desires that conflict with their earlier wishes. Drawing on Harry Frankfurt’s concept of second-order volitions, I argue that the preferences of the pre-dementia self (the “then-self”) should, in most cases, take precedence over those of the post-dementia self (the “now-self”) – particularly in instances where the now-self has lost the capacity to form second-order volitions and is no longer able to meaningfully repudiate prior values and commitments.
Keywords
Dementia, Advance Directives, Second-Order Volitions, Alzheimer’s, Then-Self, Now-Self
Discipline
Bioethics and Medical Ethics | Estates and Trusts
Research Areas
Humanities
Publication
Bioethics
First Page
1
Last Page
6
ISSN
0269-9702
Identifier
10.1111/bioe.70085
Publisher
Wiley
Citation
HIRMIZ, Rand.(2026). Dementia, advance directives, and second-order volitions. Bioethics, , 1-6.
Available at: https://ink.library.smu.edu.sg/soss_research/4269
Copyright Owner and License
Authors-NC-ND
Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-No Derivative Works 4.0 International License.
Additional URL
https://doi.org/10.1111/bioe.70085