Whose will is it, anyway? A discussion of advance directives, personal identity, and consensus in medical ethics

I consider objections to the use of living wills based upon the discontinuity of personal identity between the time of the execution of the directive and the time the person becomes incompetent. Recent authors, following Derek Parfit's "Complex View" of personal identity, have argued that there is often not sufficient identity of interests between the competent person who executes the living will and the incompetent patient to warrant the use of the advance directive. I argue that such critics err by seeking personal identity in a purely descriptive manner. By exploring Buchanan and Brock's concept of "surviving interests", an argument is developed that certain future-oriented acts have a normative force that contributes to the narrative unity which is constitutive of personal identity. This narrative concept of the self is entailed by many of our ordinary practices and challenges the philosophical consensus to view the self in a more dynamic and communitarian manner.