Collective moral imagination: making decisions for persons with dementia

Much debate concerning 'precedent autonomy'--that is, the authority of former, competent selves to govern the welfare of later. non-competent selves--has assumed a radical discontinuity between selves, and has overlooked the 'bridging' role of intimate proxy decision-makers. I consider a recent proposal by Lynn et al. (1999) that presents a provocative alternative, foregrounding an imagined dialogue between the formerly competent patient and her/his trusted others. I consider what standards must be met for such dialogues to have moral force, appealing to narrative and feminist ethics. I then critique the dualistic construction of selves implicit in much of the advance directive literature, noting the continuities of dependence, character, and body, as well as the social dimension of the construction of selves.