Of Meatballs, Autonomy, and Human Dignity: Neuroethics and the Boundaries of Decision Making Among Persons with Dementia

摘要

Autonomy is deemed a basic principle of the physician-patient relationship: more generally, that people have a right to be treated according to their informed preferences and wishes. But there are situations of cognitive impairment in which it is no longer clear whether the patient is in fact able to understand his or her prior preferences. In such cases, the attempt to respect the patient’s autonomy may become highly problematic. An interesting real case of a patient suffering from Alzheimer’s disease—described in literature—gives the opportunity to discuss the complex interplay of factors that are at stake in such cases: In different circumstances, some ethical considerations become more relevant while others dim. Respecting human dignity should always be the landmark consideration, but with the caveat that it may involve different things in different situations and phases. In particular, attention should be paid to the value and the limits of honoring precedent autonomy, as a way of respecting human dignity. This shows that implementing human dignity in borderline areas of cognitive and decision-making capacities requires an ever more sophisticated understanding of what is happening in the patient’s brain, and of how and when the disease is impairing the patient’s capacities. In discussing how to deal with the change of dietary orientation of an individual, it is proposed here to take a different step forward compared to the classic debate on critical interests and experiential interests in responding to the wishes of patients suffering from cognitive impairment.