in the interval between drawing up the will and it coming into operation. Someone
who anticipates that they would rather be allowed to die than undergo a particular
kind of treatment might well have opted differently had they known the extent to
which that treatment had improved. The second reason concerns change in
personal identity over time. To what extent is it reasonable for a younger version of
me to legislate on what will be in the best interests of an older me? I might, by the
time it is necessary, come to have taken an entirely different attitude to risk-taking,
for example. Or I might have become an entirely different person.
Dworkin [11] cites the case of Margo, someone with Alzheimer's dementia who
`despite her illness, or maybe somehow because of it, ... is undeniably one of the
happiest people I have known. There is something graceful about the degeneration
her mind is undergoing, leaving her carefree, always cheerful' [12]. This is an
unusual consequence of Alzheimer's disease which, more often, leaves people
anxious, confused and profoundly disoriented. But that is the point. Had Margo
considered the prospect of dementia and executed an advance directive, she might
well have decided that she would not wish to receive treatment for any other life-
threatening illness once she was suffering from Alzheimer's. Had she done so, and
the relevant situation had arisen, would it be better to respect the autonomy of the
person Margo had once been and comply with the wishes set out in the advance
directive? Or would it be better to address the best interests of the person Margo
now is, and treat her for any adventitious, life-threatening illnesses unless and until
the Alzheimer's deteriorated much further? [13]
10.10 Withdrawing treatment
Consent to or refusal of treatment is not the only problem in this area. There can be
patients from whom treatment can be withdrawn, on the grounds that they are, in
fact, dying and it would be considered neither proper nor humane simply to
prolong the dying process. Both the American and British Medical Associations
endorse this view, as do the Catholic and Anglican Churches:
`The cessation of the employment of extraordinary means to prolong the life of
the body when there is irrefutable evidence that biological death is imminent is
the decision of the patient and/or his immediate family.' [14]
`In its narrow current sense, euthanasia implies killing, and it is misleading to
extend it to cover decisions not to preserve life by artificial means when it would
be better for the patient to be allowed to die. Such decisions coupled with a
determination to give the patient as good a death as possible, may be quite
legitimate' [15]
`... normally one is held to use only ordinary means ... that is to say, means that
do not involve any grave burden for oneself or another ... Consequently, if it
appears that the attempt at resuscitation constitutes such a burden for the family
that one cannot in all conscience impose it upon them, they can lawfully insist
that the doctor should discontinue those attempts and the doctor can lawfully
comply.' [16]218 Nursing Law and Ethics