Entering the fog: On the borderlines of mental capacity

Indiana Law Journal

Volumn 83, Issue 4, 2008, Pages 1619-1649

  Herring, Jonathan ^a  

^a EXETER COLLEGE   (United Kingdom)

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EID: 56049119159     PISSN: 00196665     EISSN: None     Source Type: Journal    
DOI: None     Document Type: Conference Paper

References (171)

1. See, e.g., GEORGE P. SMITH, II, THE CHRISTIAN RELIGION AND BIOTECHNOLOGY: A SEARCH FOR PRINCIPLED DECISION-MAKING (2005); GEORGE P. SMITH, II, FAMILY VALUES AND THE NEW SOCIETY: DILEMMAS OF THE 21ST CENTURY (1998); GEORGE P. SMITH, II, HUMAN RIGHTS AND BIOMEDICINE (2000); GEORGE P. SMITH, II, LEGAL AND HEALTHCARE ETHICS FOR THE ELDERLY (1996) [hereinafter SMITH, ETHICS].
2. See, e.g., George P. Smith, II., The Elderly and Patient Dumping, 73 FLA. BAR J. 85 (1999).
3. Especially SMITH, ETHICS supra note 1.
4. In this article, the terms "competence" and "capacity" are used interchangeably. Some lawyers suggest that the two terms have different meanings in that competence/incompetence is a legal standard, while capacity/incapacity refer to facts about a patient's abilities, although there is no consistency in this usage. See Philip Bielby, The Conflation of Competence and Capacity in English Medical Law: A Philosophical Critique, 8 MED., HEALTH CARE & PHIL. 357 (2005).
5. The term "mild cognitive impairment" is sometimes used to describe those who possess borderline mental capacity, although its use is controversial. Jullian C. Hughes, The Heat of Mild Cognitive Impairment 13 PHIL., PSYCHIATRY, & PSYCHOL. 1 (2006).
6. Roger C. Jones & Timothy Holden, A Guide to Assessing Decision-Mating Capacity, 12 CLEVELAND CLINICAL J. MED. 971 (2004).
7. Michael Gunn, The Meaning of Incapacity, 2 MED. L. REV. 8, 9 (1994).
8. For a non-technical discussion of the impact of Alzheimer's Disease, see JOHN BAYLEY, ELEGY FOR IRIS (1999); ANN DAVIDSON, ALZHEIMER'S, A LOVE STORY: ONE YEAR IN MY HUSBAND'S JOURNEY (1997). For a more academic discussion, see JULIAN C. HUGHES, STEPHEN J. LOUW & STEVEN R. SABAT, DEMENTIA: MIND, MEANING AND THE PERSON (2005).
9. Linda Clare, The Construction of Awareness in Early-Stage Ahheimer's Disease: A Review of Concepts and Models, 43 BRIT. J. CLINICAL PSYCHOL. 155 (2004); Leslie Pickering Francis, Decision-Making at the End of Life: Patients with Ahheimer's or Other Dementias, 35 GA. L. REV. 539 (2001); Bob Woods & Rebecca Pratt, Awareness in Dementia: Ethical and Legal Issues in Relation to People with Dementia, 9 AGING & MENTAL HEALTH 423 (2005).
10. Seena Fazel, Tony Hope & Robin Jacoby, Dementia, Intelligence, and the Competence to Complete Advance Directives, 454 LANCET 48 (1999).
11. For a discussion of attempts to maximize capacity among those with dementia, see Susan Slaughter & Jane Bankes, The Functional Transitions Model: Maximizing Ability in the Context of Progressive Disability Associated with Ahheimer's Disease, 26 CAN. J. AGING 39 (2007).
12. See, e.g., PRINCIPLES OF MEDICAL LAW (Andrew Grubb ed., 2d ed. 2004) (Chapter 3 concerns the competent patient and Chapter 4 concerns the incompetent patient.).
13. DERYCK BEYLEVELD & ROGER BROWNSWORD, CONSENT IN THE LAW 1-35 (2007).
14. The right to bodily integrity is an essential component of the right to liberty protected by the Fourteenth Amendment of the U.S. Constitution. Cruzan v. Dir., Mo. Dep't of Health, 497 U.S. 261, 279 (1990); Union Pac. RR. Co. v. Botsford, 141 U.S. 250, 251 (1891).
15. R (Burke) v. Gen. Med. Council, [2004] EWHC (Admin) 1879 (Eng.); R (Pretty) v. Dir. of Public Prosecutions, [2001] UKHL 61 (Eng.); Re A (Children), [2001] 2 WLR 480 (Eng.); Friend v. Civil Aviation Auth. 5 Feb 1998 The Times; Sec. of State of the Home Dep't v. Robb [1995] Fam. 127 (Eng.); Airedale NHS Trust v. Bland [1993] A.C. 789 (Eng.); Re T (Adult: Refusal of Treatment) [1993] Fam. 95 (Eng.); Re R (A Minor)(Wardship: Consent to Treatment) [1992] Fam. 11 (Eng.); Re F (Mental Patient: Sterilization) [1990] 2 A.C. 1 (Eng.); Sidaway v. Bd. of Governors of the Bethlem Royal Hosp. [1985] A.C. 871.
16. Schloendorff v. Society of N.Y. Hosp., 105 N.E. 92, 93 (N.Y. 1914).
17. In re T (Adult: Refusal of Treatment), [1993] Fam. 95 (Eng.); see also Bruce J. Winick, Competency to Consent to Treatment: The Distinction Between Assent and Objection, 28 HOUS. L. REV. 15 (1991).
18. R (Burke) v. Gen. Med. Council, [2005] EWCA1003 (Eng.) at ¶ 61 (approving Munby, J. in R (Burke) v. Gen. Med. Council, [2004] EWHC 1879 (Admin)).
19. Although quite what "best interests" mean in this context is hotly debated.
20. NORMAN L. CANTOR, MAKING MEDICAL DECISIONS FOR THE PROFOUNDLY DISABLED 1 (MIT Press, Cambridge MA, 2005).
21. See In re Conservatorship of Drabick, 245 Cal. Rptr. 840, 847 (Cal. Ct. App. 1988); Nancy J. Knauer, Defining Capacity: Balancing the Competing Interests of Autonomy and Need, 12 TEMP. POL. & CIV. RTS. L. REV. 321 (2003).
22. [1994] 1 W.L.R. 290 (Fam.) (Eng.).
23. In re W (Adult: Refusal of Medical Treatment), [2000] EWHC 901(Fam.) (Eng.), a prisoner was found to have capacity to refuse treatment even though he was convinced there was a conspiracy against him.
24. Of course, the best interest test may not reach this conclusion but instead decide that it would promote her welfare to attend the services.
25. Marshall B. Kapp, Decisional Capacity in Theory and Practice: Legal Process Versus "Bumbling Through," 6 AGING & MENTAL HEALTH 413 (2002).
26. R. Jones, Ethical and Legal Issues in the Care of People with Dementia, 11 REV. IN CLINICAL GERONTOLOGY 245 (2001).
27. For further arguments that apply to parents and children, see Jonathan Herring, The Human Rights Act and the Welfare Principle in Family Law-Conflicting and Complementary?, 11 CHILD & FAMILY L.Q. 223 (1999) (promoting a particular understanding of best interests, that is "relationship-based welfare," which requires a consideration of the issue at hand in the context of the relationship between the parties).
28. Vanessa Raymont, William Bingley, Alec Buchanan, Anthony S. David, Peter Hayward, Simon Wesseley & Matthew Hotopfa, Prevalence of Mental Incapacity in Medical Inpatients and Associated Risk Factors: Cross Sectional Study, 364 LANCET 1421 (2004).
29. GEORGE J. ANNAS, AMERICAN HEALTH LAW 652 (1990).
30. 376 N.E. 2d (Mass. App. Ct. 1978).
31. One explanation for the use of a higher test in practice is that where the decision appears bizarre it is more likely the decision will be challenged in court and therefore the medical practitioner will want to do be doubly sure that the finding of capacity is beyond question. See Alec Buchanan, Mental Capacity, Legal Competence and Consent to Treatment, 97 J. ROYAL SOC'Y OF MED. 415 (2004).
32. L.H. Roth, A. Meisel & C.W. Lidz, Tests of Competency to Consent to Treatment, 134 AM. J. PSYCHIATRY 279, 293 (1977). For a useful analysis of different tests that have been used see M.J. Gunn, J.G. Wong, I.C.H. Clare & A.J. Holland, Decision Making Capacity, 7 MED. L. REV. 296 (1999); Samantha Weyrauch, Comment, Decision Making for Incompetent Patients: Who Decides and by What Standards?, 35 TULSA L.J. 765 (2000)
33. Ron Berghmans, Donna Dickenson & Ruud Ter Meulen, Mental Capacity: In Search of Alternative Perspectives, 12 HEALTH CARE ANALYSIS 251 (2004).
34. BRITISH MED. ASS'N, ASSESSMENT OF MENTAL CAPACITY: GUIDANCE FOR DOCTORS AND LAWYERS (2d ed. 2004). But see Michel Silberfeld & David Checkland, Faulty Judgment, Expert Opinion, and Decision-Making Capacity, 20 THEORETICAL MED. & BIOETHICS 377 (1999) (expressing skepticism at the effectiveness of experts in assessing competence.).
35. Jessica Wilen Berg, Paul S. Appelbaum & Thomas Grisso, Constructing Competence: Formulating Standards of Legal Competence to Make Medical Decisions, 48 RUTGERS L. REV. 345 (1996).
36. For the U.K. law, see Mental Capacity Act 2005, c. 9, s. 1(2). For the U.S. law, see Winick, supra note 17, at 21-27.
37. N.H. REV. STAT. ANN. §§ 137-J:2 (V) (2005) ("Capacity to make health care decisions means the ability to understand and appreciate generally the nature and consequences of a health care, including the significant benefits and harms of and reasonable alternatives to any proposed health care.").
38. S.C. CODE ANN. §§ 44-66-20(6) (2005) ('"Unable to consent' means unable to appreciate the nature and implications of the patient's condition and proposed health care, to make a reasoned decision concerning the proposed health care, or to communicate that decision in an unambiguous manner.").
39. Mental Capacity Act 2005, c. 9, s. 3(1) (Eng.); see also MO. REV. STAT. § 404.805.1(2) (2006); OR. REV. STAT. § 127.505(13) (2006).
40. ALLEN E. BUCHANAN & DAN W. BROCK, DECIDING FOR OTHERS: THE ETHICS OF SURROGATE DECISION MAKING (1990).
41. Mental Capacity Act 2005, s. 1(3) (England).
42. Alastair R. Maclean, Caesarean Sections, Competence and the Elusion of Autonomy, WEB J. CURRENT LEGAL ISSUES, http://webjcli.ncl.ac.uk/1999/issue1/maclean1.html; Ben A. Rich, Medical Paternalism v. Respect for Patient Autonomy: The More Things Change the More They Remain the Same, 10 MICH. ST. UNIV. J. MED. & L. 87 (2006).
43. Judith Mosoff, Motherhood Madness and Law, 45 U. TORONTO L.J. 107 (1995); Peggy Foster, Informed Consent in Practice, in FEMINIST PERSPECTIVES ON HEALTH CARE LAW 53 (Sally Sheldon & Michael Thomson eds., 1998).
44. Nancy J. Knauer, Defining Capacity: Balancing the Competing Interests of Autonomy and Need, 12 TEMP. POL. & CIV. RTS. L. REV. 321 (2003).
45. Susan R. Martyn and Henry J. Bourguignon, Physicians' Decisions About Patient Capacity: The Trojan Horse of Physician-Assisted Suicide, 6 PSYCH. PUB. POL'Y & L. 388 (2000).
46. ALLEN E. BUCHANAN & DAN W. BROCK, DECIDING FOR OTHERS: THE ETHICS OF SURROGATE DECISION MAKING (1990); James F. Drane, The Many Faces of Competency, 15 HASTINGS CTR REP. 17 (1985).
47. D. Strang, D.W. Molloy & C. Harrison, Capacity to Choose Place of Residence: Autonomy vs Beneficence?, 14 J. PALLIATIVE CARE 25, 26 (1998); see also James L. Werth Jr., Requests for Physician-Assisted Death: Guidelines for Assessing Mental Capacity and Impaired Judgment, 6 PSYCH. PUB. POL'Y & L. 348 (2000).
48. Marc Tunzi, Can the Patient Decide? Evaluating Patient Capacity in Practice, 64 AM. FAMILY PHYSICIAN 299 (2001).
49. Tom Buller, Competence and Risk-Relativity, 15 BIOETHICS 93 (2001); Mark R. Wicclair, The Continuing Debate Over Risk-Related Standards of Competence, 13 BIOETHICS 149 (1999).
50. Joseph DeMarco, Competence and Paternalism, 16 BIOETHICS 231 (2002); Gita S. Cale, Continuing the Debate Over Risk-Related Standards of Competence, 13 BIOETHICS 131 (1999).
51. Mark R. Wicclair, The Continuing Debate Over Risk-Related Standards of Competence, 13 BIOETHICS 149 (1999); Ian Wilks, The Debate Over Risk-Related Standards of Competence, 11 BIOETHICS 413 (1997).
52. Wilks, supra note 51. Contra CaLe, supra note 50.
53. Charles M. Culver & Bernard Gert, The Inadequacy of Incompetence, 68 MILBANK Q. 619 (1990); Tom Buller, Competence and Risk-Relativity, 15 BIOETHICS 93 (2001).
54. Nancy J. Knauer, Defining Capacity: Balancing the Competing Interests of Autonomy and Need, 12 TEMP. POL. & CIV. RTS. L. REV. 321 (2003).
55. Id. at 343.
56. Wilks, supra note 51.
57. Indeed, for most commentators there becomes a point when autonomy may not be respected. If you wish to remove all your limbs in political protest, the law in many jurisdictions will prevent you from doing so. See JONATHAN HERRING, MEDICAL LAW AND ETHICS 123 (2006).
58. Daniel Callahan, Terminating Life-Sustaining Treatment of the Demented, 25 HASTINGS CTR. REP. 26 (1995); Sanford H. Radish, Letting Patients Die: Legal and Moral Reflections, 80 CAL. L. REV. 857 (1992).
59. JOSEPH RAZ, THE MORALITY OF FREEDOM (1986).
60. Kadish, supra note 58.
61. Ronald Dworkin, Autonomy and the Demented Self, 64 MILBANK Q. 4, 8 (1986).
62. M. Parker, Competence by Consequence: Ambiguity and Incoherence in the Law, 25 MED. & L. 1(2006).
63. IAN KENNEDY, TREAT ME RIGHT: ESSAYS IN MEDICAL LAW AND ETHICS (1988).
64. John Eekelaar, The Emergence of Children's Rights, 6 OXFORD J. LEGAL STUD. 161, 182 (1986) ("[T]hat most dangerous but most precious of rights: the right to make their own mistakes.").
65. JONATHAN GLOVER, CAUSING DEATH AND SAVING LIVES 80-81 (1977).
66. In re T (Refusal of Treatment), [1993] Fam. 95 (Eng.); see also Winick, supra note 17.
67. J. Savulescu & R.W. Momeyer, Should Informed Consent Be Based on Rational Beliefs?, 23 J. MED. ETHICS 282 (2000).
68. MARILYN FRIEDMAN, AUTONOMY, GENDER, POLITICS 5-6 (2003).
69. Id. at 6.
70. Id.
71. Beate Rössler, Problems with Autonomy, 17 HYPATIA 143 (2002).
72. Precisely what the limits would be lie outside the scope of this article.
73. See Søren Holm, Autonomy, Authenticity, or Best Interest, 4 MED. HEALTH CARE & PHIL. 153, 154-55 (2001).
74. Ben A. Rich, Medical Paternalism v. Respect for Patient Autonomy: The More Things Change the More They Remain the Same, 10 MICH. ST. U.J. MED. & L. 87 (2006).
75. In re Grady, 426 A.2d 467, 481-83 (N.J. 1981); see also In re K.I., 735 A.2d 448, 450 (D.C. 1999); In re L.W., 482 N.W.2d 60, 70 (Wis. 1992).
76. In re L.H.R., 321 S.E.2d 716, 722-23 (Ga. 1984); In re Conservatorship of Torres, 357 N.W.2d 332, 341 (Minn. 1984); In re Guardianship of Ingram, 689 P.2d 1363, 1372 (Wash. 1984).
77. Most courts restrict the application of substitute judgment to cases where the individual was once competent and, therefore, evidence can be found as to the person's subjective preferences. See In re K.I., 735 A.2d 448, 455 (D.C. 1999).
78. Allen E. Buchanan, The Limits of Proxy Decisionmaking for Incompetents, 29 UCLA L. REV. 386 (1981); Rebecca Dresser, Missing Persons: Legal Perceptions of Incompetent Patients, 46 RUTGERS L. REV. 609 (1994).
79. CANTOR, supra note 20, at 105; Eric C. Miller, Listening To The Disabled: End-Of-Life Medical Decision Making And The Never Competent, 74 FORDHAM L. REV. 2889 (2006).
80. Mental Capacity Act 2005, c. 9, s. 4(6) (Eng.).
81. For a recent English judicial acknowledgement that a best interests test will not necessarily match the patients wishes see R (Burke) v. Gen. Med. Council, [2005] EWCA 1003, ¶ 30 (Eng.).
82. John A. Robertson, Organ Donation by Incompetents and the Substituted Judgment Doctrine, 76 COLUM. L. REV. 48 (1976).
83. S. Halliday & L. Witteck, Decision-Making at the End-of-Life and the Incompetent Patient: A Comparative Approach, 22 MED. & L. 533 (2003).
84. Norman L. Cantor, Discarding Substituted Judgment and Best Interests: Toward a Constructive Preference Standard for Dying, Previously Competent Patients Without Advance Instructions, 48 RUTGERS L. REV. 1193 (1996).
85. 464 N.E.2d 959, 960 (Mass. App. Ct. 1984).
86. Id., at 965. But see George J. Annas, Law and the Life of Sciences: The Case of Mary Hier: When Substituted Judgment Becomes Sleight of Hand 14 HASTINGS CENTRE REP 23 (1984).
87. 689 P.2d 1363, 1370 (Wash. 1984).
88. CANTOR, supra note 20, at 204.
89. E.g., Superintendent of Belchertown State Sch. v. Saikewicz, 370 N.E.2d 417, 432 (Mass. 1977). Cf. In re Storar, 420 N.E.2d 64 (N.Y. 1981) (citing physical resistance as evidence of incapacity).
90. FIONA RANDALL & R.S. DOWNIE, THE PHILOSOPHY OF PALLIATIVE CARE: CRITIQUE AND RECONSTRUCTION (2006); Matti Häyry Another Look at Dignity, 13 CAMBRIDGE Q. HEALTHCARE ETHICS 7 (2004); Lennart Nordenfelt, Dignity and the care of the elderly, 6 MED., HEALTH CARE & PHIL. 103 (2003).
91. Roger Brownsword, Human rights - What hope? Human dignity - What scope?, in ETHICS, LAW AND SOCIETY 189 (Jennifer Gunning & Soren Holm, eds. 2005).
92. E.g., I. Randers & A-C Mattiasson, Autonomy and Integrity: Upholding Older Adult Patients' Dignity, 45 J. ADVANCED NURSING 63 (2003).
93. See generally Jose Miola, The Need for Informed Consent: Lessons from the Ancient Greeks, 15 CAMBRIDGE Q. HEALTHCARE ETHICS 152 (2006); Lennart Nordenfelt, The Varieties of Dignity 12 HEALTHCARE ANALYSIS 69 (2004); S. Martyn, Substitute Judgment, Best Interests and the Need for Best Respect, 3 CAMBRIDGE Q. HEALTHCARE ETHICS 3 (1994).
94. S. Pleschberge, Dignity and the Challenge of Dying in Nursing Homes: The Residents ' View, 36 AGE & AGEING 197 (2007).
95. CANTOR, supra note 20, at 206; see also Elysa R. Koppelman, Dementia and Dignity: Towards a New Method of Surrogate Decision Making, 27 J. MED. & PHIL. 65 (2002).
96. Lennart Nordenfelt, Dignity and the Care of the Elderly 6 MED., HEALTH CARE & PHIL. 130 (2003); Lennart Nordenfelt, Dignity of the Elderly, 6 MED., HEALTH CARE & PHIL. 99 (2003).
97. See the discussion in L. Örulv and N. Nikku, Dignity Work in Dementia Care: Sketching a Microethical Analysis, 6 DEMENTIA 507 (2007).
98. V. Molinari, L.B. McCullough, J.H. Coverdale, and R. Workman, Principles and Practice of Geriatric Assent, 10 AGING & MENTAL HEALTH 48 (2006).
99. ISAIAH BERLIN, Two Concepts of Liberty, in FOUR ESSAYS ON LIBERTY 118, 131 (1969).
100. It is protected under Article 5 of the European Convention on Human Rights, U.N. Convention of Human Rights, Article 9, and U.S. CONST. amend. XIV (right to liberty).
101. Dawn Brooker, What is Person-centred Care in Dementia?, 13 REVIEWS IN CLINICAL GERONTOLOGY 215 (2004).
102. Koppelman, supra note 95, at 65.
103. Eric C. Miller, Note, Listening to the Disabled: End-of-Life Medical Decision Making and the Never Competent, 74 FORDHAM L. REV. 2889, at 2920 (2006).
104. Dworkin, supra note 61, at 4.
105. Michael J. Newton, Precedent Autonomy: Life-Sustaining Intervention and the Demented Patient, 8 CAMBRIDGE Q. HEALTHCARE ETHICS 189 (1999).
106. Christopher B. Rosnick & Sandra L. Reynolds, Thinking Ahead: Factors Associated with Executing Advance Directives, 15 J. AGING & HEALTH 409 .(2003).
107. Robert E. Enck, Advance Directives: Burden or Benefit?, 20 AM. J. HOSPICE & PALLIATIVE CARE 329 (2003)
108. S. Sahm, R. Will & G. Hommel, Attitudes Towards and Barriers to Writing Advance Directives Amongst Cancer Patients, Healthy Controls, and Medical Staff, 31 J. MED. ETHICS 437, 440 (2005).
109. Martin Eisemann & Jörg Richter, Relationships Between Various Attitudes Towards Self-Determination in Health Care with Special Reference to an Advance Directive, 25 J. MED. ETHICS 37 (1999); Thomas A. Mappes, Persistent Vegetative State, Prospective Thinking, and Advance Directives, 13 KENNEDY INST. ETHICS J. 119 (2003).
110. Leslie P. Francis, supra note 9, at 572 (2001)
111. Alasdair R. Maclean, Advance Directives, Future Selves and Decision-making, 14 MED. L. REV. 291 (2006).
112. Francis, supra note 9, at 572.
113. Inez de Beaufort, The View from Before, 7 AMER. J. BIOETHICS 57 (2007).
114. See also Michael Quant, Precedent Autonomy and Personal Identity, 9 KENNEDY INST. ETHICS J. 365 (1999).
115. RONALD DWORKIN, LIFE'S DOMINION 224 (1993).
116. For a critical look at Dworkin's writings on this, see John Finnis, Euthanasia, Morality, and Law, 31 LOY. L. A. L. REV. 1123 (1998).
117. DWORKIN, supra note 115, at 227.
118. JEFF MCMAHAN, THE ETHICS OF KILLING: PROBLEMS AT THE MARGINS OF LIFE 502-03 (2002).
119. Andrew D. Firlik, Margo's Logo, 9 J. AMER. MED. ASS'N 201 (1991).
120. David Degrazia, Advance Directives, Dementia and 'the Someone Else Problem', 13 BIOETHICS 373 (1999); Julian C. Hughes, Views of the Person with Dementia, 27 J. OF MED. ETHICS 86 (2001).
121. JOHN LOCKE, AN ESSAY CONCERNING HUMAN UNDERSTANDING (1961); DEREK PARFIT, REASONS AND PERSONS 205-07 (1984).
122. An extreme view is that a person with severe dementia ceases to be a person at all. See the discussion in Allen Buchanan, Advance Directives and the Personal Identity Problem, 17 PHIL. & PUB. AFF. 277, 280 (1988).
123. ERIC T. OLSON, THE HUMAN ANIMAL: PERSONAL IDENTITY WITHOUT PSYCHOLOGY (1997); MARYA SCHECHTMAN, THE CONSTITUTION OF SELVES (1996).
124. Maclean, supra note 111, at 291.
125. CHARLES TAYLOR, SOURCES OF THE SELF: THE MAKING OF THE MODERN IDENTITY (1989).
126. See generally Ben A. Rich, Prospective Autonomy and Critical Interests: A Narrative Defense of the Moral Authority of Advance Directives, 6 CAMBRIDGE Q HEALTHCARE ETHICS 138 (1997); Hughes, supra note 120, at 86; Tom Kitwood, The Experience of Dementia, 3 AGING & MENTAL HEALTH 179 (1997).
127. Nancy K. Rhoden, The Limits of Legal Objectivity. 68 N.C. L. REV. 845, 852 (1990).
128. Rich, supra note 126, at 146.
129. FRIEDMAN, supra note 68, at 39.
130. Ronald Dresser, Dworkin on Dementia: Elegant Theory, Questionable Policy, in BIOETHICS: AN ANTHOLOGY 312, 316-17 (Helga Kuhse & Peter Singer eds., 1999).
131. Callahan, supra note 58, at 26.
132. DANIEL GILBERT, STUMBLING ON HAPPINESS (2005). I am grateful to Dean Lauren Robel for introducing me to this book.
133. Michelle Moody-Adams, On the Old Saw that Character Is Destiny, in IDENTITY, CHARACTER, AND MORALITY: ESSAYS IN MORAL PSYCHOLOGY 111, 124-25 (Owen Flanagan & Amelie O. Rorty eds., 1990).
134. Rebecca Dresser, Schiavo's Legacy: The Need for an Objective Standard, 35 HASTINGS CENTER REP. 20 (2005).
135. Rebecca Dresser, Missing Persons: Legal Perceptions of Incompetent Patients, 46 RUTGERS L. REV. 609 (1994).
136. Id. at 611.
137. On the difficulties of imagining what it would be like to be different see DANIEL C. DENNETT, CONSCIOUSNESS EXPLAINED 441-42 (1991); THOMAS NAGEL, THE VIEW FROM NOWHERE 13-27 (1986).
138. Dresser, supra note 135, at 613.
139. John A. Robertson, Second Thoughts on Living Wills, 21 HASTINGS CENTER REP. 6, 7 (1991).
140. Holm, supra note 73, at 156-58.
141. Agnieszka Jaworska, Respecting the Margins of Agency: Alzheimer's Patients and the Capacity to Value, 28 PHIL. & PUB. AFF. 105, 108 (1999).
142. Dresser, supra note 130, at 36.
143. Buchanan, supra note 122, at 280-83.
144. Dena Davis, Help! My Body is Being Invaded by an Alien!, 7 AMER. J. BIOETHICS 60 (2007).
145. Ahsan v. University Hospitals Leicester NHS Trust, (2006) EWHC 2624 (Q.B.).
146. Elizabeth B. Gedge, Collective Moral Imagination: Making Decisions for Persons with Dementia, 29 J. MED. & PHIL. 435 (2004).
147. Penney Lewis, Medical Treatment of Dementia Patients at the End of Life: Can the Law Accommodate the Personal Identity and Welfare Problems?, 13 EUR. J. HEALTH L. 219 (2006).
148. Maclean, supra note 111, at 291.
149. Francis, supra note 9, at 592.
150. ALZHEIMER'S ASS'N, BASICS OF ALZHEIMER'S DISEASE: WHAT IT IS AND WHAT YOU CAN DO 8 (2007), available at http://www.alz.org/national/documents/brochure_basicsofalz_low.pdf
151. Id.
152. Peter Whitehouse, The End of Alzheimer Disease?, 15 ALZHEIMER DISEASE & ASSOCIATED DISORDERS 59 (2001).
153. JOANNE LYNN, SICK TO DEATH AND NOT GOING TO TAKE IT ANYMORE!: REFORMING HEALTH CARE FOR THE LAST YEARS OF LIFE (2004).
154. Peter Whitehouse, The Next 100 Years of Alzheimer's - Learning to Care, Not Cure, 6 DEMENTIA 459 (2007).
155. Carolyn Sargent and Carolyn Smith-Morris, Questioning our Principles: Anthropological Contributions to Ethical Dilemmas in Clinical Practice, 15 CAMBRIDGE Q. OF HEALTHCARE ETHICS 123 (2006).
156. Berghmans et al., supra note 33, at 252.
157. Id., at 258.
158. Id.
159. Stephen G. Post, Comments on Research in the Social Sciences Pertaining to Alzheimer's Disease: A More Humble Approach, 5 AGING & MENTAL HEALTH (Supplement 1) S17 (2001).
160. Ho Mun Chan, Sharing Death and Dying: Advance Directives, Autonomy and the Family, 18 BIOETHICS 87 (2004).
161. Sara Horton-Deutsch, Prudence Twigg & Rebecca Evans, Health Care Decision-making of Persons with Dementia, 6 DEMENTIA 105 (2007).
162. George P. Smith, The Vagaries of Informed Consent, 1 IND. HEALTH L. REV. 109 (2004).
163. Id. at 122.
164. See generally Jonathan Herring, Where Are the Carers in Healthcare Law and Ethics?, 27 LEGAL STUD. 51 (2007).
165. I have expanded and justified this approach in Jonathan Herring, The Place of Carers, in LAW AND BIOETHICS (Michael Freeman ed., 2008).
166. Susan A. Channick, The Myth of Autonomy at the End-of-Life: Questioning the Paradigm of Rights, 44 VILL. L. REV. 577 (1999).
167. Alfred I. Tauber, PATIENT AUTONOMY AND THE ETHICS OF RESPONSIBILITY 143 (2005).
168. Pleschberge, supra note 94 at 197.
169. ELs Steeman, Jan Godderis, Mieke Grypdonck, Nele De Bal & Bernadette Dierckx De Casterlé, Living with Dementia from the Perspective of Older People: Is it a Positive Story?, 11 AGING & MENTAL HEALTH 119 (2007).
170. David H. Smith, Seeing and Knowing Dementia, in DEMENTIA AND AGING: ETHICS, VALUES, AND POLICY CHOICES 45, 51 (Robert H. Binstock, Stephen G. Post, & Peter J. Whitehouse eds., 1992).
171. Jaworska, supra note 141, at 130.