Practical Identity: an essay on personhood, autonomy and pathology

This dissertation is a two-stage project. In the second part (chapter four) I apply an account of personhood and autonomy to the use of advance directives in mental health care. In the first part (the chapters one, two and three) I try to provide that account in terms of agency. In the first chapter I argue that a neo-Kantian ‘reason view’ of persons cannot be satisfactory and that such a view had better be developed into a narrative view of personhood. In chapter two I discuss a candidate for such a picture: Marya Schechtman’s narrative self-constitution view. Pre-commitment in psychiatric practice not only raises questions of self-constitution but also puzzles of self-government. So, before I can embark on the project of applying my view to advance directives, I also have to develop a theory of personal autonomy. My proposal in the third chapter builds on the work of Harry Frankfurt and Michael Bratman on autonomy. My claim is that persons are autonomous if they identify wholeheartedly with (parts of) their self-constituting narrative. In the fourth chapter, I engage my narrative accounts of personhood and autonomy with the use of Ulysses contracts, and the use of advance directives in the case of Alzheimer’s disease. It turns out that my narrative outlook on personhood and autonomy can solve the identity puzzles in both cases. It can also underpin a moral justification of the use of Ulysses contracts. Yet, in fine it cannot supply surviving arguments for a moral justification of the use of advance directives in the Alzheimer’s case.

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