{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T17:39:24Z","timestamp":1761845964597,"version":"3.41.2"},"reference-count":27,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,1,27]],"date-time":"2025-01-27T00:00:00Z","timestamp":1737936000000},"content-version":"vor","delay-in-days":26,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Nursing Philosophy"],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:p>The moral authority of advance directives (ADs) in the context of persons living with dementia (PLWD) has sparked a multifaceted debate, encompassing concerns such as authenticity and the appropriate involvement of caregivers. Dresser critiques ADs based on Parfit's account of numeric personal identity, using the often\u2010discussed case of a PLWD called Margo. She claims that dementia leads to a new manifestation of Margo emerging, which then contracts pneumonia. Dworkin proposes that critical interests, concerning one's higher moral values, trump experiential interests (things or activities one enjoys because they are pleasurable). Dresser argues that Margo's current experiential interests override her self's critical ones, as they contribute significantly to her quality of life (QoL). To render the argument more realistic, I introduce a variation in which Margo develops delirium, a common and severe comorbidity in PLWD. I argue that delirium could precipitate a sudden decline in experiential interests and, consequently, a deterioration in QoL. Given the uncertain trajectory of Margo's illness, I contend that her competent self's critical interests, as reflected in her AD, along with her right to self\u2010ownership, should take precedence over current experiential interests. Thus, the AD possesses moral authority. However, it is imperative for healthcare professionals to offer consultations for PLWD, facilitating an understanding of ADs and enabling a shared decision\u2010making process. Such consultations are essential for honouring the autonomy and dignity of PLWD, ensuring that their values and preferences guide ethical decision\u2010making amidst the complexities of dementia care.<\/jats:p>","DOI":"10.1111\/nup.70016","type":"journal-article","created":{"date-parts":[[2025,1,27]],"date-time":"2025-01-27T12:23:42Z","timestamp":1737980622000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Navigating Dementia and Delirium: Balancing Identity and Interests in Advance Directives"],"prefix":"10.1111","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2122-6661","authenticated-orcid":false,"given":"M.","family":"Rutenkr\u00f6ger","sequence":"first","affiliation":[{"name":"Department of Medical Psychology University Medical Center Hamburg\u2010Eppendorf Hamburg Germany"},{"name":"Uehiro Oxford Institute University of Oxford Oxford UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,1,27]]},"reference":[{"key":"e_1_2_15_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40520-014-0297-9"},{"key":"e_1_2_15_3_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.books.9780890425596"},{"key":"e_1_2_15_4_1","doi-asserted-by":"publisher","DOI":"10.1080\/15265161.2020.1714793"},{"key":"e_1_2_15_5_1","doi-asserted-by":"publisher","DOI":"10.2307\/2219802"},{"key":"e_1_2_15_6_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12916-014-0192-4"},{"key":"e_1_2_15_7_1","unstructured":"Campaign for Dignity in Dying.2023. Accessed June 26 2023.https:\/\/www.dignityindying.org.uk\/."},{"key":"e_1_2_15_8_1","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2012.00073"},{"key":"e_1_2_15_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/ene.14450"},{"key":"e_1_2_15_10_1","doi-asserted-by":"publisher","DOI":"10.2307\/3527839"},{"volume-title":"Life's Dominion: An Argument About Abortion and Euthanasia","year":"1993","author":"Dworkin R.","key":"e_1_2_15_11_1"},{"key":"e_1_2_15_12_1","doi-asserted-by":"publisher","DOI":"10.1080\/08959420.2023.2182565"},{"key":"e_1_2_15_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(15)00101-5"},{"key":"e_1_2_15_14_1","doi-asserted-by":"publisher","DOI":"10.3233\/ADR-210025"},{"key":"e_1_2_15_15_1","doi-asserted-by":"publisher","DOI":"10.1093\/jmp\/jhr055"},{"key":"e_1_2_15_16_1","unstructured":"German Alzheimer Society e.V.2023 Mai 13.Die H\u00e4ufigkeit von Demenzerkrankungen.https:\/\/www.deutsche-alzheimer.de\/fileadmin\/Alz\/pdf\/factsheets\/infoblatt1_haeufigkeit_demenzerkrankungen_dalzg.pdf."},{"key":"e_1_2_15_17_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinternmed.2012.3203"},{"key":"e_1_2_15_18_1","doi-asserted-by":"publisher","DOI":"10.1080\/13607863.2021.1947968"},{"key":"e_1_2_15_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2013.05.015"},{"key":"e_1_2_15_20_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11673-021-10159-3"},{"volume-title":"Patientenverf\u00fcgungen zwischen Selbstbestimmung und staatlicher F\u00fcrsorge\u2013Mehr Patientenautonomie durch das 3. Bt\u00c4ndG?","year":"2015","author":"Kaufmann B.","key":"e_1_2_15_21_1"},{"key":"e_1_2_15_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.echu.2010.02.006"},{"key":"e_1_2_15_23_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0201051"},{"volume-title":"Reasons and Persons","year":"1984","author":"Parfit D.","key":"e_1_2_15_24_1"},{"key":"e_1_2_15_25_1","doi-asserted-by":"publisher","DOI":"10.1136\/medethics-2018-104971"},{"volume-title":"Being You: A New Science of Consciousness","year":"2021","author":"Seth A.","key":"e_1_2_15_26_1"},{"key":"e_1_2_15_27_1","doi-asserted-by":"publisher","DOI":"10.1023\/A:1011491100267"},{"key":"e_1_2_15_28_1","doi-asserted-by":"publisher","DOI":"10.1080\/15265161.2020.1781955"}],"container-title":["Nursing Philosophy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/nup.70016","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,1,30]],"date-time":"2025-01-30T10:22:52Z","timestamp":1738232572000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/nup.70016"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1]]},"references-count":27,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2025,1]]}},"alternative-id":["10.1111\/nup.70016"],"URL":"https:\/\/doi.org\/10.1111\/nup.70016","archive":["Portico"],"relation":{},"ISSN":["1466-7681","1466-769X"],"issn-type":[{"type":"print","value":"1466-7681"},{"type":"electronic","value":"1466-769X"}],"subject":[],"published":{"date-parts":[[2025,1]]},"assertion":[{"value":"2023-07-25","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-01-12","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-01-27","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70016"}}