How to End Our Stories: A Study of The Perspectives of Seniors on Dementia and Decisionmaking

Abstract

Because dementia can cause individuals to make decisions that they otherwise would not, the law needs a mechanism to determine which decisions are entitled to the respect of the legal system and which may be overridden by others. In the philosophical literature, three primary theories for how to make this determination have been offered. First, "Cognitivism" posits that whether a decision should be recognized is a function of the mechanical functioning of the individual's brain at the time the decision is made. Second, "Essentialism" holds that decisions should be recognized so long as they are consistent with the cluster of values and attributes that define the individual. Third, "Narrativism" argues that decisions should be respected where they follow from the life story of the individual making them.

In the growing tradition of experimental philosophy, this Article empirically analyzes support for these three alternative theories in a mixed-methods study involving a population of American seniors, including an online survey (n=235) and interviews (n=25). Close analysis of the results revealed a near-consensus that Narrativism is the theoretical framework through which participants understood the question of when the legal system should intervene in private decision-making. In short, participants wanted the legal capacity to make decisions taken from them only when dementia became so advanced that they would no longer be the same person they previously had been, which they understood as a question of narrative continuity.

Note:
Funding Information: The study that gave rise to the paper was funded by the Petrie-Flom Center for Health Law Policy, Bioethics, and Biotechnology at Harvard Law School.

Competing Interest Declaration: The author has no competing interests to declare.

Keywords: elder law, dementia, decision-making, capacity, decision-making capacity, private law, experimental philosophy, empirical legal studies