The impact of personal identity on advance directives

Advance directives record our voluntary choices and provide guidelines for people making decisions on our behalf when we are no longer capable of making substantiated, reasoned choices for ourselves. In some circumstances, especially when no curative treatments are available, prior wishes for a painless, quick, and dignified end of life are the last bellowing of autonomy. In other cases, however, respecting the advance directive is not the right answer. When large shifts in psychology have resulted from illness, and autonomy cannot be restored, prior wishes may become obsolete. Therefore, a new conceptual framework for adjudicating the applicability of advance directives is needed.