Autonomy and end-of-life

All of our lives come to an end. For most people in Western societies, this is not until they reach a relatively advanced age, often 80 years and above. For others, death comes earlier, whether unexpectedly as when someone dies in car crash, or after a short or long period of physical decline as when a middle-aged person develops terminal cancer. To the extent that people experience such a stage of decline, usually with the prior knowledge that it will result in their death, we tend to speak of their ‘end-of-life-stage’. In this chapter, my aim is to analyze one of the main ways in which our personal autonomy might be, and often is, undermined during this stage, namely that we come to suffer from severe cognitive impairments. To be more precise, I seek to show how two different philosophical views on personal autonomy can lead to very different verdicts on how severely cognitively impaired individuals may or ought to be treated in various contexts, whereby I will be mostly critical on one of the views discussed. On the first view, we cease to have autonomy-interests once we become severely cognitively impaired as we will no longer be capable of reflecting upon what makes our life worth living. On the second view, we continue to have such interests provided that we independently endorsed a conception of the good life before we became severely cognitively impaired