Researcher ORCID Identifier


Graduation Year


Document Type

Open Access Senior Thesis

Degree Name

Bachelor of Arts



Reader 1

Rivka Weinberg

Reader 2

Dion Scott-Kakures

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As the global population ages, the incidence of degenerative memory disorders such as Alzheimer's and dementia is expected to rise. The frequency of complex medical decision-making challenges for these patients will subsequently increase. It is now common practice for patients to provide advance directives outlining the care they wish to receive; in the case they are deemed incompetent to perform adequate decision making. However, patients with dementia occasionally express wishes contrary to those stated in their advance directives. This divergence creates ambiguity about which wishes should be honored and for who those wishes are being honored for. I aim to address this question through the lens of personal identity. By examining several theories of persistence of personal identity through memory loss, I argue that the significant mental changes associated with dementia challenge the effectiveness of applying prior expressed articulation and advance directives. We should treat the current expressed wishes of patients with dementia as legitimate guides to the nature of care they receive. We need to reassess our over-reliance on advance directives and incorporate the current expressed wishes of patients with dementia into the medical decision-making process.