When making decisions on behalf of someone, is asking what they would have wanted a good way to respect their autonomy? Against prevalent assumptions, I argue that in decisions about the care and treatment of those with advanced dementia, the notion of ‘what one would have wanted’ is conceptually, epistemically, and practically problematic. The problem stems from the disparity between the first‐person subjectivity of the past person and that of the present person. The transformative nature of dementia renders the very meaning of ‘what the patient would have wanted’ problematic. When applied to those with advanced dementia, the subjunctive notion is either (i) incoherent, (ii) fundamentally indeterminate, or (iii) normatively irrelevant.

中文翻译：

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解读“人们想要什么”

当代表某人做出决定时，询问他们想要什么是尊重他们自主权的好方法吗？与普遍的假设相反，我认为，在对晚期痴呆症患者进行护理和治疗的决策中，“人们想要什么”的概念在概念上、认知上和实践上都是有问题的。问题源于过去人和现在人的第一人称主体性之间的差异。痴呆症的变革性本质使得“患者想要什么”的含义变得有问题。当应用于晚期痴呆症患者时，虚拟语气概念要么（i）语无伦次，（ii）根本上不确定，要么（iii）规范上不相关。