This book deals with one of the most urgent and pervasive – yet in some respects one of the most neglected – problems in bioethics: decision making for incompetents. Until quite recently, bioethicists have tended to focus on articulating, justifying, and implementing the rights of self-determination of competent patients. When the special problems of the incompetent have been squarely addressed it has usually been in a less than systematic fashion and often only for certain classes of incompetents, such as disabled newborns.

The present work offers a broader and more systematic account. Part One develops and defends a theoretical framework; Part Two applies the theory to the distinctive problems of three important classes of individuals, many of whose members are incompetent: the elderly, minors, and psychiatric patients. This book is directed toward an extremely broad audience. We believe it will be of considerable interest to lawyers and judges, physicians, nurses, social workers and other health care professionals, health policy analysts and health policy makers, moral philosophers, and, of course, bioethicists. Although as a whole it is written for a rather general audience, there are some sections which may be of greater interest to somerather than others. For example, much of Chapter 3 might be omitted or skimmed by those who do not have a special interest in the philosophical perplexities of personal identity and their bearing on the use of advance directives.