In this article, I consider whether the advance directive of a person in minimally conscious state ought to be adhered to when its prescriptions conflict with her current wishes. I argue that an advance directive can have moral significance after its issuer has succumbed to minimally conscious state. I also defend the view that the patient can still have a significant degree of autonomy. Consequently, I conclude that her advance directive ought not to be applied. Then I briefly assess whether considerations pertaining to respecting the patient's autonomy could still require obedience to the desire expressed in her advance directive and arrive at a negative answer.
Early in 2011, Illinois joined the ranks of states that recognize civil unions between both same-sex and opposite-sex couples. The law gives partners in these unions “the same legal obligations, responsibilities, protections and benefits as are afforded or recognized by the law of Illinois to spouses.” Despite the fact that Illinois and most other states still reserve marriage for opposite-sex couples, the option of civil unions will make it easier for some couples to make health care decisions for one another should one of them become incapacitated. Surrogate decision-makers for health care are a significant topic for everyone, but the issue has special resonance for same-sex couples because the law in most jurisdictions excludes same-sex couples from the benefits that marriage and some civil unions confer in those health care decisions. Timothy F. Murphy, "Surrogate Health Care Decisions and Same-Sex Relationships," Hastings Center Report 41, no. 3 (2011): 24-27.