This paper considers the meaning of decision-making, including substitute decisionmaking, for persons with dementia. The paper discusses the historical development of adult guardianship, from the King’s stewardship of the property of “fools” and “lunatics” to the modern mechanisms of substitute decision-making, and the relationship between substitute decision-making and a particular ideal of autonomy. The paper concludes with a discussion of Bentley v Maplewood Seniors Care Society, a case concerning the present choices of a woman with dementia, the decisions set out in the “living will” she drafted many years earlier (prior to dementia), and the decisions made by the woman’s (purported) representatives on her behalf. Th e case invites us to consider whether the decisions of the former, mentally capable self can ever trump the choices of the current self with dementia.
