Cognitive Impairment and the Ethics of Consent

This book examines the complex relationship between consent and cognitive impairment across various domains of human experience. Author Samuel Director’s central argument provocatively asserts that impairment undermines consent far less than is commonly believed by ethicists and in public opinion. Through detailed case studies spanning sexual ethics, medical decisions, and business transactions, Director demonstrates that many individuals with significant impairments—including dementia, intoxication, cognitive disability, and severe mental illness—can still provide valid consent. The book analyzes several distinct categories of impairment, including permanent impairment of previously unimpaired individuals, permanent impairment from birth, temporary impairment, an impaired ability to value life, impaired factual self-understanding, and impairment from behavioral biases. It concludes by exploring the broader implications of these findings, including the proposal that individuals anticipating future impairment might use "Ulysses Contracts" to constrain their future impaired (but still competent) selves. Unlike other recent works on consent that focus mostly on metaphysical issues, Cognitive Impairment and the Ethics of Consent is empirically informed and case-based, making it accessible to both philosophers and biomedical clinicians.