Whose Preferences?

Transformative experiences are experiences that change the way you understand the world, and in the process, they change who you are. As such, they are experiences that are both epistemically and personally transformative. The epistemic transformation involves a discovery: until you undergo the experience, you don’t know what it will be like to be your future, transformed self. The personal transformation involves the way the experience changes the kind of person you are (or more colloquially, “changes who you are”). Who you’ll become is different, in some important and salient way, from who you are now. In my (Paul 2014), I develop an account of the conceptual and psychological structure of transformative experience. Using this account, I argue that the self-changes such experiences involve, combined with the epistemic limitations we face with regard to what we can first-personally know before the transformation, raises distinctive problems for decisionmaking in transformative contexts. On my approach, a persisting person is taken to be a temporally extended entity composed of a series of continuous, appropriately related selves. A person who persists through a transformative experience is realized by one kind of self before the transformation and by a different kind of self after the transformation: the new, replacement self, is created in response to the transformative experience. Examples of transformative experiences include fighting in a war, having one’s first child, becoming sighted after a life of blindness, getting a cochlear implant, losing a loved one, getting divorced, and having a religious conversion. There are two especially important features to note about the structure of these types of experiences. First, because it is unlike other kinds of experiences they have had, in an important and distinctive sense, a person cannot imagine what the transformative experience will be like for them before they undergo it. Second, because it will change the kind of person they are, some central and important elements of what they care about will change. As Walsh (2020) argues, cases of dementia can be instances of cognitively transformative experiences: they can be cases where a person has an epistemic transformation that creates a personal transformation. In dementia, the epistemic transformation involves a radical change in an individual’s cognitive capacities, changing, in a deep and salient way, the nature of their lived experience of their relationships, their cognitive abilities, and their sense of the world around them. These changes lead to personal transformation: changes in some of their core preferences, for example, their preferences regarding lifeprolonging treatment in medical contexts. This type of cognitively transformative experience exhibits the classic structure of transformation, where the self that exists before the transformation (the “ex ante” self) is psychologically incommensurable with the self that is created by the transformation (the “ex post” self). The incommensurability stems, in the first instance, from a radical change in the nature and character of the individual’s lived experience, which results in one or more core preference changes. Importantly, there is no higher-order preference structure that is consistent across the changes in self: there is no way to make the preferences of the ex ante self consistent with the ex post self. (For discussion, see Paul 2015a, 2015b; Pettigrew 2015; Paul and Quiggin 2018, and Pettigrew 2019.) For example, Mrs. Black (ex ante) prefers not to receive life-prolonging medical treatment if she can longer recognize friends and family, while Mrs. Black (ex post) prefers the medical treatment, as she is happy and content with her current state, despite her inability to recognize friends and family members. In the case as described, there is no higher-order preference that can resolve this conflict. Before the transformation, she prefers not to receive the treatment. Afterwards, she does. This raises the pressing question: which temporal stage (which self) of Mrs. Black should decide the question of whether she is to receive treatment? In my (Paul 2014), I discussed these issues in the context of concerns about disability, and suggested that cases