Narrative identity and narrative autonomy: a contextual approach to persons and pediatric decision-making

The importance of personal identity to the survival of the self is an issue of considerable debate. Derek Parfit, in reasons and persons, argues persuasively against its importance, claiming that we can know all we need to know about the survival of a person without being able to answer the question of identity. This view, I argue, is shortsighted. The confusion surrounding the importance of personal identity stems from a failure to appreciate two distinct forms of identification: identification-as and identification-with. I argue that this latter form of identification, which can be understood as narrative identity, should be the focus of our concern regarding questions of personal identity. The use of narrative identity, understood as identification-with, not only provides a better understanding of the self, but it also enhances our understanding of autonomy. This interpretation of autonomy will prove important to understanding how children can participate meaningfully in treatment decisions.