 We will discuss only radical cognitive disabilities that are congenital or early-onset. The question of how moral status is affected by the loss of important cognitive functions is a distinct one, both for those who believe such functions confer moral status and those who do not. Concerning the former, the question is whether moral status can survive the loss of the functions on the basis of which it was conferred. For those who deny that moral status requires the possession of those functions, their loss may still raise important questions about personal identity, and about the first-person authority of the earlier, nondisabled self over the later, disabled self. The treatment of “once-competent” individuals in minimally conscious states, or with severe dementia, thus raises distinct issues about the impact of psychological discontinuity or loss of mental function on the relationship of human individuals to their past or future selves. There has been a protracted controversy, and a large literature, on these issues (Dresser 1995; Dworkin 1994; Stone 2007); they deserve separate discussion.