 A slightly different point concerns globally incompetent patients. Despite the emphasis in the field on treating DMC as decision-relative, there are, of course, some patients who because of more extreme impairments are unable to make all or almost all of their own medical decisions. In the case of globally incompetent patients who once were competent and who wrote advance directives, it is usually assumed that the directive comes into force once the patient reaches this state (Appelbaum 2007; Krohm &amp; Summers 2002). However, this simple assumption has been powerfully challenged. For example, Jaworska (1999) has argued that many patients with mid-stage Alzheimer’s dementia retain the capacity to value (they remain, in her words, “valuers”), even though increasing confusion and forgetfulness about facts may mean that they no longer count as competent to make their own treatment decisions (because they fail understanding and reasoning). Jaworska argues that although such patients lack decision-making capacity, they are not yet at the point where their advance directives have the greatest authority. Their currently held values are still much more relevant to decisions made for them. In short, Jaworska draws attention to the fact that various significant capacities of persons can come apart. We usually value decision-making capacities like understanding and reasoning because these enable us to pursue our valued ends. But Jaworska underscores the fact that a person may continue to have currently valued ends even when she has lost the abilities needed for pursuing them effectively. In these cases, rather than revert to an advanced directive, Jaworska thinks we should (within reason) aim to help such patients pursue the ends they are no longer able to pursue on their own.