We argue that contemporary conceptualizations of “persons” have failed to achieve the moral goals of “person-centred care” (PCC, a model of dementia care developed by Tom Kitwood) and that they are detrimental to those receiving care, their families, and practitioners of care. We draw a distinction between personhood and selfhood, pointing out that continuity or maintenance of the latter is what is really at stake in dementia care. We then demonstrate how our conceptualization, which is one that privileges the lived (...) experiences of people with dementia, and understands selfhood as formed relationally in connection with carers and the care environment, best captures Kitwood’s original idea. This conceptualization is also flexible enough to be applicable to the practice of caring for people at different stages of their dementia. Application of this conceptualization into PCC will best promote the well-being of people with dementia, while also encouraging respect and dignity in the care environment. (shrink)

“Bodily autonomy” has received significant attention in bioethics, medical ethics, and medical law in terms of the general inviolability of a patient’s bodily sovereignty and the rights of patients to make choices (e.g., reproductive choices) that concern their own body. However, the role of the body in terms of how it can or does contribute to a patient’s capacity for, or exercises of their autonomy in clinical decision-making situations has not been explicitly addressed. The approach to autonomy in this paper (...) is aligned with traditional theories that conceive autonomy in terms of an individual’s capacities for, and exercises of rational reflection. However, at the same time, this paper extends these accounts by arguing that autonomy is, in part, embodied. Specifically, by drawing on phenomenological conceptions of the experience of autonomy, we argue that, in principle, the body is a necessary component of the capacity for autonomy. Secondly, through the presentation of two different cases, we highlight ways in which a patient’s body can contribute to the autonomy of treatment choices. Ultimately, we hope to encourage others to explore additional conditions under which a concept of embodied autonomy should be employed in medical decision making, how its underlying principles might be operationalised in clinical situations, and its consequences for approaches to patient autonomy in healthcare practice, policy, and law. (shrink)

One goal of this paper is to argue that autobiographical memories are extended and distributed across embodied brains and environmental resources. This is important because such distributed memories play a constitutive role in our narrative identity. So, some of the building blocks of our narrative identity are not brain-bound but extended and distributed. Recognising the distributed nature of memory and narrative identity, invites us to find treatments and strategies focusing on the environment in which dementia patients are situated. A second (...) goal of this paper is to suggest various of such strategies, including lifelogging technologies such as SenseCams, life story books, multimedia biographies, memory boxes, ambient intelligence systems, and virtual reality applications. Such technologies allow dementia patients to remember their personal past in a way that wouldn’t be possible by merely relying on their biological memory, in that way aiding in preserving their narrative identity and positively contributing to their sense of well-being. (shrink)

In their valuable call-for-action article, Wexler and Specker Sullivan (2023) propose an integration–inclusion–impact axis for “translational neuroethics,” to face the challenges and criticisms tha...

When a loved one dies, it is common for the bereaved to feel profoundly lonely, disconnected from the world with the sense that they no longer belong. In philosophy, this experience of ‘loss and loneliness’ has been interpreted according to both a loss of possibilities and a loss of the past. But it is unclear how these interpretations apply to the distinctive way in which loss and loneliness manifest in old age. Drawing on the phenomenological analyses of old age given (...) by de Beauvoir and Améry, I consider how the diminishment of the capacity for projection and recollection complicate recent interpretations of loss and loneliness, whilst nevertheless reinforcing the conclusion that in old age subjectivity is necessarily impoverished. Developing a critical stance on de Beauvoir and Améry’s underlying conception of subjectivity, I turn to Levinas in considering whether or not there is a way to reimagine subjectivity such that the estrangement and alienation of older adults might be ameliorated rather than exacerbated. Grounded in the passive body-in-itself rather than the self-transcending capacity of the body-for-itself, I suggest it becomes possible to reconceptualise the experience of loss and loneliness in old age; both in terms of what is lost and what needs to be restored if older adults are to be helped to find themselves at home in the world in the midst of, and indeed because of, manifold loss. (shrink)

The discipline of knowledge translation (KT) emerged as a way of systematically understanding and addressing the challenges of applying health and medical research in practice. In light of ongoing and emerging critique of KT from the medical humanities and social sciences disciplines, KT researchers have become increasingly aware of the complexity of the translational process, particularly the significance of culture, tradition and values in how scientific evidence is understood and received, and thus increasingly receptive to pluralistic notions of knowledge. Hence, (...) there is now an emerging view of KT as a highly complex, dynamic, and integrated sociological phenomenon, which neither assumes nor creates knowledge hierarchies and neither prescribes nor privileges scientific evidence. Such a view, however, does not guarantee that scientific evidence will be applied in practice and thus poses a significant dilemma for KT regarding its status as a scientific and practice-oriented discipline, particularly within the current sociopolitical climate. Therefore, in response to the ongoing and emerging critique of KT, we argue that KT must provide scope for relevant scientific evidence to occupy an appropriate position of epistemic primacy in public discourse. Such a view is not intended to uphold the privileged status of science nor affirm the “scientific logos” per se. It is proffered as a counterbalance to powerful social, cultural, political and market forces that are able to challenge scientific evidence and promote disinformation to the detriment of democratic outcomes and the public good. (shrink)

There is thought to be a rich connection between the self and the phenomenology of episodic memory. Despite the emphasis on this link, the precise relation between the two has been underexplored. In fact, even though it is increasingly acknowledged that there are various facets of the self, this notion of the multifaceted self has played very little role in theorizing about the phenomenology of episodic memory. Getting clear about the complex phenomenology of episodic memory involves getting clear about various (...) components that contribute to the sense of self. Inspired by work on 4E cognition, and focusing on the phenomenological feature of felt connections, we show that the phenomenology of episodic memory can be modulated by focusing on different facets — embodied, extended, embedded, and ecological — of the self. (shrink)

Recent analytic-philosophical works in the field of situated cognition have proposed to conceptualize the self as deeply entwined with the environment, and even as constituted by it. A common move has been to characterize the self in narrative terms, and then to argue that the narrative self is partly constituted by narratives about the past that are scaffolded (shaped and maintained) by, or distributed over, a variety of objects that can rekindle episodic memories. While we are sympathetic to these approaches, (...) here we propose a different strategy to situate the self—one which can be seen as complementing the narrative one, and which draws from concepts and ideas central to the phenomenological-existentialist tradition. We suggest, first, that the self has a sense of its past not just via narratives and episodic memories, but in virtue of being embodied and thus, importantly, _sedimented_ (in other words, it has, or rather is, a _body memory_). Embodiment and sedimentation, in turn, always necessarily imply an environment or a situation, entailing that the self is also _inherently situated_. Second, we discuss the future-oriented dimension of selfhood, and argue that we understand ourselves as _projected_ into the future, again not necessarily only narratively and reflectively, but also tacitly, in a bodily and inherently situated way. (shrink)

This contribution sets out to criticize the prominent metaphor of “death while alive” in the context of dementia. We first explain the historical origin and development as well as the philosophical premises of the image. We then take a closer look at its implications for understanding dementia and societal attitudes and behaviours towards those affected. In doing so, we adopt a life course perspective that seeks to account for the ethical significance of the temporal extension and structure of human life. (...) According to this perspective, individual existence in time is characterized by normative standards of age-appropriate behavior, evaluative standards of a good life, and teleological notions of successful development which require theoretical analysis and ethical discussion. Such a perspective can contribute significantly to spelling out the implications of the metaphor of death while alive and to criticizing their problematic aspects. Indeed, it makes clear that this metaphor aligns dementia with a different point in the human life course, thus ultimately framing it as a kind of deviation from the biographical norm, a disruption in an assumed temporal order of existence. At the same time, the life course perspective can help to understand why this conception involves ethically problematic distortions and blind spots. The resulting considerations allow conclusions with regard to medical and care ethical debates about self-determination, surrogate decision making, and advance directives in the context of dementia. Furthermore, on a theoretical-conceptual level, they also illustrate the importance of a biography- and culture-sensitive approach to philosophical and ethical reasoning in biomedicine and the life sciences. (shrink)

In this paper, I address the effects of social distancing for embodied lived experience in relation to dementia care and experiences of dementia. From a critical phenomenological perspective, I focus specifically on the safety measures of physical distancing and face-masking in pandemic times, asking whether they might risk marginalizing and disembodying people with dementia, especially in isolated healthcare settings. As much as these measures offer physical protection against spreading the virus, I consider how they might disrupt intersubjective processes (e.g., calming (...) social or therapeutic touch) and contribute to “an alienated bodily communication” (Dolezal 2020). From Husserl and Merleau-Ponty’s philosophies of embodiment and enactive theories of intersubjectivity, to more recent phenomenological work on illness, many authors argue that our existential being-in-the-world is embodied in multimodal and intersubjective ways (Fuchs and De Jaeger 2009; Carel 2016; Ratcliffe 2008; Kontos 2011). For this reason, our lived bodies need to stay in touch and positively interact with other lived bodies. Based on empirical studies of multisensory and interactive therapy in nursing homes before and during the COVID-19 pandemic, I emphasize the effects of distant socializing for patients, care, and carers. My aim is to address the broader structures and discursive practices, which have undergone dramatic changes due to the spread of COVID-19. (shrink)