In this paper I consider, in connection with dementia, two views of the person. One view of the person is derived from Locke and Parfit. This tends to regard the person solely in terms of psychological states and his/her connections. The second view of the person is derived from a variety of thinkers. I have called it the situated-embodied-agent view of the person. This view, I suggest, more readily squares with the reality of clinical experience. It regards the person as (...) embedded in a history and culture. The human person is also an embodied agent. I contend that this view encourages a more appropriate approach towards the ethical issues that arise in dementia and towards people with dementia. (shrink)

Marya Schechtman offers a new theory of personal identity, which captures the importance of being able to reidentify people in our daily lives. She sees persons as loci of practical interaction, and defines the unity of such a locus in terms of biological, psychological, and social functions, mediated through social and cultural infrastructure.

Im Zeichen steigender Lebenserwartung, individualisierter Lebensentwürfe und wachsender medizinischer Eingriffsmöglichkeiten ist die Ethik herausgefordert, sich ausdrücklich und systematisch mit der Bedeutung der zeitlichen Erstreckung, Verlaufsstruktur und Einteilung unseres Lebens auseinanderzusetzen. Einen ersten Ansatzpunkt dazu bietet die im entwicklungspsychologischen und sozialwissenschaftlichen Bereich ausgebildete Lebensverlaufsperspektive. Am Beispiel des Alterns wird zunächst das Desiderat einer angemessenen ethischen Auseinandersetzung mit den normativen Aspekten menschlicher Zeitlichkeit aufgezeigt. Vor diesem Hintergrund werden die theoretischen Grundzüge der Lebensverlaufsperspektive umrissen und in ihrer Leistungsfähigkeit für die ethische Theoriebildung erörtert. (...) Das Hauptaugenmerk liegt auf drei Konzepten: Altersnormen als normative Standards altersgemäßen Verhaltens, Phasenideale als evaluative Maßstäbe der Lebensabschnittsgestaltung sowie Ablaufpläne als diachrone Schemata lebensgeschichtlicher Vorgänge. Abschließend werden Anwendungsmöglichkeiten und Grenzen einer solchen Lebensverlaufsperspektive in der Ethik erörtert. (shrink)

Few early debates in bioethics invigorated the field to the same extent as the one concerning whether or not young children could be used in nontherapeutic research. Though some of the issues in the debate were never fully settled, a consensus emerged, reflected in the Common Rule—that surrogates could consent to use children in such research, although once the level of risk rises above minimal, additional stipulations are required. Nontherapeutic research on cognitively impaired elderly people raises equally complex ethical issues, (...) but there has been a dearth of debate in the literature about whether such research is ethically permissible. Instead, there have been many published recommendations regarding the circumstances under which such research can occur. (shrink)

The idea that dementia is essentially a return to childhood and those affected must somehow be similar to children constitutes a deeply rooted and pervasive cultural trope. While such tropes may be helpful in making sense of an otherwise elusive and inscrutable state, they can at the same time promote inadequate understandings of dementia and hence also influence our attitudes and behaviour towards those affected in several problematic ways. In the present work, we provide a detailed account of the origins (...) and implications of the idea that people with dementia are somehow similar to children. In order to spell out the normative significance of this trope and to analyse its shortcomings, we will rely on a life‐course perspective. We will point out that the second‐childhood trope does not do justice to the particularities of the life phases of both children and people with dementia. This lack of biographical sensitivity brings about undignified treatment of and harm to those who have previously lived more autonomous lives. In conclusion, we will argue that people with dementia should not be equated with children as they are at a different point in their lives. This critical analysis of the second‐childhood trope shows the usefulness of a culturally and biographically sensitive theoretical framework for bioethical reflection. In particular, it provides reasons to reject infantilizing attitudes and behaviours and instead take seriously the personality, values and preferences shaped throughout the course of an individual's life. (shrink)

Social death is apparent when people are considered unworthy of social participation and deemed to be dead when they are alive. Some marginalized groups are more susceptible to this treatment than others, and one such group is people with dementia. Studies into discrimination towards older people are well documented and serve as a source of motivation of older people’s social movements worldwide. Concurrently, theories of ageing and care have been forthcoming in a bid to improve the quality of responses to (...) older people in times of need. Included in this theorizing has been the analysis of values and approaches that paid carers convey to citizens who require their help. In this article, the values and approaches of social workers and mental health nurses bring to people with dementia are considered within the context of social life and social death. It is based on a small study that undertook to critically examine how participation of people with dementia was facilitated. A thanatological lens was used to interpret inclusive and exclusive practices which potentially create opportunity for participation or reinforce the loss of citizenship for older people with dementia. (shrink)