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)

According to a Kantian conception truthfulness is characterised as a requirement of respect for the agency of another. In lying we manipulate the other’s rational capacities to achieve ends we know or fear they may not share. This is paradigmatically a failure of respect. In this paper we argue that the importance of truthfulness also lies in significant part in the ways in which it supports our agential need to make sense of the world, other people, and ourselves. Since sense-making (...) is something we do together, and that we can support or undermine, it generates norms of interaction that constitute a further, distinct, mode of recognition and respect for another’s agency. But the requirements of truthfulness and support for sense-making sometimes conflict. Through a series of cases, we analyze why and when a rigid insistence on truthfulness is disrespectful of the other and undermining of their agency. (shrink)

_ Source: _Page Count 22 Analysis of the concept of habit has been relatively neglected in the contemporary analytic literature. This paper is an attempt to rectify this lack. The strategy begins with a description of some paradigm cases of habit which are used to derive five features as the basis for an explicative definition. It is argued that habits are social, acquired through repetition, enduring, environmentally activated, and automatic. The enduring nature of habits is captured by their being dispositions (...) of a certain sort. This is a realist account of habits insofar as the dispositions put forward must fit into some recognizable underlying system – in the case of humans a biological system – to fill the role as set out by the definition. This role is wide-ranging; in addition to the familiar cases of habitual behavior, habitual activities also include thinking, perceiving, feeling, and willing. (shrink)

BackgroundViral pandemics present a range of ethical challenges for policy makers, not the least among which are difficult decisions about how to allocate scarce healthcare resources. One important question is whether healthcare workers should receive priority access to a vaccine in the event that an effective vaccine becomes available. This question is especially relevant in the coronavirus pandemic with governments and health authorities currently facing questions of distribution of COVID-19 vaccines.Main textIn this article, we critically evaluate the most common ethical (...) arguments for granting healthcare workers priority access to a vaccine. We review the existing literature on this topic, and analyse both deontological and utilitarian arguments in favour of HCW prioritisation. For illustrative purposes, we focus in particular on the distribution of a COVID-19 vaccine. We also explore some practical complexities attendant on arguments in favour of HCW prioritisation.ConclusionsWe argue that there are deontological and utilitarian cases for prioritising HCWs. Indeed, the widely held view that we should prioritise HCWs represents an example of ethical convergence. Complexities arise, however, when considering who should be included in the category of HCW, and who else should receive priority in addition to HCWs. (shrink)

Soofi1 aims to develop an account of dignity in dementia care based on Nussbaum’s capabilities approach. He does this by drawing on the Kitwood and Bredin2 list of well-being indicators, in order to fill out her account of human flourishing to cover aspects such as practical reasoning that appear beyond the reach of those with relatively severe dementia. As Soofi points out, Nussbaum’s claim that such lost abilities can be compensated through guardianship measures is implausible. He asserts in response that (...) his account of dignity is sufficient to address the desiderata he sets out at the start, including especially the problem of exclusionary implications any putative account should address. So far, so good, but an objection Soofi raises for his own account is that it seems unable to cover cases of severe late-stage dementia. His response is, > …that there is insufficient factual evidence to suggest that people at the very advanced stages of dementia lose all capabilities. But for the sake of argument, let’s suppose that this is true. This, however, still does not undermine the conceptual rigour of the modified version of Nussbaum’s account. This is because the list of the dementia-specific capabilities that I …. (shrink)

Ronald Dworkin argued that Advance Directives informed by a principle of autonomy ought to guide decisions in relation to the treatment of those in care for dementia. The principle of autonomy in play presupposes a form of competence that is tied to the individual person making the Directive. This paper challenges this individualist assumption. It does so by pointing out that the competence of a patient is inherently relational, and the key illustrative case to make this point is the case (...) of music therapy. In music therapy, a relatively recent treatment modality in aged care, patients previously thought to be permanently unresponsive are shown on the contrary to be capable of significant levels of social agency. The conclusion to draw is that Advance Directives that fail to acknowledge the real possibility of such relational competence are misapplied. (shrink)

This chapter contains sections titled: The Key: Losing Oneself Windsurfing Performance, Psychology, and Embedded Cognition Windsurfing and Flow.

In some recent criminal cases in the United States a defense has been mounted based on an affliction known as Dissociative Identity Disorder (DID) (formerly Multiple Personality Disorder). The crux of the defense rests on the proposition that a dominant personality was incapable of appreciating the nature and quality of wrongfulness of conduct caused by an alter personality. This defense has been successful in some cases, but not others, and so philosophers, lawyers, and psychiatrists are now in debate in an (...) attempt to clarify the issues. One of the salient issues involves the question of personal identity between the individual who allegedly committed the offense and the individual who stands accused. Stephen Behnke and Walter Sinnott-Armstrong have recently put forward a test for establishing personal identity in these cases. In this discussion, I present reasons for rejecting their proposal. (shrink)

In what sense is a person addicted to drugs or alcohol incompetent, and so a legitimate object of coercive treatment? The standard tests for competence do not pick out the capacity that is lost in addiction: the capacity to properly regulate consumption. This paper is an attempt to sketch a justificatory framework for understanding the conditions under which addicted persons may be treated against their will. These conditions rarely obtain, for they apply only when addiction is extremely severe and great (...) harm threatens. It will be argued also that to widen the measures currently in place in some jurisdictions, though philosophically well-motivated, would require very strong evidence of a set of conditions disposing a person to an addictive future. It is doubtful that any such currently available evidence is strong enough to justify coercive treatment. Nevertheless, coercive treatment of addiction is already a reality, with the potential for more, and so some discussion will be presented regarding the extraordinary safeguards necessary to prevent misapplication of such treatment policies. (shrink)

The decline in autobiographical memory function in people with Alzheimer’s dementia has been argued to cause a loss of self-identity. Prior research suggests that people perceive changes in moral traits and loss of memories with a “social-moral core” as most impactful to the maintenance of identity. However, such research has so far asked people to rate from a third-person perspective, considering the extent to which hypothetical others maintain their identity in the face of various impairments. In the current study, we (...) examined the impact of perspective, comparing first- and third-person perspectives, as well as memory type. This online study asked 201 participants to consider hypothetical scenarios in which either themselves or another person experienced different types of memory failures associated with a diagnosis of AD. For each scenario, participants rated the degree to which the depicted individual remained the same person, and how impactful the impairment was. Social semantic memory failures – involving failures to recognise a loved one – were rated as most detrimental to self-continuity, and procedural memory failures the least. Averaged across all memory types, people considered their own and their partner’s self-continuity to be more resilient to memory failures than that of a parent or stranger. However, this pattern was reversed for some memory types: forgetting semantic or episodic information about close relationships was rated as more detrimental from a first-person than third-person perspective. Our findings suggest that perspective and type of memory impairment interact to impact judgements about the extent to which people maintain their identity when they experience dementia, and highlight the importance of social relationships to maintaining a sense of self. (shrink)

Journal of Applied Philosophy, EarlyView.

It is ordinarily thought that in Alzheimer's dementia, memory loss leads to a loss of the self. There is a familiar sense in which this is true given that there is, evidently, a close connection between episodic memory and personal identity. This view goes back to John Locke who argued that remembering our own experiences enabled the continuity of consciousness he thought constitutive of personal identity. Locke was also motivated by the idea—to be applied in "forensic" contexts—that continuity of consciousness (...) was necessary in the appropriation of past actions as one's own. As we will see there is another type of connection between a person's psychology and morality—not involving questions of... (shrink)

The destruction and pollution of the natural environment poses two problems for philosophers. The first is political and pragmatic: which theory of the environment is best equipped to impact policymakers heading as we are toward a series of potential ecocatastrophes? The second is more central: On the environment philosophers tend to fall either side of an irreconcilable divide. Either our moral concerns are grounded directly in nature, or the appeal is made via an anthropocentric set of interests. The lack of (...) a common ground is disturbing. In this paper I attempt to diagnose the reason for this lack. I shall agree that wild nature lacks features of intrinsic moral worth, and that leaves a puzzle: Why is it once we subtract the fact that there is such a lack, we are left with strong intuitions against the destruction and/or pollution of wild nature? Such intuitions can be grounded only in a strong sense of aesthetic concern combined with a common-sense regard for the interests of sentient life as it is indirectly affected by the quality of the environment. I suggest also that of the positions on offer, a hybrid theory of the environment is best suited to address our first problem, that of having an effective influence in the polity. (shrink)

Though famously Derek Parfit is known for his reductionism about persons, he does, in fact, also profess a form of realism about persons based on the way the language of persons and personal identity is used. We might say that Parfit is an ontological reductionist about persons but not a conceptual reductionist. In this discussion note I try to bring out a difficulty for this kind of hybrid view by showing that there are many ways – too many in fact (...) – in which we use the language of persons and personal identity that cannot be reconciled with the core of Parfitian ontological reductionism. If it is true that the kind of reconciliation Parfit and his followers assent to is untenable, then a stark choice is presented between reductionism and a repudiation of most, if not all vestiges of realism. A genuine reductionist ought to choose against the latter. (shrink)