Philosophers have become newly interested in the ethics of sex. One promising feature of this new discussion is that it has been broadening our moral lens to include individuals whose sexual interests have historically been denied or ignored. One such group is the elderly. Contrary to popular belief, many elderly people want to have sex and see it as a regular part of their lives. If society harbors ignorance about or prejudice against elderly sexuality, it harbors stronger views against the (...) sexual expression of elderly people with dementia. People with dementia are often prohibited by nursing‐home staff, sometimes in extreme ways, from having sex with their partners. This prohibition is at least partly motivated by the goal of protecting the vulnerable. However, cutting people with dementia off from sex has negative health effects and is a needless restriction of their autonomy. In this article, I argue that the expanding moral lens in sexual ethics should include the sexual expression of elderly individuals with dementia and that their sexual expression should be respected. Specifically, I argue that many people with dementia are competent to consent to sexual activity with their long‐term partners. (shrink)

The literature on epistemic injustice has thus far confined the concept of testimonial injustice to speech expressions such as inquiring, discussing, deliberating, and, above all, telling. I propose that it is time to broaden the horizons of testimonial injustice to include a wider range of expressions. Controversially, the form of communication I have in mind is non-verbal expression. Non-verbal expression is a vital, though often overlooked, form of communication, particularly for people who have certain neurocognitive disorders. Dependency upon non-verbal expression (...) is a common feature of some forms of neurocognitive disorders such as ‘intellectual disabilities’, autism and late-stage dementia. According to the narrow definition of testimonial injustice currently championed in the literature, people who express non-verbally are exempt from testimonial injustice. However, when we consider cases where meaningful communications from non-verbal people are dismissed or ignored in virtue of identity prejudice, there seems to be a distinct testimonial harm at play. Using late-stage dementia as a case study, I argue that the definition of testimonial injustice should be expanded to include all communicative practices, whether verbal or non-verbal, to encompass the epistemic harms inflicted upon some of the most marginalised in our society. (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)

Philosophers concerned with what would be good for a person sometimes consider a person’s past desires. Indeed, some theorists have argued by appeal to past desires that it is in the best interests of certain dementia patients to die. I reject this conclusion. I consider three different ways one might appeal to a person’s past desires in arguing for conclusions about the good of such patients, finding flaws with each. Of the views I reject, the most interesting one is (...) the view that prudential value is, at least partly, concerned with the shape of a life as a whole. (shrink)

"Our literature is replete with complaints about the chaotic state of the systematics of psychoses and every psychiatrist knows that it is impossible to come to any common understanding on the basis of the old diagnostic labels. ... Thus, not even the masters of science can make themselves understood on the basis of the old concepts and with many patients the number of diagnoses made equals the number of institutions they have been too. ... Errors are the greatest obstacles to (...) the progress of science; to correct such errors is of more practical value than to achieve new knowledge. We have here eliminated chaos of terms behind which useful concepts of disease were mistakenly sought; we have eliminated a veritable forest of boundary posts, not one of which indicated any natural line of demarcation. ... By the term „dementia praecox“ or „schizophrenia“ we designate a group of psychoses whose course is at times chronic, at times marked by intermittent attacks, and which can stop or retrograde at any stage, but does not permit a full restitutio ad integrum. The disease is characterized by a specific type of alteration of thinking, feeling, and relation to the external world which appears nowhere else in this particular fashion." Eugen Bleuler. Dementia Praecox or the Group of Schizophrenias. Translated by Joseph Zinkin. International Universities Press, New York, 1950. (shrink)

This study aimed to understand the preserved elements of self-identity in persons with moderate to severe dementia attributable to Alzheimer’s disease. A semi-structured interview was developed to explore the narrative self among residents with dementia in a residential care facility and residents without dementia in an independent living setting. The interviews were transcribed verbatim from audio recordings and analyzed for common themes, while being sensitive to possible differences between the groups. The participants with dementia showed evidence (...) of self-reference even though losses in explicit memory were evident. The most noticeable difference between the two groups was time frame reference. Nonetheless, all participants showed understanding of their role in relationships and exhibited concrete preferences. Our findings suggest that memory loss and other cognitive deficits associated with moderate to severe dementia do not necessarily lead to a loss of “self.”. (shrink)

In this paper, I answer the following question: suppose that two individuals, C and D, have been in a long-term committed relationship, and D now has dementia, while C is competent; if D agrees to have sex with C, is it permissible for C to have sex with D? Ultimately, I defend the view that, under certain conditions, D can give valid consent to sex with C, rendering sex between them permissible. Specifically, I argue there is compelling reason to (...) endorse the following thesis: -/- Prior Consent Thesis: D, when competent, can give valid prior consent to sex with her competent partner (C) that will take place after she has dementia, assuming that D is the same person as she was when she gave prior consent, meaning that, if D, when competent, gave prior consent to sex with C, then C may permissibly have sex with D. In section I, I explain both the background and the existing literature on this issue. In section II, I outline relevant stipulations about the kinds of cases I will be examining. In section III, I defend the Prior Consent Thesis. And, in section IV, I address objections to the Prior Consent Thesis. (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 paper introduces the concept of ‘skeuomorphic reassurance’ as a guiding principle for human interfaces in technological development and design, particularly for older people and people with dementia (PwD). Skeuomorphs exhibit decorative design elements reminiscent of ‘parent’ objects that incorporated such design elements because they were structurally integral. Human interfaces adopted by new technologies need to be carefully balanced between novelty and recognisability. -/- The philosophy of personhood is discussed in the context of dementia, concluding that the subjective (...) character of conscious mental processes is an irreducible feature of reality, and that the persistence of personhood in PwD constitutes a further argument in support of this assertion. -/- Assistive technologies that aid family and carers, as well as PwD, and their relationships, need to ensure that skeuomorphic reassurance is incorporated in their design, not least because older people and PwD need recognisable interfaces today, but, as this paper argues, because the problems today’s over-65s have with digital technologies may quite likely not go away, but re-present themselves generation after generation, unless skeuomorphic reassurance is built into their design. (shrink)

I develop Tetsurō Watsuji’s relational model of the self as “betweenness”. I argue that Watsuji’s view receives support from two case studies: solitary confinement and dementia. Both clarify the constitutive interdependence between the self and the social and material contexts of “betweenness” that define its lifeworld. They do so by providing powerful examples of what happens when the support and regulative grounding of this lifeworld is restricted or taken away. I argue further that Watsuji’s view helps see the other (...) side of this deprivation, how reconstructing aspects of betweenness is, at the same time, a reconstruction of the self. I conclude by briefly indicating further consequences of this view. (shrink)

Suicide is a major public health issue in many industrialized countries. It is one of the top ten causes of death and older age is a significant risk factor for suicide. For example, in Japan older adults (age ≥ 65) shared about 18.5% of total population but account for 24% of all suicide, in Taiwan, older adults representing 12.4% of the total population and account for 28.9% of suicide death. Dementia is a broad term for a progressive deterioration in (...) memory ability and dementia patients ran higher risk for suicide. (shrink)

Advance directives are intended to extend patient autonomy by enabling patients to prospectively direct the care of their future incapacitated selves. There has been much discussion about issues such as whether the future incompetent self is identical to the agent who issues the advance directives or whether advance directives can legitimately secure patient autonomy. However, there is another important question to ask: to what extent and in what conditions is it ethically appropriate for one to limit the liberty or agency (...) of one’s future incompetent self by issuing an advance directive? -/- In this paper, I use a virtue-ethical approach to explore this question, focusing on the case of an advance directive for the future self with moderate dementia. First, I examine virtuous attitudes with regard to autonomy and argue that one can manifest vices or ethically undesirable character traits in trying to intervene in the future self’s life. In particular, I argue that this case can manifest vices such as disdainfulness, intellectual arrogance, and self-dictatorship, which is the vice of trying to control one’s life to an excessive degree, and that a self-dictator fails to give due moral consideration to the future self’s liberty or agency. I then introduce the Daoist idea of wu-wei, which recommends embracement of what happens in one’s life, as one of the possible remedies for the overemphasis on the value of autonomy and control. (shrink)

Do laypeople think that moral responsibility is compatible with determinism? Recently, philosophers and psychologists trying to answer this question have found contradictory results: while some experiments reveal people to have compatibilist intuitions, others suggest that people could in fact be incompatibilist. To account for this contradictory answers, Nichols and Knobe (2007) have advanced a ‘performance error model’ according to which people are genuine incompatibilist that are sometimes biased to give compatibilist answers by emotional reactions. To test for this hypothesis, we (...) investigated intuitions about determinism and moral responsibility in patients suffering from behavioural frontotemporal dementia. Patients suffering from bvFTD have impoverished emotional reaction. Thus, the ‘performance error model’ should predict that bvFTD patients will give less compatibilist answers. However, we found that bvFTD patients give answers quite similar to subjects in control group and were mostly compatibilist. Thus, we conclude that the ‘performance error model’ should be abandoned in favour of other available model that best fit our data. (shrink)

Loss of self is widely regarded to be a consequence of dementia, and this perceived loss presents a variety of problems - not least because a clear understanding of the concept of self is elusive. This paper suggests a way to cut through problems that arise because we rely on conceptions of self in our understanding of the effects of dementia. It is proposed that we can avoid reliance on the concept of self through an approach based in (...) in bio-phenomenology. Such an approach would help us better understand the inner life of those with dementia and assist us to recognize that even in late stage dementia they are semiotic subjects with unique value. (shrink)

Without doubt already ‘higher’ animals which as such have phenomenal perception possess an animalic soul. The contrasting comparison of animal and robot proves to be revealing: What does the animal have that the robot does not? A key role here plays Hegel’s interpretation, which can be addressed as a phenomenology of the ‘animalic soul’. His dictum ‘Only what is living feels a lack’ refers to the principle of self-preservation which governs everything organic. Concerning higher animals this too appears as the (...) basis of the soul: Everything, which the animal perceives thus has existential sense, self-preservation-sense. At the same time it becomes clear that robot perception is not capable of a constitution of sense, but is characterized by dementia of sense. Concretely systemtheoretically regarded, the relatedness to sense of the animal subject is here interpreted as an emergence phenomenon of the system constituted by the cooperative of perception, valuation and behavior (perc-val-act-system). In this emergentist perspective, there is, as it were, the dualism of solely-physical being and of immaterial-mental being, which at the same time is a monism with regard to the physical basis alltogether. (shrink)

In his paper, ‘What moral work can Nussbaum’s account of human dignity do in the context of dementia care?’, Soofi seeks to modify Nussbaum’s conception of dignity to deal with four key objections that arise when appeals to dignity are made in the context of dementia care. We will not discuss the first of these, the redundancy of dignity talk, since this issue has already been much discussed in the literature. Instead, we will focus on the remaining three (...) issues raised, that of the exclusion of persons with advanced dementia from having dignity, unjustified speciesism as a ground of human dignity, and the unclear practical implications that follow from having dignity. (shrink)

Loss of personal identity in dementia can raise a number of ethical considerations, including the applicability of advance directives and the validity of patient preferences that seem incongruous with a previous history of values. In this chapter, we first endorse the self-concept view as the most appropriate approach to personal continuity in healthcare. We briefly describe two different types of dementia, Alzheimer’s dementia (AD) and behavioral-variant frontotemporal dementia (bv-FTD). We identify elements considered important for the continuation (...) of a self-concept, including continuation of memories, consistency in personality traits and personal preferences, and continued endorsement of certain moral tenets. We show that, depending on which element is considered most important for personal identity, continuity of a self-concept for individuals with distinct types of dementia will be affected and assessed differently. Utilizing a variety of empirical evidence, we argue that persistence of memory, personality traits, and preferences are not the most important for the maintenance of personal identity. Instead, as studies aimed to capture the folk-psychological view of personal continuity demonstrate, judgements about continuity depend primarily on the persistent commitment to widely shared moral beliefs. Because of that, we argue that individuals with bv-FTD are more likely to lose their sense of self than individuals whose dementia primarily affects memory, such as Alzheimer’s disease. We end the chapter by showing how the importance of moral beliefs for continuity of self can be used to provide guidance to health-care professionals when considering changes in preference by individuals with dementia. (shrink)

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)

Commentary on Walsh, E. 2020. Cognitive transformation, dementia, and the moral weight of advance directives. The American Journal of Bioethics. 20(8): 54–64.

The paper investigates whether it is plausible to hold the late stage demented criminally responsible for past actions. The concern is based on the fact that policy makers in the United States and in Britain are starting to wonder what to do with prison inmates in the later stages of dementia who do not remember their crimes anymore. The problem has to be expected to become more urgent as the population ages and the number of dementia patients increases. (...) This paper argues that the late-stage demented should not be punished for past crimes. Applicable theories of punishment, especially theories with an appropriate expressivist, or communicative element, fail to justify the imprisonment of the late-stage demented. Further imprisonment would require a capacity for comprehension on the part of the punished, and, under certain narrowly specified conditions, even a capacity to be at least in principle capable of recalling the crime again. (shrink)

This paper takes a novel approach to the active bioethical debate over whether advance medical directives have moral authority in dementia cases. Many have assumed that advance directives would lack moral authority if dementia truly produced a complete discontinuity in personal identity, such that the predementia individual is a separate individual from the postdementia individual. I argue that even if dementia were to undermine personal identity, the continuity of the body and the predementia individual’s rights over that (...) body can support the moral authority of advance directives. I propose that the predementia individual retains posthumous rights over her body that she acquired through historical embodiment in that body, and further argue that claims grounded in historical embodiment can sometimes override or exclude moral claims grounded in current embodiment. I close by considering how advance directives grounded in historical embodiment might be employed in practice and what they would and would not justify. (shrink)

In this commentary, I critique three aspects of Emily Walsh's proposal to reduce the moral and legal weight of advance directives: (1) the ambiguity of its initial thesis, (2) its views about the ethics and legality of clinical practice, and (3) its interpretation and application of Ronald Dworkin’s account of advance directives and L.A. Paul's view on transformative experience. I also consider what Walsh’s proposal would mean for people facing the prospect of dementia. I conclude that our reasons to (...) honor many advance directives survive the move to a transformative experience framework. (shrink)

This paper argues that 'duality' accounts of time, as exemplified by Henri Bergson's, Edmund Husserl's, and John McTaggart's ideas, parallel the decomposition of temporal experience in depressive psychosis into objective and subjective dimensions of time. The paper also proposes to comprehend the full-fledged depressive temporal delusion, in which the subjective flow of time comes to a standstill, via the idea of a double orientation to reality characteristic of schizophrenic delusions. In the depressive temporal delusion a person claims that time is (...) not moving while simultaneously her cognitive orientation in temporal surroundings remains largely unaffected, hence the double orientation. The juxtaposition of temporal experience in depression with the temporal disorientation in dementia enables us to situate the depressive delusion regarding the flow of time in the middle of a proposed scale of the disintegration of normal temporal experience. (shrink)

I seek to emphasize Immanuel Kant’s lingering and unsavory impact on medical ethics by emphasizing Kantian ethics’ disregard for non- rational humans. We must be considerate when discussing individuals who have some form of dementia, conditions that irreversibly diminish the ability to use rational thought, sometimes to a degree of severity that hinders essential daily functions. I argue that to consider ourselves proponents of human equality we must treat humans with dementia as members of the kingdom of ends.

A high level of confidence in the identity of individuals is required to let them die as ordered by an advance directive. Thus, if we are animalists, then we should lack the confidence required to apply lethal advance directives to the cheerfully demented, or so I argue. In short, there is consensus among animalists that the best way to avoid serious objections to their account is to adopt an ontology that denies the existence of brains, hands, tables, chairs, iced-tea, and (...) lemonade. The adoption of such an ontology reduces the justificatory force of commonsense, which is key in arguing that we are animals and that we persist as long as we are biologically alive. With this loss of justification comes the loss of a high level of confidence that Quinn-pre-dementia’s lethal advanced directive applies to Quinn-post-dementia, via identity. If we do not have a high level of confidence that Quinn-pre-dementia’s advanced directive applies to Quinn-post- dementia, then it is not enough (on its own) to let Quinn-post-dementia die. (shrink)

-/- Caring for loved ones with dementia can sometimes necessitate a loose relationship with the truth. Some might view such deception as categorically immoral, and a violation of our general truth-telling obligations. I argue that this view is mistaken. This is because truth-telling obligations may be limited by the particular relationships in which they feature. Specifically, within caregiving relationships, we are often permitted (and sometimes obligated) to deceive the people with whom we share them. Our standing to deceive follows (...) from certain features of caregiving relationships. Specifically, they are relationships that involve obligations to promote a person's interests and values (and not simply their autonomy), that often permit us to assume the hypothetical consent of the person with whom we share them, and in which we are often entitled to act out of self-interest. Once we appreciate these features, we will be able to recognize that the truth-telling norms governing our relationships with loved ones with dementia do not represent a radical departure from our general truth-telling obligations, but are instead consistent with truth-telling norms that feature in other caregiving relationships. In addition, we will be able to understand why we may feel conflicted about lying to loved ones with dementia, even when lying is permissible. (shrink)

Abstract: Alzheimer's disease (AD) is one of the most common types of dementia. Symptoms appear gradually and end with severe brain damage. People with Alzheimer's disease lose the abilities of knowledge, memory, language and learning. Recently, the classification and diagnosis of diseases using deep learning has emerged as an active topic covering a wide range of applications. This paper proposes examining abnormalities in brain structures and detecting cases of Alzheimer's disease especially in the early stages, using features derived from (...) medical images. The entire brain image was passed on through the transmission of Xception learning architectures. The Convolutional Neural Network (CNN) was constructed with the help of separable convolution layers that It can automatically learn general features from imaging data for classification. (shrink)

In this article, we focus on the definition and application of the sliding scale of capacity. We show that the current interpretations of the sliding scale confound distinct features of the medical decision, such as its urgency, its severity, or its complexity, that do not always covary.We propose that the threshold for assessing capacity should be adjusted based solely on the cognitive complexity of the decision at hand. We further suggest that the complexity of a decision should be identified based (...) on a patient’s particular cognitive deficits. We utilize the current research on the types of deficits that characterize amnestic dementias and examine which types of medical decisions might be most complex for patients with that type of dementia. We conclude that applying the sliding scale based on individualized judgments of cognitive complexity will improve accuracy of assessment of capacity and enable capable patients to participate in medical decision making. (shrink)

I am a philosopher with Parkinson’s Disease. Over the past several years I’ve been trying to write about my situation. I wrote about how I was forced to face the disease. I described how the disease twists and distorts my world. Then I asked myself, as a philosophy writer and teacher, whether I could say anything that might help myself or others facing life with Parkinson’s? I found ideas in the ancient Stoics and expanded them with ideas about time, coming (...) up with suggestions for living as excellently as possible despite the disease. Looking at those suggestions, I realized how the special awareness, resolve, and attention I was suggesting would be eaten away by dementia, and I know that a majority of Parkinson’s patients face dementia if they survive long enough. What can philosophy say to me or any person whose self and philosophy are being erased? Writing about such issues has helped me deal with my situation, and maybe my essay might be useful for others dealing with decline. (shrink)

We present a theory of human artistic experience and the neural mechanisms that mediate it. Any theory of art has to ideally have three components. The logic of art: whether there are universal rules or principles; The evolutionary rationale: why did these rules evolve and why do they have the form that they do; What is the brain circuitry involved? Our paper begins with a quest for artistic universals and proposes a list of ‘Eight laws of artistic experience’ -- a (...) set of heuristics that artists either consciously or unconsciously deploy to optimally titillate the visual areas of the brain. One of these principles is a psychological phenomenon called the peak shift effect: If a rat is rewarded for discriminating a rectangle from a square, it will respond even more vigorously to a rectangle that is longer and skinnier that the prototype. We suggest that this principle explains not only caricatures, but many other aspects of art. Example: An evocative sketch of a female nude may be one which selectively accentuates those feminine form-attributes that allow one to discriminate it from a male figure; a Boucher, a Van Gogh, or a Monet may be a caricature in ‘colour space’ rather than form space. Even abstract art may employ ‘supernormal’ stimuli to excite form areas in the brain more strongly than natural stimuli. Second, we suggest that grouping is a very basic principle. The different extrastriate visual areas may have evolved specifically to extract correlations in different domains , and discovering and linking multiple features into unitary clusters -- objects -- is facilitated and reinforced by direct connections from these areas to limbic structures. In general, when object-like entities are partially discerned at any stage in the visual hierarchy, messages are sent back to earlier stages to alert them to certain locations or features in order to look for additional evidence for the object . Finally, given constraints on allocation of attentional resources, art is most appealing if it produces heightened activity in a single dimension rather than redundant activation of multiple modules. This idea may help explain the effectiveness of outline drawings and sketches, the savant syndrome in autists, and the sudden emergence of artistic talent in fronto-temporal dementia. In addition to these three basic principles we propose five others, constituting a total of ‘eight laws of aesthetic experience’. (shrink)

Through this contribution I aim to explore the horizons and limits of digital medicine in light of an embodied approach to the issue of care. I will sketch the historical background of digital medicine and show the contemporary status of this interdisciplinary field, as well as its applications and outcomes. Then, I will address a critique of the computational theory of mind (CTM) upon which many contemporary mental health apps are designed. This approach to the mind is inscribed into the (...) modern trend of neuromania, which conceives the embodied, living human being as a mere series of data analyses and algorithms, with the brain as the seat of the person. Drawing on continental philosophy and classical phenomenology I will develop a notion of health conceived as a moral enterprise, showing how wellbeing and vitality are not reducible to a product made by technologies or doctors, but rather they are the results of an embodied encounter. As such, empathy and person-centered care cannot be achieved by digital medicine. They are the result of a journey into the regions of recognition, embodied presence and the aliveness constituting the person. Finally, I will show how the issue of care cannot be separated from an embodied encounter between people, especially in case of dementia. (shrink)

It seems obvious that phenomenally conscious experience is something of great value, and that this value maps onto a range of important ethical issues. For example, claims about the value of life for those in a permanent vegetative state, debates about treatment and study of disorders of consciousness, controversies about end-of-life care for those with advanced dementia, and arguments about the moral status of embryos, fetuses, and non-human animals arguably turn on the moral significance of various facts about consciousness. (...) However, though work has been done on the moral significance of elements of consciousness, such as pain and pleasure, little explicit attention has been devoted to the ethical significance of consciousness. In this book Joshua Shepherd presents a systematic account of the value present within conscious experience. This account emphasizes not only the nature of consciousness, but the importance of items within experience such as affect, valence, and the complex overall shape of particular valuable experiences. Shepherd also relates this account to difficult cases involving non-humans and those with disorders of consciousness, arguing that the value of consciousness influences and partially explains the degree of moral status a being possesses, without fully determining it. The upshot is a deeper understanding of both the moral importance of phenomenal consciousness and its relations to moral status. This book will be of great interest to philosophers and students of ethics, bioethics, philosophy of psychology, philosophy of mind and cognitive science. (shrink)

The phrase ‘person‐centred care’ (PCC) reminds us that the fundamental philosophical goal of caring for people is to uphold or promote their personhood. However, such an idea has translated into promoting individualist notions of autonomy, empowerment and personal responsibility in the context of consumerism and neoliberalism, which is problematic both conceptually and practically. From a conceptual standpoint, it ignores the fact that humans are social, historical and biographical beings, and instead assumes an essentialist or idealized concept of personhood in which (...) a person is viewed as an individual static object. From a practical standpoint, the application of such a concept of personhood can lead to neglect of a person's fundamental care needs and exacerbate the problems of social inequity, in particular for older people and people with dementia. Therefore, we argue that our understanding of PCC must instead be based on a dynamic concept of personhood that integrates the relevant social, relational, temporal and biographical dimensions. We propose that the correct concept of personhood in PCC is one in which persons are understood as socially embedded, relational and temporally extended subjects rather than merely individual, autonomous, asocial and atemporal objects. We then present a reconceptualization of the fundamental philosophical goal of PCC as promoting selfhood rather than personhood. Such a reconceptualization avoids the problems that beset the concept of personhood and its application in PCC, while also providing a philosophical foundation for the growing body of empirical literature that emphasizes the psychosocial, relational, subjective and biographical dimensions of PCC. (shrink)

This chapter discusses the Ganser syndrome and gives a brief account on its clinical features. A significant number of clinicians in Europe continued accepting Ganser's basic postulates that the patients showed significant memory disorder and 'answers towards the question' within the framework of traumatic or reactive hysteria. In elderly patients, Ganser type symptoms may be indicative of the onset of dementia. Ganser syndrome raises the question of the interaction between concepts, ideology and clinical observation. The clinician must be aware (...) that a misdiagnosed case of Ganser-type hysteria may result in lawsuits, unnecessary surgical interventions, inappropriate use of minor and major tranquillizers, and social consequences that may be destabilizing for the patient and family. Positive results in the organic investigation should lead to a firm diagnosis and disconfirmation of Ganser syndrome. Persistent negative results and dramatic improvement should tend to confirm the diagnosis. (shrink)

It is widely held that every person is a person essentially, where being a person is having special mental properties such as intelligence and self-consciousness. It follows that nothing can acquire or lose these properties. The paper argues that this rules out all familiar psychological-continuity views of personal identity over time. It also faces grave difficulties in accounting for the mental powers of human beings who are not intelligent and self-conscious, such as foetuses and those with dementia.

The term “value of life” can refer to life’s intrinsic dignity: something nonincremental and time-unaffected in contrast to the fluctuating, incremental “value” of our lives, as they are longer or shorter and more or less flourishing. Human beings are equal in their basic moral importance: the moral indignities we condemn in the treatment of e.g. those with dementia reflect the ongoing human dignity that is being violated. Indignities licensed by the person in advance remain indignities, as when people might (...) volunteer their living, unconscious bodies for surrogacy or training in amputation techniques. Respect for someone’s dignity is significantly impacted by a failure to value that person’s very existence, whatever genuine respect and good will is shown by wanting the person’s life to go well. Valuing and respecting life is not, however, vitalism: there can be good and compelling reasons for eschewing some means of prolonging life. (shrink)

As the world population is rapidly aging, stakeholders must address the care of the elderly with great concern. Also, loss of dignity is often associated with aging due to dementia, mobility problems and diminished functional autonomy. However, dignity is a polysemic term that is deemed useless by some ethicists. To counter this claim, we propose four concepts to define it better and make use accurately of this notion. These are human dignity, dignity of identity, dignities of excellence and attributed (...) dignities. Finally, we explain the importance of solicitude and human dignity in the care of the elderly. This will ensure the respect, friendship and dignity of the elderly in providing geriatric ethical care. (shrink)

Insofar as many older adults fit some definition of disability, disability studies and gerontology would seem to have common interests and goals. However, there has been little discussion between these fields. The aim of this paper is to open up the insights of disability studies as well as philosophy of disability to discussions in gerontology. In doing so, I hope to contribute to thinking about the good life in late life by more critically reflecting upon the meaning of the body, (...) ability, and the variability of each. My central argument is that we should conceptualize age‐associated bodily variations and abilities not in terms of individual capacity, but in terms of what I call “the extended body.” It is in light of the meaning of embodiment and ability in general that we must think differently and more capaciously about the meaning of late life in particular. (shrink)

We have begun work on two separate but related ontologies for the study of neurological diseases. The first, the Neurological Disease Ontology (ND), is intended to provide a set of controlled, logically connected classes to describe the range of neurological diseases and their associated signs and symptoms, assessments, diagnoses, and interventions that are encountered in the course of clinical practice. ND is built as an extension of the Ontology for General Medical Sciences — a high-level candidate OBO Foundry ontology that (...) provides a set of general classes that can be used to describe general aspects of medical science. ND is being built with classes utilizing both textual and axiomatized definitions that describe and formalize the relations between instances of other classes within the ontology itself as well as to external ontologies such as the Gene Ontology, Cell Ontology, Protein Ontology, and Chemical Entities of Biological Interest. In addition, references to similar or associated terms in external ontologies, vocabularies and terminologies are included when possible. Initial work on ND is focused on the areas of Alzheimer’s and other diseases associated with dementia, multiple sclerosis, and stroke and cerebrovascular disease. Extensions to additional groups of neurological diseases are planned. The second ontology, the Neuro-Psychological Testing Ontology (NPT), is intended to provide a set of classes for the annotation of neuropsychological testing data. The intention of this ontology is to allow for the integration of results from a variety of neuropsychological tests that assay similar measures of cognitive functioning. Neuro-psychological testing is an important component in developing the clinical picture used in the diagnosis of patients with a range of neurological diseases, such as Alzheimer’s disease and multiple sclerosis, and following stroke or traumatic brain injury. NPT is being developed as an extension to the Ontology for Biomedical Investigations. (shrink)

Seele kommt zweifellos schon ‚höheren‘ Tieren zu, die als solche über phänomenale Wahrnehmung verfügen. Als aufschlussreich erweist sich der kontrastierende Vergleich von Tier und Roboter: Was hat das Tier, was der Roboter nicht hat? Schlüsselfunktion kommt hier Hegels Deutung zu, die als eine Phänomenologie der ‚animalischen Seele‘ angesprochen werden kann. Sein Diktum ‚Nur ein Lebendiges fühlt Mangel‘ verweist auf das alles Organische durchwaltende Prinzip Selbsterhaltung als Grund des Seelischen: Alles, was das Tier wahrnimmt, hat dadurch existentiellen Sinn, Selbsterhaltungs-Sinn. Zugleich wird (...) deutlich, dass die Roboter-Wahrneh- mung nicht zur Sinn-Konstitution befähigt, sondern durch Sinn-Demenz charakterisiert ist. Konkret-systemtheoretisch wird die Sinnbezogenheit des Tiersubjekts hier als Emergenzphänomen desjenigen Systems gedeutet, das durch die Kooperative von Wahrnehmung, Bewertung und Verhalten (Perc-Eval-Act-System) konstituiert wird. In dieser emergentistischen Perspektive gibt es so gleichsam den Dualismus des ‚bloß Physischen‘ und des Ideell-Seelischen, der im Hinblick auf die insgesamt physische Basis zugleich ein Monismus ist. (shrink)

That Kant’s moral thought is invoked by both advocates and opponents of a right to assisted dying attests to both the allure and and the elusiveness of Kant’s moral thought. In particular, the theses that individuals have a right to a ‘death with dignity’ and that assisting someone to die contravenes her dignity appear to gesture at one of Kant’s signature moral notions, dignity. The purposes of this article are to outline Kant’s understanding of dignity and its implications for the (...) ethics of assisted dying. According to Kant, that which has dignity must be treated as an end in itself and may not permissibly be exchanged for that which merely has price. Kant’s reasoning thus seems to preclude acts of self-killing, including voluntary assisted dying, that rest on individual self-interest, since a person’s interests merely have price. However, a recognizably Kantian view of dignity can permit assisted dying under two sets of circumstances: First, it can be permissible for agents who anticipate a degradation of their rational agency due to conditions such as dementia to direct others to end their lives once sufficiently demented. In so doing, such agents in effect exercise a right to impose obligations on others regarding how their bodies, which will at some future point no longer be the vessels of their rational agency, are to be disposed of. Second, Kant errs in supposing that our dignity can stem solely from our moral personality, i.e., from our capacity to abide by universalizable moral principles. Rather, complete dignity also requires the capacity for setting discretionary ends and the means to those ends, i.e., the dignity of humanity. Individuals with prolonged and intense depression, in severe pain, or with serious disability may lack humanity while retaining their moral personality. In such cases, I propose that their opting to end their lives, with or without the assistance of others, does not amount to exchanging their dignified selves for something which merely has price and is therefore not objectionable on Kantian grounds. (shrink)

Generacja sandwicz - grupa osób w wieku średnim, która ze wzglȩdu na swoj¸a} centraln¸a} pozycjȩ w strukturze wieku i w zwi¸a}zanej z ni¸a} stratyfikacji wiekowej stanowi generacjȩ, które jednocześnie opiekuje siȩ osobami starszymi i osobami młodszymi. Zjawisko to określane jest też jako "kobiety w środku" lub "złapani w środku". Koncepcja "generacji sandwicz" w w¸a}skim ujȩciu odnoszona jest przeważnie do tradycyjnie postrzeganych ról opiekuńczych kobiet, które s¸a} w wieku środkowym, a zarazem na przedpolu starości. W ujȩciu feministycznym społeczne oczekiwania wobec kobiet (...) znajduj¸a}cych siȩ miȩdzy 40. a 60. rokiem życia s¸a} zorientowane z jednej strony na udzielanie pomocy dzieciom i młodzieży w uzyskaniu samodzielnego dorosłego życia, z drugiej zaś s¸a ukierunkowane na udzielanie pomocy pielȩgnacyjnej starszemu pokoleniu szczególnie w przypadku niepełnosprawności, otȩpienia lub choroby Alzheimera. Oczekiwania wobec powyższych ról opiekuńczych s¸a sformalizowane w mniejszym lub wiȩkszym stopniu co prowadzi do nierówności miȩdzy kobietami i mȩżczyznami. ** Sandwich generation - a group of middle-aged people who, due to its central position in the age structure and related age stratification is a generation that simultaneously takes care of elderly people and younger people. This phenomenon is also referred to as "women in the middle" or "caught in the middle". The concept of "sandwich generation" in a narrow sense refers mainly to the traditionally perceived caring roles of women who are middle-aged and at the same time on the forefront of old age. In the feminist approach, the social expectations towards women between 40 and 60 years old are oriented on helping children and young people to get an independent adult life, on the other hand they are oriented towards providing care to the older generation, especially in the case of disability, dementia or Alzheimer’s disease. Expectations regarding these care roles are formalized in a smaller one or to a greater extent which leads to inequality between women and men. (shrink)

In psychiatry some disorders of cognition are distinguished from instances of normal cognitive functioning and from other disorders in virtue of their surface features rather than in virtue of the underlying mechanisms responsible for their occurrence. Aetiological considerations often cannot play a significant classificatory and diagnostic role, because there is no sufficient knowledge or consensus about the causal history of many psychiatric disorders. Moreover, it is not always possible to uniquely identify a pathological behaviour as the symptom of a certain (...) disorder, as disorders that are likely to differ both in their causal histories and in their overall manifestations may give rise to very similar patterns of behaviour. -/- Consider delusions as an example. It wouldn’t be correct to define delusions as those beliefs people form as a result of a neurobiological deficit and a hypothesis-evaluation deficit (as some versions of the two-factor theory of delusions suggest), because for some delusions no neurobiological deficit may be found, and reasoning biases and motivational factors may be contributors to the formation of the delusion (e.g. McKay et al., 2005). Moreover, it would be a mistake to define delusions as symptoms of schizophrenia alone, because they occur also in other disorders, including dementia, amnesia, and delusional disorders. Thus, aetiological considerations may appear in the description and analysis of delusions, but do not feature prominently in their definition. -/- In this paper I argue that the surface features used as criteria for the classification and diagnosis of disorders of cognition are often epistemic in character. I shall offer two examples: confabulations and delusions are defined as beliefs or narratives that fail to meet standards of accuracy and justification. Although classifications and diagnoses based on features of people’s observable behaviour are necessary at these early stages of neuropsychiatric research, given the variety of conditions in which certain phenomena appear, I shall attempt to show that current epistemic accounts of confabulations and delusions have limitations. Epistemic criteria can guide both research and clinical practice, but fail to provide sufficient conditions for the identification of delusions and confabulations, and fail to demarcate pathological from non-pathological narratives or beliefs. -/- Another limitation of current epistemic accounts – which I shall not address here – is the excessive focus on epistemic faults of confabulations and delusions at the expense of their epistemically neutral or advantageous features (see Bortolotti and Cox, 2009). This may lead to a misconception of delusions and confabulations, and to an oversimplification in the assessment of the needs of people who require clinical treatment for their psychotic symptoms. (shrink)

Gerontology together with its subfields, such as social gerontology, geragogy, educational gerontology, political gerontology, environmental gerontology, and financial gerontology, is still a relatively new academic discipline that is currently intensively developing, expanding research fields and combining various theoretical and practical perspectives. The interdisciplinarity, transdisciplinarity, and multidisciplinarity of research on ageing and old age, despite its vast thematic, methodological and theoretical diversity, have a common denominator, which is the focus of research work on improving the quality of life of older people. (...) It is the concern for the components of quality of life such as welfare and well-being as well as focus on learning about phenomena conditioning successful ageing that has become motivators and premises hidden or visible in many texts included in the Research Topic “Perspectives and Theories of Social Innovation for Ageing Population.” The Research Topic that we are presenting to our readers is unique not only because of its size but above all because of its novelty and social involvement, visible in the content of individual chapters. The presented collection includes 17 articles prepared in total by 76 authors from the following countries: China, Finland, Germany, Ghana, Hungary, Ireland, Israel, Italy, Japan, the Netherlands, Poland, Portugal, Slovenia, Spain, Sweden, the United Kingdom, and the United States. Two journals were combined with this Research Topic: “Frontiers in Public Health” and “Frontiers in Sociology.” The presented Research Topic contains seven types of articles covering: two community case studies, eight original research articles, two perspective articles, one hypothesis and theory paper, one policy and practice review, one methods article, and two book reviews. The rationale to start work on this set of texts was the desire to continue and deepen the research analyses of the editors of this set, which concern the development of social innovations for the ageing population as well as changes of public policy on ageing. This Research Topic deals with topics covering issues such as social learning, intergenerational transmission, senior entrepreneurship, creative content creation by older adults, care services, raising the independence of older people in their living environments, dementia challenges, the image of the older generation in local social policies, new trends in qualitative research on old age, strategies for dealing with chronic diseases, the use of digital tools in health education, the silver economy/longevity economy, age-friendly environments, the diversity of structures and social services, preparation for old age, and food safety. The wide variety of submitted texts shows several selected and, according to the authors, current challenges that contemporary seniors have to face. The articles comprising this Research Topic are organized according to five themes. (shrink)

The fourth amendment to the German Medicinal Products Act (Arzneimittelgesetz) states that nontherapeutic research in incompetent populations is permissible under the condition that potential research participants expressly declare their wish to participate in scientific research in an advance research directive. This article explores the implementation of advance research directives in Germany against the background of the international legal and ethical framework for biomedical research. In particular, it addresses a practical problem that arises from the disclosure requirement for advance research directives. (...) We show that, if the disclosure standard for advance research directives is set at a token level, nontherapeutic research in incompetent populations becomes practically impossible. To resolve this issue, we suggest the disclosure standard be set at a type level. (shrink)

What does it mean to respect autonomy and encourage meaningful consent to treatment in the case of patients who have dementia or are otherwise incompetent? This question has been thrown into sharp relief by the Law Lords' decision in R.v Bournewood Community and Mental Health NHS Trust, ex parte L.

Die Fälle und die Erscheinungsformen von Ordnungswahn sind in Deutschland zahlreich und vielfältig infolge der Institutionalisierung des Wahns, weswegen Zwangsvorstellungen und Zwangshandlungen dieser Art nicht als therapiebedürftige Zwangsstörungen gelten, und jegliche Versuche, die Tendenz umzukehren, abgewehrt werden. Lernunfähigkeit und Unbeeinflußbarkeit schizophrener Personen und ihrer Gruppen machen jeden Vorsatz, etwas an bestehenden Verhältnissen zu ändern, zu beinah unmöglicher Aufgabe.

This paper introduces three new criteria that a theory of personal identity ought to satisfy: (1) material holism, (2) narrative unity, and (3) narrative integrity. Material holism guards against the undesirable consequence of positing the person as part and existentially distinct from the organismal whole, of which it is dependent and interconnected. Narrative unity ensures that continuity between the beginning, middle, and end of a human life is sufficiently accounted for. Narrative integrity secures fidelity and congruence between each part and (...) the whole, the whole to each part. Jeff McMahan’s Embodied Mind Account (EM) fails to satisfy each of these. On McMahan’s account, human persons and human organisms are distinct entities, human persons come into existence after its human organism, and human persons may go out of existence before their human organism. Moreover, fetuses, infants, the congenitally severely cognitively impaired, those with severe dementia, and the comatose are non-persons. A theory of personal identity that incorporates holism and narrative can provide a better explanation of human existence, life and death, and the identity paradox of dicephalic twins. If accepted, EM must either be rejected or ameliorated, and the new criteria ought to be incorporated in contemporary research of personal identity. (shrink)

This work is a phenomenological exploration of overgeneral memory in depressed patients. It reviews the current philosophical literature on the first-person experience of depression, which has so far omitted the phenomenon of overgeneral memory. However, this phenomenon is well documented within psychology; and this essay will show that its symptomatic appearance in depression and subsequent disturbance of self- experience justifies attention to the phenomenon within the phenomenology of depression. Both the theory of embodiment and the extended mind thesis work extensively (...) with the nature of memory in other conditions such as Alzheimer's and dementia. Thus, these philosophical approaches will be utilised in an analysis of overgeneral memory; this will enrich the philosophy of depression, memory and self and highlight the value of the concepts of embodiment and the extended mind. Moreover, this philosophical interrogation suggests a route toward therapeutic interventions to help patients suffering from overgeneral memory applying techniques from extended mind and cognition studies. (shrink)