Dementia is a harm involving a decline in mental capacity and functional ability as well as behavioural and mood changes. Evidence suggests, however, that dementia need not only be viewed in terms of impairment conjuring images of dysfunction, dependence and depersonalization. Recent research pays increasing attention to the emotional and practical abilities that dementia sufferers retain long after even severe cognitive loss.
This paper supports this broader understanding of the process of dementia and argues that individuals with even severe dementia are not simply lost to themselves, their families and carers. Drawing on narrative accounts of the self and the concept of recognition; I argue that dementia may also be viewed as a condition of human life that offers an opportunity to interrogate our assumptions about autonomy, personhood and relationship. In addition, it foregrounds communicative, contextual and everyday dimensions of the moral realm.
In turn, I apply this perspective to an analysis of some of the key ethical issues that arise for people with dementia, family members, care workers and health professionals. These range from crisis decision-making (e.g. withholding and withdrawing life prolonging treatments) to challenging dilemmas (e.g. sexual inhibition, abuse and balancing freedom and safety) as well as everyday concerns (e.g. truth-telling, confidentiality, communication and capacity to decide).