Returning To Personhood: On The Ethical Significance Of Paradoxical Lucidity In Late-Stage Dementia
By David M Lyreskog
About Dementia
Dementia is a class of medical conditions which typically impair our cognitive abilities and significantly alter our emotional and personal lives. The absolute majority of dementia cases – approximately 70% – are caused by Alzheimer’s disease. Other causes include cardiovascular conditions, Lewy body disease, and Parkinson’s disease. In the UK alone, it is estimated that over 1 million people are currently living with dementia, and that care costs amount to approximately £38 billion a year. Globally, it is estimated that over 55 million people live with dementia in some form, with an expected 10 million increase per year, and the cost of care exceeds £1 trillion. As such, dementia is widely regarded as one of the main medical challenges of our time, along with cancer, and infectious diseases. As a response to this, large amounts of money have been put towards finding solutions over decades. The UK government alone spends over £75 million per year on the search for improved diagnostics, effective treatments, and cures. Yet, dementia remains a terrible enigma, and continues to elude our grasp.
Dementia, Pagal, or Neurocognitive Disorder: What Is In a Name?
By Doug McConnell
A recent BBC news story has drawn attention to the fact that there isn’t a word for “dementia” in many South Asian languages and some South Asian people living in the UK still use the stigmatising Punjabi word “pagal”, meaning “crazy” or “mad”. The news story implicitly assumes that the word “dementia” is non-stigmatising but this is disputed. If the word “dementia” is itself stigmatizing, are anglophones really in a position to criticize other languages? Can we adopt a non-stigmatising word for dementia? Continue reading
A Puzzle about Dementia
Dementia is one of the biggest challenges facing the British NHS, with one in three people developing the disease after the age of 65. This partly explains why there has been such excitement in scientific circles over intravenous immunoglobulin (IVIg), which appears to slow the rate of mental decline in sufferers from Alzheimer’s.
Obviously, from the societal point of view, dementia is a bad thing, and so this news is good. But from the personal point of view, should I be concerned about dementia – at least in its more severe forms? Epicurus famously claimed that we shouldn’t fear death, since when it arrives we won’t be around any more. Many seem to think the same about severe dementia, despite the fact that many – often the same people – also fear such a state.
Here’s how that view might arise. Imagine some extremely unpleasant experience, such as a very painful operation for which anaesthetic is for some reason unavailable. If you’re told you’re about to have such an operation, you will be very afraid, because you think the person under the knife will be you – it is you who will be feeling all that pain. But severe dementia can also be extremely unpleasant, so why isn’t it just like the operation?
There is one big difference. When the surgeon approaches you with her knife, you will have many of the same memories, beliefs, desires, and so on that you have right now. There will be a great deal of what Derek Parfit calls psychological connectedness and continuity between your mental states now and those you’ll have just before the operation. But that isn’t the case with dementia. You will have lost nearly all your memories, and so on. All that will be left is the capacity for conscious experience. And though that conscious experience might be deeply unpleasant, the line of thought goes, that doesn’t matter especially to you, since ‘you’ won’t be around any more, and there will be no important psychological continuity and connectedness between that individual and you now.
My own response to the prospect of dementia, however, is different. I can’t see why it matters very much whether, during the unpleasant experience, I have the same memories, beliefs, and so on that I do now. Consider the painful operation again. It might be so painful that you can’t *think* of anything else while it’s going on – so your memories, beliefs, and so on are entirely inaccessible. Does that somehow make it less bad? What I care about is what will be experienced by the capacity for consciousness I now possess, and if that capacity is going to be exercised in the future in such a way that there is consciousness of seriously unpleasant experiences – whether through some operation, or dementia – that concerns me now whatever memories, beliefs, and so on I am going to have, or indeed lack, in the future.
The immorality of public consolation in the face of ageing
In case you didn’t know: The EU is currently celebrating the “European Year for Active Ageing and Solidarity between Generations”. The paramount aim of this initiative is to increase the well-being of the elderly by raising awareness that they can still contribute to society by ageing actively, that is, utilising their abilities for their own good and the good of society. In the best case, according to this initiative, not only older people will benefit from ageing actively but also younger ones who do not have the experience and wisdom of earlier generations. Although this is a noble aim, the answer to the question why there should be such a European Year is a gross and seriously immoral distortion of reality: “Because, too often, getting old is perceived as a threat instead of an achievement, both for individuals and for societies. […] Staying active as we grow older is key to tackling the challenge of ageing.” Continue reading
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