Question A person with dementia is gradually losing the capacity to think and problem solve, remember, use language and behave as they once did. However, the person-centred approach to caring for people with dementia asserts that the 'personhood' of each person is present despite this decline in abilities. What is a person in the context of dementia and how do we understand the person who has dementia in philosophical terms?

Accepted:
June 12, 2007

Comments

The person centered approach to psychotherapy is a widelyused methodology. (See, for example, www.person-centered.org) In contrast with some other methods, theperson centered approach leverages the patient’s own resources in therapy,rather than relying on the authority of the therapist. As your questionsuggests, this approach may seem problematic for patients with dementia. Suchpatients have diminished cognitive (and possibly affective) resources. To whatextent can such patients with contribute to their own psychotherapy? Clearly this is a matter of degree. As one’sabilities to reason, remember, and use language diminish, any form of therapywill be difficult to carry out. Person centered therapists who work with suchpatients are trained to take such limitations into account.

In philosophy there is the synchronic problem of personhood,namely what makes someone a person at a time, and the diachronic problem ofpersonal identity, or what makes someone the same person at two differenttimes. One could be a person at one timebut not the same person at some two distinct moments of time. Of course thisdepends on one’s theories of synchronic and diachronic identity as well as thenature and severity of the patient’s dementia. For example, if you hold thatliving human beings are persons (at a time and over time) in virtue of thepossession of an immaterial soul, then individuals with dementia are stillpersons at a time and over time. If you hold that an individual must have asome level and/or type of cognitive functioning (e.g. memory, language) to be aperson at a time, and must possess memories of his or her past in order to bethe same person over time, then some individuals with dementia would not countas either persons at a time or the same person over time. The problem ofpersonhood is one of the thorniest of philosophical issues, and one can’t dojustice to the range of possible answers to your question in the confines ofthis space. A good introduction to theissue is John Perry’s little book, ADialogue on Personal Identity and Immortality, (Hackett, 1978).