Steve Matthews

Practitioners of person-centred care (PCC) for people living with dementia aspire to preserve and honour personhood through respect, relational care, and the promotion of agency and interests; yet its practical realisation often falters. This paper isolates an important moral-psychological element required for PCC’s fulfilment: the professional stance of compassionate understanding. Drawing upon philosophical analysis and empirical literature, the paper conceives this stance as a capacity combining enlightened compassion with four aspects of ethically informed care: forbearance, moral perception, skilled virtue, and empowerment. Compassionate understanding reconciles emotional attunement with the disciplined detachment required for professional endurance, thereby mitigating burnout while sustaining moral sensitivity and integrity. Grounded in an examination of dementia care practices, the paper argues that compassionate understanding constitutes an ethically desirable framework through which person-centred norms are realised.

The trauma and anguish professional people encounter in their work over time can lead to losses in competence and occupational burnout. However, the practice of detachment designed to avoid these outcomes can tip over into losses in the ability to connect with clients, and even to alienation from the professional role itself. Some have thought that the proper regulation of levels of empathic concern ensures a balance between these two poles. I argue against this and instead advocate for a stance I call compassionate understanding. I contend that this best achieves sustained professionalism while remaining morally attuned to the norms of one’s occupation. I focus on health care to illustrate what is at stake in compassionate understanding, though the position I defend has applications across a significant range of professions.

The trauma and anguish professional people encounter in their work over time can lead to losses in competence and occupational burnout. However, the practice of detachment designed to avoid these outcomes can tip over into losses in the ability to connect with clients, and even to alienation from the professional role itself. Some have thought that the proper regulation of levels of empathic concern ensures a balance between these two poles. I argue against this and instead advocate for a stance I call compassionate understanding. I contend that this best achieves sustained professionalism while remaining morally attuned to the norms of one’s occupation. I focus on health care to illustrate what is at stake in compassionate understanding, though the position I defend has applications across a significant range of professions.

Jennifer Blumenthal-Barby (2024) has called for bioethics to end talk about personhood, asserting that such talk has the tendency to confuse and offend. It will be argued that this has only limited application for (largely) private settings. However, in other settings, theorizing about personhood leaves a gap in which there is the risk that the offending concept will get uptake elsewhere, and so the problem Blumenthal-Barby nominates may not be completely avoided. In response to this risk, an argument is presented in support of the idea that the role of philosophers and bioethicists, far from ending talk of personhood, ought to be to clarify the concept, and to do so in nuanced ways, given its application for specific kinds of impairments. The case of dementia is used to illustrate this in the context of person-centered care. Ironically, given the stigma attached to dementia, far from the need to end talk of personhood, bioethicists are needed to rescue the concept and clarify its role.

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.

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.

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.

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 …

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.

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.

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...

_ 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.

_ 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.

Addictions are commonly accompanied by a sense of shame or self-stigmatization. Self-stigmatization results from public stigmatization in a process leading to the internalization of the social opprobrium attaching to the negative stereotypes associated with addiction. We offer an account of how this process works in terms of a range of looping effects, and this leads to our main claim that for a significant range of cases public stigma figures in the social construction of addiction. This rests on a social constructivist account in which those affected by public stigmatization internalize its norms. Stigma figures as part-constituent of the dynamic process in which addiction is formed. Our thesis is partly theoretical, partly empirical, as we source our claims about the process of internalization from interviews with people in treatment for substance use problems.

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.

It has become quite common for people to develop `personal'' relationships nowadays, exclusively via extensive correspondence across the Net. Friendships, even romantic love relationships, are apparently, flourishing. But what kind of relations really are possible in this way? In this paper, we focus on the case of close friendship. There are various important markers that identify a relationship as one of close friendship. One will have, for instance, strong affection for the other, a disposition to act for their well-being and a desire for shared experiences. Now obviously, while all these features of friendship can gain some expression through extensive correspondence on the Net, such expression is necessarily limited –you cannot, e.g., physically embrace the other, or go on a picnic together. The issue we want to address here however, is whether there might be distinctive and important influences on the structure of interaction undertaken on the Net, that affect the kind of identity ``Net-friends'''' can develop in relation to one another. In the normal case, one develops a close friendship, and in doing so, one''s identity, in part, is shaped by the friendship. To some extent, through extensive shared experience, one comes to see aspects of the world (and of oneself) through the eyes of one''s friend and so, in part, one''s identity develops in an importantly relational way, i.e., as the product of one''s relation with the close friend. In our view, however, on account of the limits of, and/or the kind of, shared contact and experience one can have with another via correspondence on the Net, there are significant structural barriers to developing the sort of relational identity that is a feature of close friendship. In arguing our case here, and by using the case of Net ``friendship'''' as our foil, we aim to shed light on the nature and importance of certain sorts of self-expression and relational interaction found in close friendship.

Defining privacy is problematic because the condition of privacy appears simultaneously to require separation from others, and the possibility of choosing not to be separate. This latter feature expresses the inherent normative dimension of privacy: the capacity to control the perceptual and informational spaces surrounding one’s person. Clearly the features of separation and control as just described are in tension because one may easily enough choose to give up all barriers between oneself and the public space. How could the capacity for privacy give rise to its absence? Yet both the separation and control features of privacy do seem indispensable to any sensible understanding of it. In this paper I set out an approach to defining privacy that keeps these features and avoids the tension between them

What is the role and value of pleasure in addiction? Foddy and Savulescu have claimed that substance use is just pleasure-oriented behavior. They describe addiction as "strong appetites toward pleasure" and argue that addicts suffer in significant part because of strong social and moral disapproval of lives dominated by pleasure seeking. But such lives, they claim, can be autonomous and rational. The view they offer is largely in line with the choice model and opposed to a disease model of addiction. Foddy and Savulescu are sceptical of self-reports that emphasize the ill effects of addiction such as loss of family and possessions, or that claim an absence of pleasure after tolerance sets in. Such reports they think are shaped by social stigma which makes available a limited set of socially approved addiction narratives. We will not question the claim that a life devoted to pleasure can be autonomously chosen. Nor do we question the claim that the social stigma attached to the use of certain drugs increases the harm suffered by the user. However our interviews with addicts reveal a genuinely ambivalent and complex relationship between addiction, value, and pleasure. Our subjects did not shy away from discussing pleasure and its role in use. But though they usually valued the pleasurable properties of substances, and this played that did not mean that they valued an addictive life. Our interviews distinguished changing attitudes towards drug related pleasures across the course of substance use, including diminishing pleasure from use over time and increasing resentment at the effects of substance use on other valued activities. In this paper we consider the implications of what drug users say about pleasure and value over the course of addiction for models of addiction. Well don't get me wrong, I love using mate. If I could use successfully I would. I'd still be using. I love using. I just don't like the shit that comes with it.

Psychotherapy and counselling services are now available on-line, and expanding rapidly. Yet there appears almost no ethical analysis of this on-line mode of delivery of such professional services. In this paper I present such an analysis by considering the limitations on-line contact imposes on the nature of the professional–client relationship. The analysis proceeds via the contrast between the face-to-face case and the on-line case. At the core of the problem must be the recognition that on-line interaction imposes a physical barrier largely permitting only those disclosures of self we choose to make available, and greatly restricting the range of involuntary features and behaviours. I show why this is problematic, first, for the development of a close professional–client relationship, with particular emphasis on such failures as diagnosis and monitoring of the patient. Second I describe the importance of the development of professional character, and of how the on-line environment fails to provide a context for such character traits to emerge and develop.

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.