Dementia is an illness that raises important questions about our own attitudes to illness and aging. It also raises very important issues beyond the bounds of dementia to do with how we think of ourselves as people--fundamental questions about personal identity. Is the person with dementia the same person he or she was before? Is the individual with dementia a person at all? In a striking way, dementia seems to threaten the very existence of the self.LThis book brings together philosophers (...) and practitioners to explore the conceptual issues that arise in connection with this increasingly common illness. Drawing on a variety of philosophers such as Descartes, Lock, Hume, Wittgenstein, the authors explore the nature of personal identity in dementia. They also show how the lives and selfhood of people with dementia can be enhanced by attention to their psychological and spiritual environment. Throughout, the book conveys a strong ethical message, arguing in favor of treating people with dementia with all the dignity they deserve as human beings. The book covers a range of topics, stretching from talk of basic biology to talk of a spiritual understanding of people with dementia. Accessibly written by leading figures in psychiatry and philosophy, the book presents a unique and long overdue examination of an illness that features in so many of our lives. (shrink)

We reflect, using a vignette, on conceptual tensions and the value judgements that lie behind difficult decisions about whether or not the older person with dementia should return home or move into long-term care following hospital admission. The paper seeks, first, to expose some of the difficulties arising from the assessment of residence capacity, particularly around the nature of evaluative judgements and conceptual tensions inherent in the legal approach to capacity. Secondly, we consider the assessment of best interests around place (...) of residence, which demonstrates significant conceptual tensions. In addition, ‘best interests’ raise issues around the perception of risk and the perceptions of the family and crucially involve the notions of autonomy and trust. Finally, we not only gesture at some practical considerations based on insights from values-based medicine, but also make the suggestion that we require tighter functional assessments of residence capacity coupled with broader judgements about best interests. (shrink)

Since independence, at least 28 African countries have legalized some form of gambling. Yet a range of informal gambling activities have also flourished, often provoking widespread public concern about the negative social and economic impact of unregulated gambling on poor communities. This article addresses an illegal South African numbers game called fahfee. Drawing on interviews with players, operators, and regulatory officials, this article explores two aspects of this game. First, it explores the lives of both players and runners, as well (...) as the clandestine world of the Chinese operators who control the game. Second, the article examines the subjective motivations and aspirations of players, and asks why they continue to play, despite the fact that their aggregate losses easily outstrip their aggregate gains. In contrast with those who reduce its appeal simply to the pursuit of wealth, I conclude that, for the (mostly) black, elderly, working class women who play fahfee several times a week, the associated trade-off—regular, small losses, versus the social enjoyment of playing and the prospect of occasional but realistic windfalls—takes on a whole new meaning, and preferences for relatively lumpy rather than steady consumption streams help explain the continued attraction of fahfee. This reinforces the need to understand players’ own accounts of gambling utility rather than simply to moralistically condemn gambling or to dismiss gamblers behaviour as irrational. (shrink)

Dementia is an illness that raises important questions about our own attitudes to illness and aging. It also raises very important issues beyond the bounds of dementia to do with how we think of ourselves as people - fundamental questions about personal identity. Is the person with dementia the same person he or she was before? Is the individual with dementia a person at all? In a striking way, dementia seems to threaten the very existence of the self. This book (...) brings together philosophers and practitioners to explore the conceptual issues that arise in connection with this increasingly common illness. Drawing on a variety of philosophers such as Descartes, Locke, Hume, Wittgenstein, the authors explore the nature of personal identity in dementia. They also show how the lives and selfhood of people with dementia can be enhanced by attention to their psychosocial and spiritual environment. Throughout, the book conveys a strong ethical message, arguing in favour of treating people with dementia with all the dignity they deserve as human beings. The book covers a range of topics, stretching from talk of basic biology to talk of a spiritual understanding of people with dementia. Accessibly written by leading figures in psychiatry and philosophy, the book presents a unique and long overdue examination of an illness that features in so many of our lives. (shrink)

A good deal of concern is generated when a person with dementia wanders. One putatively easy technological remedy is to consider electronic tagging. This possibility, however, raises a dif erent set of ethical concerns. In this paper we report the results of a survey that was intended to elicit people’s views about the ethical issues surrounding the topic of tagging in dementia. There was broad agreement in response to the scenario used in the survey that electronic tagging could be an (...) ethically reasonable way to deal with wandering in people who are confused. It was seen as considerably better than locking doors as a way to maintain a person’s safety. There were, however, concerns and uncertainties about principles relating to civil liberties, stigma and dignity. And there appeared to be some weight behind the view that electronic tagging of confused people who wander requires professional involvement, the nature of which would need to be decided. population in general. (shrink)

In this paper the current legislative landscape and the challenges researchers face in obtaining informed consent in acute situations are explored. In such situations, some current guidelines can be difficult or impossible to apply. Capacity should be formally assessed before consent is sought to ensure that vulnerable persons are neither inappropriately recruited to a study nor denied the opportunity to participate. However, there is little guidance in current legislation as to how this should be achieved. When the patient is considered (...) to be unable to provide prospective informed consent, other forms are sometimes permissible, although all have specific drawbacks. First, it is argued that a brief instrument, suitable for the acute situation, is needed to determine whether patients have the capacity to consent to clinical trials. Secondly, it is argued that there are areas of the informed consent process that require review, and ways that improvements could be made are suggested. (shrink)

This article examines the relationship between the classical Marxist tradition and the conceptual roots of totalitarianism. Here totalitarianism is understood to entail the attempt to frame the developmental impulses of modernity within the logic of a premodern political imaginary—defined as internally homogenous and transparent to itself. In the first part, we take issue with those who try to distinguish between the thought of Marx and Engels, and who insist that it is only in Engels's thought that the traces of a (...) totalitarian politics might be found. In the second section, we outline briefly the context within which Marx's thought was developed, after which we argue that Marx's vision of communism is dependent on the three-phase vision of historical process which he inherited from Hegel. Without denying the historical peculiarities of the imposition of communism in Russia, we conclude that it is out of this latter vision of history that the conceptual roots of totalitarianism must be located. (shrink)

In emergency research, obtaining informed consent can be problematic. Research to develop and improve treatments for patients admitted to hospital with life-threatening and debilitating conditions is much needed yet the issue of research without consent (RWC) raises concerns about unethical practices and the loss of individual autonomy. Consistent with the policy and practice turn towards greater patient and public involvement in health care decisions, in the US, Canada and EU, guidelines and legislation implemented to protect patients and facilitate acute research (...) with adults who are unable to give consent have been developed with little involvement of the lay public. This paper reviews research examining public opinion regarding RWC for research in emergency situations, and whether the rules and regulations permitting research of this kind are in accordance with the views of those who ultimately may be the most affected. (shrink)