Hastings Center Report, Volume 52, Issue 1, Page 32-41, January/February 2022.

Across care settings, the practice of lying to or withholding the truth from people living with dementia is common, yet it is objected to by many. Contrary to this common discomfort, I have argued in previous work that respecting members of this group as moral equals sometimes requires deceiving them. In this paper, I test my proposed practice against complex, controversial cases, demonstrating both its theoretical strength and its practical value for those working in social care.

Elizabeth Barnes has recently developed an account of disability that is sensitive to the role of self-evaluation. To have a physical disability is, according to Barnes, to have a body that is merely different from the norm. Yet, as Barnes notes, some disabilities will genuinely frustrate some life plans. It may be the case, therefore, that a disability is instrumentally bad for a person and that acquiring one may be a genuine loss. Equally, however, a person may genuinely value a (...) disability such that it is instrumentally good for them and that they experience the acquiring of it as a gain. Notably, Barnes explicitly restricts this analysis to physical disabilities, leaving open the status of mental disabilities. Nevertheless, Barnes does not rule out the extension of her model to this category, and she expresses a desire to see future work on other disabilities built upon it. This article takes up this challenge, making the case that to possess a mental disability is merely to possess a minority mind. (shrink)

The dispute between the transgender-rights movement and “gender-critical” activists represents a stark division in British public discourse. Although the issues of contention are numerous and require their own philosophical treatment, a core metaphysical concern underlies them. Gender-critical activists, such as Kathleen Stock, tend to argue that recognizing trans women as women requires erasing the category of biological sex. This implies that all trans women are male, and thus recognizing them as women rips female biology from the root of the category (...) “woman.” In this article, I argue that this view is mistaken. As exogenously produced sex characteristics should count toward a person's sex classification, all trans women are female. (shrink)

Carers often interfere with the choices of people living with dementia. On neorepublican and (most) relational egalitarian views, interference can be justified if it tracks a person's interests: if it does not lead to a relationship of domination. However, the kind of environment-shaping interventions carers often pursue would be considered infantilising or objectionably paternalistic in other cases. In this paper, I defend this indirect approach and argue that it offers the best prospects of dementia care without domination.

Despite negative effects on their health and social lives, many informal carers of people living with dementia claim to be acting in accordance with a moral obligation. Indeed, feelings of failure and shame are commonly reported by those who later give up their caring responsibilities, suggesting a widespread belief that professional dementia care, whether delivered in the person's own home or in an institutional setting, ought always to be a last resort. In this paper, however, I suggest that this common (...) intuition gets things the wrong way around. Adopting a relational egalitarian framework, I argue that the most serious injustices engendered by present‐day dementia care services are contingent on broader societal structures—they can thus be ameliorated relatively easily (if resource intensively) by changing those structures. Informal dementia care, on the other hand, carries similar risks of injustice and is much more resistant to structural reform. While there may be moral obligations to provide informal dementia care in present‐day societies, then, they arise because of the deficiencies of professional care, not the virtues of its informal counterpart. Though we may be far from achieving just care arrangements in most of our societies, we must never lose sight of the fact that, when we engage in morally permitted informal dementia care, we are exercising our last resort. (shrink)

This article takes as its starting point the moral requirement to include persons with serious cognitive impairments in democratic decision‐making. That said, including such persons poses particular practical challenges to effective democratic participation. Nussbaum has set out the most extensive proposals for inclusion based on a model of guardianship, but we find they fall short due to not suitably respecting and facilitating the subjective decision‐making of impaired persons. Instead, we argue for a model of co‐constitution, whereby aides work within a (...) supported decision‐making paradigm to arrive at political choices in collaboration with impaired persons. To flesh out this model, we propose collaboration be based on three ideal types of interaction – expert, Socratic, and deliberative – designed to accommodate differing degrees and types of cognitive impairments. We further argue that the aide should have a relationship of detached professionalism with the impaired person and therefore should not be the person’s carer. Finally, we conclude that this separation be combined with transparent and regular invigilation of the aide’s decision‐making process to best safeguard the process from abuse or error. (shrink)