Ethical issues

Abstract

In the broad sweep of medical ethics, the issues affecting patients with dementia are sometimes amongst the most daunting for the clinician. They concern life and death and the very nature of personhood. Philosophical thought about the moral issues raised by clinical practice aims, at a meta-level, to show us the structure of our thoughts and decision-making processes; and, at a practical level, it aims to help us make up our minds. Thus, philosophy helps us to make practical decisions on a rational basis. We shall combine these two aims. First, we shall uncover the casuistic (case-by-case) basis to moral reasoning in clinical practice, using wandering as an example. Second, we shall discuss a characterization of personhood that stresses the importance of context and culture and shows the relevance of this way of thinking for issues (e.g. ethical issues around genetics) affecting families. Third, we shall show how virtue theory deepens our understanding of the several issues in connection with dementia that involve truth-telling. We believe it is virtue ethics that provides the most useful way to understand day-to-day ethical decision-making (see Chapter 19c).