Dementia and Identity

Abstract

This thesis explores the multiple ways identity can be affected by dementia. It primarily concerns how ‘personal identity’ is affected in the early to moderate stages of dementia, and secondarily concerns how ‘personhood’ can be threatened in the late stages of dementia. When a patient’s personal identity or personhood is called into question due to their dementia, there are significant practical implications for their health and moral status. These can include issues involving autonomy, implementation of advanced directives and right to treatment. It is important to consider these issues given the increasing rates of dementia in developed countries and the substantial burden of disease this has on healthcare systems. Descriptive accounts of ‘identity’, ‘memory’ and ‘dementia’ are provided to inform discussion of these issues. Distinctions are drawn between ‘object’ and ‘agency’ theories of identity, ‘archival’ and ‘process’ models of memory, and ‘frontotemporal’ and ‘non-frontotemporal’ dementia subtypes. An agency theory of personal identity, which emphasises a person’s relationships and meaningful actions, is put forward as the more suitable approach to these problems, as it aligns better with the emerging process model of memory and better explains the direct and indirect ways dementia can affect a person’s identity. The findings of a qualitative study interviewing experienced health care professionals about these issues are also reported. This study found clinicians’ approaches to be broadly supportive of conclusions drawn by the theoretical work of this thesis, and helped to clarify where further research is needed.