Ethics and Alzheimer’s

Aaron Wang | 30 August 2024

Rational agency

The sense of self is one of the most complicated, yet unshakable, parts of life. From perceptions of profound insignificance, as captured by the philosophical epiphany of Sonder—the realization that everyone, including strangers passing in the street, has a life as complex as one's own—to the philosophy of Solipsism, which asserts that your mind is the only thing you can be certain of, the concept of self is both expansive and deeply introspective.

However, what makes up the self? This, in itself, is a complicated question. However, not wishing to subscribe to any convoluted philosophical ideology and, instead, take a more intuitive approach, the self is made up of a combination of experiences, values, and knowledge. However, from this standpoint, experiences seem to be a prerequisite to all the other components, with experiences leading to the development of values as well as knowledge.

Therefore, this article aims to focus on the impacts of Alzheimer’s disease, dementia, and similar neurodegenerative diseases from the standpoint of the accumulation of personal experiences. In taking this position, it’s assumed that humans are born tabula rasa, which means that they are born as a blank slate. However, physiological arguments can be made against this position, such as the existence of instincts. But as this article aims to explore the impacts of experiences, specifically memory, on rational agency and such, those arguments tend to fall out of the scope of this discussion.

Alzheimers and agency

Alzheimer’s disease, a neurodegenerative condition primarily affecting the elderly, progressively destroys the ability to retain memory as well as other cognitive functions such as attention, reasoning, and judgement. As explored in previous articles, Alzheimer’s disease directly destroys neurons. With the deterioration of axon terminals and the inhibition and malfunction of glial (helper) cells, the brain literally shrinks as structures and neuron connections are killed and destroyed. With widespread damage, inconsistencies and discrepancies in memory began to show. With later stage Alzheimer’s disease, people sometimes even forgot who their loved ones are.

This issue becomes significant once it’s realized that one major way that memories are experiences. Memories are how experiences are stored and how people can relive those experiences. Although theories such as psychoanalysis may argue that experiences can be repressed and never made into memories, memories still play an important role in how experiences influence our lives both consciously and subconsciously.

Therefore, it can be argued that Alzheimer's disease and memory loss directly impact rational agency. Generally, a rational agent refers to someone with the capacity to make decisions based on the evaluation of information, premises, and beliefs. However, in the context of Alzheimer's, as cognitive functions such as memory and reasoning decline, the ability to process information, evaluate options, and make informed decisions becomes impaired. Without reliable memories, the foundation of beliefs, character, and identity becomes muddled and unstable. Afflicted people may find themselves unable to weigh options, think clearly, or foresee consequences, thus leading to a gradual loss of autonomy.

Cogito, ergo sum

These words, uttered by Descartes, were representative of the movement of rationalism and denial of philosophies such as empiricism. Translating into “I think, therefore I am”, these words beautifully establish the existence of a self. However, despite the establishment that the idea of “self” exists, people without the memories or experiences don’t really know how to define that self. Memory is an indispensable part of defining self, as it is through the recollection of past experiences that people form a coherent narrative of their lives. However, Alzheimer’s disrupts this narrative by erasing memories, thus fragmenting the continuity of identity. Individual lose touch with core aspects of their identity, such as fundamental questions who they are, where they come from, and the relationships that have shaped their life.

Problematically, in the later stages of Alzheimer’s, the disease can strip away the most fundamental elements of personhood. Individuals may no longer recognize their own reflection, fail to comprehend language, or become unable to express thoughts and emotions coherently. This profound disintegration of self can be devastating for both the individual and their loved ones, as the person they once knew seems to fade away.

Our actions

Despite people with Alzheimer’s losing their sense of self, they should never be seen as non-persons. They should still be treated with dignity and respect, as they are still people. These people once had experiences, and the fact that they have a disease that takes away memories should not take away their ability to be treated as a human. However, our society doesn’t necessarily recognize this.

On a superficial level, it seems that society agrees that people with age related illnesses such as Alzheimer’s should be treated as humans. However, a lot of society’s actions don’t necessarily reflect this mindset. Not only are people with Alzheimer’s sometimes treated as byproducts of a functional society, many seniors are also treated like that. They are treated as nuisances, and there’s even a business model that capitalizes off of this: the nursing home.

Although some people may not have the resources to care for a senior, many people do have the resources to care but instead opt to send their senior into a nursing home. This choice sends the message that those seniors have outlived their usefulness, which is inherently dehumanizing. Viewed as obstacles to productivity and a functional society, these seniors are instead deposited into the nursing home, cut off from the ability to truly act autonomously and on their own initiative. This would act as a nail in the coffin for their ability to exercise rational agency and being, as there would be constant surveillance, and the will of the institutions would prevail against the will of the senior. Therefore, if resources allow, people should always treat seniors equally as other people in society, which means giving them proper care and respect rather than setting them aside.

However, what if one does not have the resources to care? This issue becomes more murkier, and one option could be sending them to a nursing home. However, if that were to be, the current model of a nursing home should be overhauled and reformed.

The nursing home

From personal experiences volunteering at nursing homes, I hold a more negative view. With the acrid smell of disinfectant and the monotonous color scheme of white, and an atmosphere of impassioned care, nursing homes feel dystopian due to its ability to diminish one’s identity. Furthermore, despite a cheery atmosphere, this institutional setting takes away a lot of the merit of personal interactions, as they may be perceived as a duty for the paycheck, despite if the intentions were genuine or not. More problematically, 64% of staff admitted to abuse and neglect of patients (Yon et al. 2019), which means that seniors may be further dehumanized in the process. Furthermore, nursing staff are at risk due to the irritable patients, with 90% of abuse being carried out by people with Alzheimer’s (Shelton, 2023). This shows that no one is necessarily happy in a nursing home, with both nurses sometimes neglecting their patients as well as non cooperative seniors.

However, the situation could improve significantly if those who have the means to care for their seniors chose to do so, rather than abandoning them.

Works Cited

Shelton, Patricia. “Nursing Home Neglect: Inadequate Training.” Nursing Homes Abuse, NursingHomesAbuse.org, 14 Sept. 2023, https://nursinghomesabuse.org/nursing-home-neglect/inadequate-training
Yon, Yongjie et al. “The prevalence of elder abuse in institutional settings: a systematic review and meta-analysis.” European journal of public health vol. 29,1 (2019): 58-67. doi:10.1093/eurpub/cky093

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