Losing persons: the pastoral imperative for affirming continued personhood for those living with dementia

Dementia is responsible for untold suffering, most significant is the fear that someone will lose themselves. This fear raises very serious pastoral questions: Who is the person living with dementia? Are they the same person they have always been or someone new? In either case, how do we treat them? Using the well-known case of Margo and the discussions between Dworkin and Dresser around advanced care directives, this article radically challenges the standard psychology view of personhood as being pastorally unhelpful in dementia cases. We argue that a relational view of personhood is not only epistemologically consistent but better suited to the pastoral challenge presented by dementia than that of the standard psychological view. While dementia represents the loss of cognitive abilities, and in many cases an entire change in personality, it does not represent either the loss of a person nor a change of personhood. Through dementia a person remains a person because they are personally related to by the same community of persons who have always loved them. This normative framework offers those living with dementia, their community, and their carers with a coherent, yet pastorally helpful response to the existential questions raised by dementia.