Fragmented personhood: Ethical subjects with dementia in a Swiss nursing home

Drawing on anthropological research conducted in public Swiss nursing homes, this paper explores how ethical subjects are constructed in interactions with people with dementia. The institutional ethical guidelines concerning resident autonomy are particularly challenging for nursing staff to follow when dealing with people with advanced dementia. For people with dementia to be able to participate in ethical life, nursing staff are called upon to account for residents on their behalf. This paper uses various observations to explore the construction of personhood in an institutional setting. In the paper, I distinguish between three frameworks of personhood: ‘momentary personhood’ grants autonomy, ‘social personhood’ demands accountability by the institution, and ‘biographical personhood’ presents coherence. Bringing together an anthropology of personhood, ethics and dementia, I argue that all the conditions of treating people with dementia as ethical subjects are met in this institutional setting. Personhood is actively (re-)constructed but remains fragmented and bound to the particular setting in which it is evoked. This paper contributes to questions of how people experience ethical lives and live under particular conditions of confinement and how formalised values of autonomy and care take on meaning in local settings.