Visiting recognition: a palimpsest model of personhood at the threshold of death

BACKGROUND: At the end of life, clinical care often reduces a person to a single dimension-a past biography, a present symptom or a future decline. Existing person-centred models offer immense value but provide limited guidance for sustaining personhood across time. METHODS: with dementia care frameworks, narrative medicine and genetic risk research. Drawing on the UK Research and Innovation (UKRI)-funded Time and Tide coastal arts project (2022), the analysis examines how recognition practices either sustain or collapse personhood's temporal complexity. Clinical observations from dementia care settings provide grounded evidence of how recognition works in practice. FINDINGS: Personhood persists across its three dimensions-past biography, present relationship and anticipated future. Ethical failures happen when we freeze a life in a single time frame-whether through Creon's political decrees, institutional care routines or the predictive profiling of apolipoprotein E (APOE)-ε4 genetic risk. Countering this requires what this essay calls 'visiting recognition': an ongoing, distributed practice that moves between a person's layers without demanding coherence. APOE-ε4 provides a case study showing how gene-gene interaction offers biological grounding for rejecting reductionist personhood models. Clinical observation reveals that biographical memory, material preferences and routine provide anchoring points for recognition even when cognitive capacity diminishes. CONCLUSIONS: Effective care at life's threshold requires institutional support for temporal recognition. Dementia care, advance planning and genomic counselling should hold memorial, relational and anticipatory dimensions simultaneously, with recognition understood as ongoing relational work rather than one-time acknowledgement.