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Ethics Paper 1
Ethics Paper #1: Moral Standing in Patients with Late Dementia
According to the Stanford Encyclopedia of Philosophy, an individual or “entity has
moral status if and only if it or its interests morally matter to some degree for the entity's
own sake, such that it can be wronged” (Jaworska). In the case of patients with late
dementia, said patients do deserve moral standing. To what extent moral standing should
be applicable though is one of the greatest controversies. One has to draw the line
somewhere, but where exactly is appropriate?
In the last century, patients with late stage dementia have not always been treated
with proper moral standing and they were not always considered beings whose interests
should be taken into consideration when making ethical decisions. In the past few decades,
moral status and more specifically progress in moral status has become more and more
evident in nursing homes. This is demonstrated by the fact that the use of physical
restraints (ie strait jackets, restraints to beds, etc) are diminishing in nursing homes. A
family member of mine is an architect who purchased a home nearly two decades ago that
was once a nursing home. In fixing up the house, he discovered several beds in the
basement with restraints on them for the residents/patients of the home. Now, when
entering a nursing home, these restraints are a thing of the past and are no longer found in
the facilities. It is clear that in recent decades, the majority of architects who design homes
for patients with dementia focus on designing long-term care facilities or skilled nursing
facilities with units that maximize freedom of the patients and allow them to wander
throughout the building in a safe way (Marquardt).
Ethics Paper 1
As Stirrat mentioned in his article on autonomy, the “complexity of some areas of
medical practice makes it difficult to make sure that patients have given their consent on
the basis of properly informed choice” (Stirrat 129). When an individual has late stage
dementia their “illness may render [them] even less able to consider these complexities”
(Stirrat 129). In these situations, as Brock and Wartman have said, it is difficult to respect a
patient’s rights and choices simply because it is difficult in theory and practice to
determine whether or not the patient is rational. In addition, it is difficult to treat a patient
in a way that is morally acceptable if the patient is having a hallucinations, paranoia,
agitation, etc which can be harmful to other individuals.
In Veatch’s book on bioethics, he discusses the definitions of whole-brain-oriented
