Skip to main content
Top
Published in: Medicine, Health Care and Philosophy 1/2020

Open Access 01-03-2020 | Dementia | Scientific Contribution

‘I am your son, mother’: severe dementia and duties to visit parents who can’t recognise you

Author: Bouke de Vries

Published in: Medicine, Health Care and Philosophy | Issue 1/2020

Login to get access

Abstract

It is commonly assumed that many, if not most, adult children have moral duties to visit their parents when they can do so at reasonable cost. However, whether such duties persist when the parents lose the ability to recognise their children, usually due to dementia, is more controversial. Over 40% of respondents in a public survey from the British Alzheimer’s Society said that it was “pointless” to keep up contact at this stage. Insofar as one cannot be morally required to do pointless things, this would suggest that children are relieved of any duties to visit their parents. In what appears to be the only scholarly treatment of this issue, Claudia Mills has defended this view, arguing that our duties to visit our parents require a type of relationship that is lost when parents no longer remember who their children are. This article challenges Mills’ argument. Not only can children be duty-bound to visit parents who have lost the ability to recognise them, I argue that many children do in fact have such duties. As I show, these duties are grounded in any special interests that their parents have in their company; the fact that visiting their parents might allow them to comply with generic duties of sociability; and/or the fact that such visits allow them to express any gratitude that they owe their parents.
Footnotes
1
Compare Lucero (2004, p. 174).
 
2
Notice that such duties are different from those that are owed to all human beings, such as duties not to torture people. At the same time, they do not require that the things that children owe their parents are owed exclusively to their parents. For example, insofar as we have duties to show gratitude to those who have made significant sacrifices for us (more on this within the final section), then this might not just generate duties to show gratitude towards our parents, but also towards a select number of other individuals who have made such sacrifices, such as friends who have supported us through thick and thin.
 
3
I.e. theories about what kinds of things are non-instrumentally valuable.
 
4
It is important though that people with dementia be approached the right way in order for these positive effects to occur. This means, inter alia, that their visitors should avoid a number of things, including using long sentences; asking many open-ended questions; asking people with dementia directly whether they remember various events; revealing their frustrations; and using Elderspeak (Alzheimer’s Society 2017).
 
5
Loneliness consists of a negatively experienced mismatch between one’s desired and realised social contact. See e.g. de Jong-Gierveld (1987).
 
6
See, for instance, Lang and Carstensen (1994).
 
7
For a discussion of the causes of facial recognition problems among people with dementia, see Lavallée et al. (2016).
 
8
Compare Hope (2010, p. 63).
 
9
To the extent that negative stereotypes about dementia are internalised, moreover, there is a risk that this will undermine the willingness of people with dementia to socialise as they come to feel unworthy of others’ company; cf. Hope (2010, p. 98).
 
10
For a more elaborate discussion of the importance of stable companionship to people’s well-being, see Brownlee (Brownlee 2016b, pp. 44–45).
 
11
See, for instance, Dworkin (1994) and Porteri (2018). In Dworkin’s view, the past autonomy-interests of individuals with severe dementia might even trump their current well-being interests in remaining alive. Specifically, he believes that any advanced directives that people have signed to be denied life-saving medical treatment if they develop severe dementia should be respected even if they live perfectly happy lives once they reach this stage of cognitive impairment.
 
12
The main exception are those who suffer from semantic dementia, who account for circa 2 percent of all people with dementia (Rogers and Friedman (2008).
 
13
As exemplified by the fact that it is often invoked by both sides in arguments. For further discussion, see Ashcroft (2005).
 
14
Without trying to list all possible scenarios where such costs are unreasonable, I take it that this will be the case when helping to provide others with opportunities for social contact makes it more difficult for people to make a living or to look after the physical needs of those for whose care they are responsible.
 
15
Two comments on filial duties to show gratitude towards parents are in order. First, whereas on some accounts, such duties can arise only when parents have done more for their children than they were morally required to, this need not be the case. For example, Schinkel (2012, p. 402) has argued that non-supererogatory parental investments might generate filial duties to show gratitude as long as the investments were sufficiently costly for the parents to make and were made out of genuine concern for the children’s well-being. Second, discharging such duties does not necessarily require that children feel grateful towards their parents. Those who reject such a requirement will usually do so because they believe that humans have insufficient control over their emotions in order to expect anything of the sort. Of course, this does not preclude them from accepting that there can be duties to try to feel grateful towards one’s parents, for example by thinking actively about all the things that one’s parents have done for one.
 
16
I am indebted to an anonymous reviewer for suggesting alternative ways of expressing gratitude to people with severe dementia.
 
17
This is based on personal communication at various academic events. I am not aware of scholars who have defended this view in print. .
 
Literature
go back to reference Blustein, J. 1982. Parents and Children: The Ethics of the Family, 1st ed. New York: Oxford University Press. Blustein, J. 1982. Parents and Children: The Ethics of the Family, 1st ed. New York: Oxford University Press.
go back to reference Brownlee, K. 2013. A Human Right Against Social Deprivation. Philosophical Quarterly 63 (251): 199–222.CrossRef Brownlee, K. 2013. A Human Right Against Social Deprivation. Philosophical Quarterly 63 (251): 199–222.CrossRef
go back to reference Cacioppo, J.T., L.C. Hawkley, and R.A. Thisted. 2010. Perceived Social Isolation Makes Me Sad: Five Year Cross-Lagged Analyses of Loneliness and Depressive Symptomatology in the Chicago Health, Aging, and Social Relations Study. Psychology and Aging 25 (2): 453–463. https://doi.org/10.1037/a0017216.CrossRef Cacioppo, J.T., L.C. Hawkley, and R.A. Thisted. 2010. Perceived Social Isolation Makes Me Sad: Five Year Cross-Lagged Analyses of Loneliness and Depressive Symptomatology in the Chicago Health, Aging, and Social Relations Study. Psychology and Aging 25 (2): 453–463. https://​doi.​org/​10.​1037/​a0017216.CrossRef
go back to reference Dworkin, R. 1994. Life’s Dominion: An Argument About Abortion, Euthanasia, and Individual Freedom (Vintage Books). New York: Vintage. Dworkin, R. 1994. Life’s Dominion: An Argument About Abortion, Euthanasia, and Individual Freedom (Vintage Books). New York: Vintage.
go back to reference Holton, R. 2016. Memory, Persons and Dementia. Studies in Christian Ethics 29 (3): 256–260.CrossRef Holton, R. 2016. Memory, Persons and Dementia. Studies in Christian Ethics 29 (3): 256–260.CrossRef
go back to reference Jeske, D. 2017. Fillial Duties. In The Palgrave Handbook of the Philosophy of Aging, ed. G. Scarre, 365–374 (1st ed. 2016 edition). New York, NY: Palgrave Macmillan. Jeske, D. 2017. Fillial Duties. In The Palgrave Handbook of the Philosophy of Aging, ed. G. Scarre, 365–374 (1st ed. 2016 edition). New York, NY: Palgrave Macmillan.
go back to reference Lavallée, M.M., D. Gandini, I. Rouleau, G.T. Vallet, M. Joannette, M.-J. Kergoat, et al. 2016. A Qualitative Impairment in Face Perception in Alzheimer’s Disease: Evidence from a Reduced Face Inversion Effect. Journal of Alzheimer’s Disease: JAD 51 (4): 1225–1236. https://doi.org/10.3233/JAD-151027.CrossRef Lavallée, M.M., D. Gandini, I. Rouleau, G.T. Vallet, M. Joannette, M.-J. Kergoat, et al. 2016. A Qualitative Impairment in Face Perception in Alzheimer’s Disease: Evidence from a Reduced Face Inversion Effect. Journal of Alzheimer’s Disease: JAD 51 (4): 1225–1236. https://​doi.​org/​10.​3233/​JAD-151027.CrossRef
go back to reference Lucero, M. 2004. Enhancing the Visits of Loved Ones of People in Late Stage Dementia. Alzheimer’s Care Today 5 (2): 173. Lucero, M. 2004. Enhancing the Visits of Loved Ones of People in Late Stage Dementia. Alzheimer’s Care Today 5 (2): 173.
go back to reference Porteri, C. 2018. Advance Directives as a Tool to Respect Patients’ Values and Preferences: Discussion on the Case of Alzheimer’s Disease. BMC Medical Ethics 19 (1): 9.CrossRef Porteri, C. 2018. Advance Directives as a Tool to Respect Patients’ Values and Preferences: Discussion on the Case of Alzheimer’s Disease. BMC Medical Ethics 19 (1): 9.CrossRef
go back to reference Stravynski, A., and R. Boyer. 2001. Loneliness in Relation to Suicide Ideation and Parasuicide: A Population-Wide Study. Suicide & Life-Threatening Behavior 31 (1): 32–40.CrossRef Stravynski, A., and R. Boyer. 2001. Loneliness in Relation to Suicide Ideation and Parasuicide: A Population-Wide Study. Suicide & Life-Threatening Behavior 31 (1): 32–40.CrossRef
go back to reference Welch, B.F. 2012. A Theory of Filial Obligations. Social Theory and Practice 38 (4): 717–737.CrossRef Welch, B.F. 2012. A Theory of Filial Obligations. Social Theory and Practice 38 (4): 717–737.CrossRef
go back to reference Wicclair, M.R. 1990. Caring for Frail Elderly Parents: Past Parental Sacrifices and the Obligations of Adult Children. Social Theory and Practice 16 (2): 163–189.CrossRef Wicclair, M.R. 1990. Caring for Frail Elderly Parents: Past Parental Sacrifices and the Obligations of Adult Children. Social Theory and Practice 16 (2): 163–189.CrossRef
Metadata
Title
‘I am your son, mother’: severe dementia and duties to visit parents who can’t recognise you
Author
Bouke de Vries
Publication date
01-03-2020
Publisher
Springer Netherlands
Keywords
Dementia
Dementia
Published in
Medicine, Health Care and Philosophy / Issue 1/2020
Print ISSN: 1386-7423
Electronic ISSN: 1572-8633
DOI
https://doi.org/10.1007/s11019-019-09931-5

Other articles of this Issue 1/2020

Medicine, Health Care and Philosophy 1/2020 Go to the issue

Scientific Contribution

Schrödinger’s Fetus

Scientific Contribution

Autism, autonomy, and authenticity