Moral Self-Orientation in Alzheimer's Dementia

People with Alzheimer's dementia experience significant neuropsychological decline, and this seems to threaten their sense of self. Yet they continue to have regard for their moral standing, especially from the feedback they receive from others in relation to such things as pride in their work, retaining a valued role, or acting out of a sense of purpose. This continuing self-regard is based on a self-image which often persists through memory loss. I will argue that in care settings the self-image ought to be assumed to remain intact. Treating a person with Alzheimer's dementia supportively and respectfully as the person with a certain role or identity-say as scientist, musician, janitor, parent, or friend-fosters an environment in which they are best able to retain what I call moral self-orientation. The latter notion is central to the well-being of social persons, and so it takes on special significance for people with dementia because, although their remembering selves are fragmenting, their self-image persists. Normative aspects of the self-image, I argue, require a social framework of support to sustain the self-image.