Autonomy and Dementia. The problematic Freedom of Healthcare of Alzheimer’s Patients

The effects of Alzheimer’s Disease (AD) are disruptive on a practical level for patients and their families, as well as for the healthcare system. They are also disruptive on a conceptual level because they challenge the traditional notion of identity and autonomy of the subject. The consequences are primarily relevant from a theoretical point of view, before one considers the practical one. By considering the current debate in bioethics and bio-law, this contribution aims to shed light on what AD can reveal about the notions of identity and autonomy. As many scholars recognize, there is a need for a ‘relational turn’ in using these concepts. In light of this relational turn, the idea of ‘being autonomous’ does not mean being sovereign of the self and exclusive authors of our own life and identity. In accordance with this new trend in bioethics, the autonomy of people with dementia is promoted, and not cancelled, through the responsibility of their doctors and care-givers, by respecting their margin of agency. In this sense, it is also possible to reconsider the convenience of advance healthcare directives in the context of AD, in the form of ‘Ulysses contracts’.