• Ethics- Research

Soofi makes a persuasive case that a modified version of Nussbaum’s capabilities approach can be used to develop effective care guidelines for persons with dementia.1 I agree with Soofi that, so elaborated, the capabilities approach can avoid the four problems that are typically taken to beset dignitarian theories—redundancy, exclusion, speciesism and vagueness. Moreover, I do not seek to challenge the utility of the care guidelines Soofi derives from the capabilities approach—they are clear, practicable and appropriately wide-ranging. I do, however, challenge the idea that this framework would be sufficient to protect the dignity of those with dementia.

To see the gap that remains to be filled, we need to unpack what Soofi’s approach can say about the wrong of degrading treatment. In the context of explaining the need to differentiate respect for dignity from respect for autonomy, Soofi notes that ‘abusive, degrading or insulting forms of caregiving compromise the dignity of people with very advanced dementia (p.2)’, even though they are no longer capable of being autonomous, and hence can’t have their autonomy disrespected. I question, though, whether a capabilities approach can fully account for this judgment. The difficulty is that a capabilities approach construes all dignity violations in terms of failure to …