INTRODUCTION

This essay addresses a narrowly circumscribed aspect of justice and the elderly. What health care and expenditure of resources on health care are owed on grounds of justice to the severely demented elderly? This is not an entirely accurate specification of the group of patients with whom I am concerned in several respects. In the great majority of cases, the severely demented are among the elderly, understood here as the over age 65 population, but in a minority of cases dementia can progress to this stage in younger persons. In that respect, my argument here will apply to the claims to care of some non-elderly as well. The effects of dementia that are my special concern here are the erosion of memory and other cognitive functions that attack and, I shall argue, ultimately destroy personal identity and personhood in the patient. While senile dementia of the Alzheimer's type is probably the most common cause of cognitive disability of the specific form that erodes personal identity, it may have other causes as well. Thus, the implications of my argument here will extend to some other severely cognitively disabled patients besides the severely demented, though for convenience I shall generally refer simply to the severely demented.