Dementia patients in the moderate-late stage of the disease can, and often do, express different preferences than they did at the onset of their condition. The received view in the philosophical literature argues that advance directives which prioritize the patient’s preferences at onset ought to be given decisive moral weight in medical decision-making. Clinical practice, on the other hand, favors giving moral weight to the preferences expressed by dementia patients after onset. The purpose of this article is to show that (...) the received view in the philosophical literature is inadequate and is out of touch with real clinical practice. I argue that having dementia is a cognitive transformative experience and that preference changes which result from this are legitimate and ought to be given moral weight in medical decision-making. This argument ought to encourage us to reduce our confidence in the moral weight of advance directives for dementia patients. (shrink)

The recent push to extend physician-aid-in-dying (PAD) to psychiatric conditions has significantly altered the ethical landscape surrounding psychiatric judgments concerning treatment-refractory il...

Abstract:This article defends the idea that colonialism still has a grasp on a valuable tool in the construction of our reality: memory. Developments in cognitive neuroscience and interdisciplinary memory studies propose that memory is far more creative and tied to one's imaginal capacities than we used to believe, suggesting that remembering is not simply a reproductive process, but a complex reconstructive process. Drawing on the psychiatric works of Frantz Fanon, in Alienation & Freedom; Black Skin, White Masks; and Wretched of (...) the Earth, this article seeks to illustrate the ways in which colonialism continues to be involved in this reconstructive memory process. Colonialism has affected both episodic memories, the kind we have as individuals regarding our own past, and collective memories, the intersubjective shared narratives we possess in our societies. I argue that dominant collective memories ought to be rejected as a means of self-preservation for racialized individuals because these memories do not do justice to the violence of colonialism. Nevertheless, rejection of dominant collective memories comes at a significant personal cost in our societies, as it creates a traumatic loop for racialized individuals. I propose that psychiatry itself plays an instrumental role in the alienation experienced by racialized individuals because psychiatry has not yet appreciated the ways in which colonialism continues to have a hold on memory. Piecing together a theory of remembering in Fanon's texts, this article suggests that this cycle of alienation can be broken, if psychiatrists incorporate Fanon's insights regarding memory into their practice. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Recognizing Wounds and Giving Uptake The Undoing of Dominant Collective MemoriesEmily Walsh*, PhD (bio)I want to begin this response by thanking Dr. Kirmayer and Dr. Potter for taking the time to craft insightful and intellectually stimulating responses to my article. Both commentaries enabled me to clarify the complexity of the question of how best to commence the undoing of dominant collective memories (DCMs) in psychiatry. In this response, I (...) will clarify what I intend to capture by the term DCMs, tackle two problems identified with my account, and end by remarking on the solutions proposed by the authors, defending that a hybrid combination of both positions leaves us with the most robust solution to the problems created by DCMs.I briefly outline in the article that DCMs are singular and exclusionary collective memories underpinned by colonialism. Potter expresses concern about being left with uncertainty regarding what sorts of DCMs serve to deny the violence faced by the colonized given this definition. This concern is important as it shows that there is some conceptual confusion about how to distinguish ordinary collective memories from DCMs, which I propose ought to be rejected. Addressing this concern would also be useful for the reason Potter makes; to help better motivate why change is required in psychiatry regarding DCMs. In response to Potter's definitional concern, I will now posit a thicker explanation of DCMs, which outlines how they are distinct from ordinary collective memories on three grounds.DCMs are unique from other kinds of collective memory insofar as they deny that there could be various perspectives of the same event. This denial occurs in multiple ways, such as silencing, scapegoating, attacking, and undermining others' perspectives, painting certain actors as all good and others as all bad. Therein lies the danger of DCMs as I have defended that people are neither wholly good nor wholly bad, but they are at the mercy of their social situation. Good examples of cases of the kind of DCMs I have in mind are how colonial nations defend their reasons for engaging in colonialism and failing to acknowledge sectors of history entirely (such as failing to recognize horror crimes against certain social and ethnic minorities). Such a failure to integrate both positive and negative parts of a nation's history is not [End Page 249] present in all contexts. For instance, Germany has integrated teaching about the horrors endured during Nazi Germany into their historical narrative of the past to avoid reproducing similar atrocities in the future. Places like the UK and Canada are slower to follow suit and admit that there are horrors present in the nation's past too.DCMs are also unique in legitimizing and reproducing negative and positive stereotypes, ideals, and cultural myths. Such stereotypes tend to be harmful such as "I expect X group always to steal," but they can also be positive "I expect X to be the most intelligent person I've ever met." As Fanon instructed us (Fanon 1964, 1967), these stereotypes are entrenched in the content of DCMs. Similarly, they are reproduced with the intent of controlling specific populations of persons. If, after all, I have 'evidence' that you are a thief by 'nature,' I will seek to protect my belongings from you. The problem is that the 'evidence' is not evidence—it is a form of DCM. The evidence fails to see processes of racialization and colonialism and thereby, advertently or inadvertently, reproduces them.As reiterated by Kirmayer in his commentary, DCMs are not primarily concerned about individual and discrete events, but they aim to produce narratives of events. According to Kirmayer, these narratives are imbued with explanations and rationalizations that drive the plot forward in time. My primary concern in the article was to show that DCMs can work to move the plot backward in time as a means of controlling specific populations—back to a time the world does not recognize as a time but forces racialized persons to keep perpetually enduring the aftereffects of (Al-Saji, 2013, 2021). Thus, there are deep contradictions in DCMs which are not present in all collective memories. On the one hand, DCMs deny the violence inflicted on the... (shrink)