"Who is still there?": phenomenological reflections on selfhood and ethical recognition in dementia care

Dementia challenges conventional autonomy models that equate moral agency with rational decision-making and consistent choice. Clinical responses-reliance on advance directives and surrogate decision-makers-often fail to capture the lived reality of persons with dementia, assuming a static self whose prior preferences remain authoritative despite cognitive decline. This paper uses phenomenology to rethink ethical recognition beyond cognitive capacity. Ricoeur's distinction between idem and ipse identity shows narrative persistence despite memory loss. Merleau-Ponty's embodied subjectivity reveals selfhood expressed through gestures, emotions and habits beyond language. Levinas's ethics emphasises moral responsibility arising from vulnerability rather than cognitive reciprocity. Together, these views support shifting from cognition-based autonomy to a model grounded in narrative, embodiment and relational responsibility. Dementia reshapes, rather than erases, moral presence. Practical implications highlight how phenomenology can deepen moral attunement in clinical and familial care.