The Web of Identity: Reframing Identity and Moral Obligation in Demenita Care
Luke Batt, The Ohio State University

Demenita and neurodegenerative diseases such as Alzheimers expose the fragility of autonomy-based or psychological-continuity models of identity. These frameworks which often tie moral worth to rational agency or memory struggle to sustain obligations once cognition declines. As a result, ethical discourse risks collapsing into paternalism or neglect. This paper proposes a multi-tiered, relational model of identity, grounding personhood in an enduring metaphysical core, expressed through relational and contextual dimensions. Moral obligations, therefore, are grounded in preserving and honoring each layer of this identity web, rather than merely protecting residual autonomy or cognitive function. The ontological core at the center draws from a Christian anthropological tradition and helps to ground a metaphysical understanding of personhood. This Imago Dei reflects a person’s intrinsic worth and endures despite erosion of memory or reason. The second marks out those relational, semi-stable social bonds which embed an individual’s identity within a community. At this level, we encounter roles which are developed and sustained by the interconnections forged between individuals and their community. The outermost layer encompasses the contextual and dynamic aspects of identity, involving current preferences, emotional expressions and evolving values. Following Agnieszka Jaworska’s notion of value commitment, I suggest that even in late-stage dementia, individuals manifest meaningful identity through adaptive emotional and aesthetic engagements with the world. By viewing personhood as a web rather than a singular property, this approach enables clinicians, caregivers, and families to participate in the ongoing recognition and preservation of the person’s identity. Ultimately, this paper argues that the true ethical test posed by dementia is not whether the patient remains a person, but whether the moral community can remain responsive to the enduring layers of identity that make that person who they are.