The advance directive conjuring trick and the person with dementia

Julian C. Hughes and Steven R. Sabat

in Empirical Ethics in Psychiatry

Published on behalf of Oxford University Press

Published in print February 2008 | ISBN: 9780199297368
Published online February 2013 | e-ISBN: 9780191754586 | DOI:

Series: International Perspectives in Philosophy & Psychiatry

The advance directive conjuring trick and the person with dementia

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In an ideal world philosophers would approach their work without prejudice or preconceptions. Of course, this is not how the world is. But, as Wittgenstein once suggested, it may be the seemingly innocuous moves that cause problems. Wittgenstein asks how philosophical problems arise and suggests:

The first step is the one that altogether escapes notice…But that is just what commits us to a particular way of looking at the matter… (The decisive movement in the conjuring trick has been made, and it was the very one that we thought quite innocent.) (Wittgenstein 1968, p. 308).

The innocent move immediately has us heading in a particular and problematic direction.

Concerning philosophical problems, Wittgenstein famously wrote:

These are, of course, not empirical problems; they are solved, rather, by looking into the workings of our language, and that in such a way as to make us recognise those workings: in despite of an urge to misunderstand them. The problems are solved, not by giving new information, but by arranging what we have always known. Philosophy is a battle against the bewitchment of our intelligence by means of language (Wittgenstein 1968, p. 109).

Hence, Wittgenstein suggests that philosophy is not empirical; but philosophical problems are solved by looking at how language works in its ordinary setting. The philosophical mistake (often leading to a dilemma) is frequently the first step – the conjuring trick – which involves abstracting language from its ordinary setting.

In this chapter we shall look at what people actually say in order to illuminate and suggest ways to solve real ethical and practical problems in connection with dementia. In the next section we shall set out these problems. Then we shall outline the empirical method used and discuss our analysis of the resulting data, which comprises conversations involving people with dementia. Finally, we shall show how the qualitative data contributes to the solution of the ethical and practical problems. And we shall briefly consider the relevance of this empirical work to philosophy.

Chapter.  8156 words. 

Subjects: Psychiatry

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