Who Should Take Care of Offenders with Dementia?

Abstract

In this contribution, I investigate the way in which our understanding of a dementia patient’s self holds relevance to issues of punishment and responsibility. This topic is motivated by the fact that some countries with particularly large prison populations—such as the United States—are starting to build specialized prison tracts for inmates with dementia. In other countries that do not have such specialized facilities, authorities are trying to find the least badly-equipped facility for such patients, and they are turning to ordinary retirement homes, forensic hospitals as well as ordinary psychiatric and geriatric hospital wards. The problem is expected to become increasingly urgent as the population ages and the number of dementia patients increases. I analyse the way in which justifications of legal (or private) punishment for offenders with dementia can depend on an account of relevant psychological features of the self. I argue that especially retributivist and expressivist justifications of punishment require the offender’s ability to comprehend that he or she is being punished for a particular action in the past and that it was him or herself who committed this action. In the second part of my paper, I distinguish between different accounts of responsibility and argue that accounts of relevant features of the self are also needed here to answer the question of whether offenders with dementia are still responsible for past or current inappropriate behavior. In the final part of the paper, I argue that potentially existing private punishment intuitions among caretakers as well as certain puzzles of responsibility interpretation can make it plausible to relieve certain caretakers from primary responsibility for offenders with dementia, especially caretakers who belong to a relevant former victim group of the offender.