Le patient dément en fin de vie : sujet ou objet de soins ?

One of the main concerns in palliative care is to soothe the suffering so that the subjectivity of the dying person's life remains intact. But does this subjectivity persist when, as in advanced dementia, the patient's consciousness or intellectual capacity is seriously altered? What do we have in order to maintain the human dimension of these bedridden silent patients whose expression of life lies outside our realm of comprehension? To deal with this question, we have chosen to examine the philosophic concepts that structure the notion of subject and to seek their relevance in the case of a patient with advanced dementia. Since the most visible element appears to be the absence of any manifestation of thought, we have, first, turned our attention to the classic concepts (Locke and Descartes) where subjectivity is anchored in the notion of consciousness. Secondly, considering the limits of a dualist approach (body versus mind), we have re-read Merleau-Ponty and Henry who re-introduce the body into the heart of the problem. This philosophic course reveals, however, an extremely solipsist vision of the subject, which does not, after all, enable us to apprehend the patient with advanced dementia. We terminate this work by examining the philosophies of Ricœur and Lévinas who envisage the subject, not alone, but in relation to the Other, in the perspective of a persisting exchange.