Various debates in bioethics have been focused on whether non-persons, such as marginal humans or non-human animals, deserve respectful treatment. It has been argued that, where we cannot agree on whether these individuals have moral status, we might agree that they have symbolic value and ascribe to them moral value in virtue of their symbolic significance. In the paper I resist the suggestion that symbolic value is relevant to ethical disputes in which the respect for individuals with no intrinsic moral (...) value is in conflict with the interests of individuals with intrinsic moral value. I then turn to moral status and discuss the suitability of personhood as a criterion. There some desiderata for a criterion for moral status: it should be applicable on the basis of our current scientific knowledge; it should have a solid ethical justification; and it should be in line with some of our moral intuitions and social practices. Although it highlights an important connection between the possession of some psychological properties and eligibility for moral status, the criterion of personhood does not meet the desiderata above. I suggest that all intentional systems should be credited with moral status in virtue of having preferences and interests that are relevant to their well-being. (shrink)

After expressing our gratitude to the commentators for their valuable analyses and assessments of Principles of Biomedical Ethics, we respond to several particular critiques raised by the commentators under the following rubrics: the compatibility of different sets of principles and rules; challenges to the principle of respect for autonomy; connecting principles to cases and resolving their conflicts; the value of and compatibility of virtues and principles; common morality theory; and moral status. We point to areas where we see common agreement (...) with our commentators and respond to their critical evaluations. (shrink)

Since John Locke, regnant conceptions of personhood in Western philosophy have focused on individual capabilities for complex forms of consciousness that involve cognition such as the capability to remember past events and one’s own past actions, to think about and identify oneself as oneself, and/or to reason. Conceptions of personhood such as Locke's qualify as cognition-oriented, and they often fail to acknowledge the role of embodiment for personhood. This article offers an alternative conception of personhood from within the tradition of (...) phenomenology of the body. The article presents a phenomenological analysis of joint musical activity in dementia care and outlines an intercorporeal conception of personhood based on this analysis. It also provides a philosophical basis for the idea that others can hold us in personhood, and it questions a strict one-body-one-person logic that has pertained in much personhood debate. (shrink)

The phrase ‘person‐centred care’ (PCC) reminds us that the fundamental philosophical goal of caring for people is to uphold or promote their personhood. However, such an idea has translated into promoting individualist notions of autonomy, empowerment and personal responsibility in the context of consumerism and neoliberalism, which is problematic both conceptually and practically. From a conceptual standpoint, it ignores the fact that humans are social, historical and biographical beings, and instead assumes an essentialist or idealized concept of personhood in which (...) a person is viewed as an individual static object. From a practical standpoint, the application of such a concept of personhood can lead to neglect of a person's fundamental care needs and exacerbate the problems of social inequity, in particular for older people and people with dementia. Therefore, we argue that our understanding of PCC must instead be based on a dynamic concept of personhood that integrates the relevant social, relational, temporal and biographical dimensions. We propose that the correct concept of personhood in PCC is one in which persons are understood as socially embedded, relational and temporally extended subjects rather than merely individual, autonomous, asocial and atemporal objects. We then present a reconceptualization of the fundamental philosophical goal of PCC as promoting selfhood rather than personhood. Such a reconceptualization avoids the problems that beset the concept of personhood and its application in PCC, while also providing a philosophical foundation for the growing body of empirical literature that emphasizes the psychosocial, relational, subjective and biographical dimensions of PCC. (shrink)

Appeals to the dignity of people with dementia are widespread in the current literature on dementia care. One influential account of dignity in the wider philosophical and bioethical literature that has remained underexplored in the context of dementia care is that of Martha Nussbaum. This paper critically examines Nussbaum’s account of dignity and aims to determine what moral guidance this account can offer for the provision of care to people with dementia. To that end, first, I identify four possible objections (...) to appeals to dignity in dementia care. These objections are (1) redundancy of the dignity talk, (2) exclusionary implications, (3) reliance on (suspect forms of) speciesism and (4) unclear practical implications. Then, I discuss whether, and to what extent, Nussbaum’s account of dignity can overcome these objections. I argue that Nussbaum’s account, in its original form, struggles to overcome the problem of exclusionary implications and consequently the problem of unclear practical implications. I argue for a modified version of Nussbaum’s account of dignity. I demonstrate that this modified version can better overcome all of the four objections, and it provides relatively clearer moral guidance for the provision of care to people with dementia. The modified version of Nussbaum’s account is predicated on a novel dementia-specific model of flourishing, which draws on Kitwood and Bredin’s empirically informed list of indicators of well-being for people with dementia. (shrink)

Allyne L. Smith, Jr.; Personhood: Beginnings and Endings, Christian bioethics: Non-Ecumenical Studies in Medical Morality, Volume 6, Issue 1, 1 January 2000, Pa.

Advances in life-saving technologies in the past few decades have challenged our traditional understandings of death. Traditionally, death was understood to occur when a person stops breathing, their heart stops beating and they are cold to the touch. Today, physicians determine death by relying on a diagnosis of ‘total brain failure’ or by waiting a short while after circulation stops. Evidence has emerged, however, that the conceptual bases for these approaches to determining death are fundamentally flawed and depart substantially from (...) the established biological conception of death. We argue that the current approach to determining death consists of two different types of unacknowledged legal fictions. These legal fictions were developed for practices that are largely ethically legitimate but need to be reconciled with the law. The considerable debate over the determination of death in the medical and scientific literature has not informed the public that vital organs are being procured from still-living donors and it seems unlikely that this information can remain hidden for long. Given the instability of the status quo and the difficulty of making the substantial legal changes required by complete transparency, we argue for a second-best policy solution: acknowledging the legal fictions involved in determining death to move in the direction of greater transparency. This may someday result in more substantial legal change to directly confront the challenges raised by life-sustaining and life-preserving technologies without the need for fictions. (shrink)

Referred to as “a foundational concept” of bioethics, personhood has long figured prominently in discussions of entities’ moral status and attendant rights and duties (Farah and Heberlein 2007, 39)...

The essay examines Robin Cook’s Coma and Priscille Sibley’s The Promise of Stardust that dramatize the reified and disposable status of the brain-dead patients who are classified as nonpersons. The essay argues that the man-machine entanglement as depicted in the novels constructs a deterritorialized and entangled form of subjectivity that intervenes in the dominant biomedical understanding of personhood and agency that we notionally associate with a conscious mind. The essay concludes its arguments by discussing Alexander Beliaev’s Professor Dowell’s Head which (...) depicts human subjectivity as an essentially embodied and distributive phenomenon and interrogates the Cartesian mind body dualism embedded in the dominant biomedical narratives. (shrink)

In her important and well-known discussion “On the Moral and Legal Status of Abortion,” Mary Anne Warren regrets that “it is not possible to produce a satisfactory defense of a woman’s right to obtain an abortion without showing that the fetus is not a human being, in the morally relevant sense.” Unlike some more cautious philosophers, Warren thinks that we can definitively demonstrate that the fetus is not a person. In this paper, Warren’s argument is critically examined with a focus (...) especially on the question of the foundation and the boundaries of the moral community. The fundamental thesis of the paper is that Warren’s approach is flawed for at least four reasons: (1) that being a person is not as obviously central to having full moral rights as Warren assumes, (2) that her exclusivism regarding moral status has dubious moral consequences independent of the abortion issue, (3) that it is not clear that a fetus is not a person, even on Warren’s own criteria, and (4) her criteria for personhood are themselves suspect. (shrink)

In end-of-life care discussions, I contend that the distinction between “having a life” vs. “being alive” is an underutilized distinction. This distinction is significant in separating different states of existence conflated by patients, families, and clinicians. In the clinical setting, applying this distinction in end-of-life care discussions aids patients’ and family members’ decision-making by helping them understand that being alive can differ from having a life. Moreover, this distinction helps them decide which state may be the most important to them. (...) After applying this distinction to three complex cases, I respond to the likely objection that “having a life” vs. “being alive” is less accurate and more controversial than other distinctions. I conclude by arguing that “having a life” vs. “being alive” is more accurate and less controversial than distinctions between medically indicated vs. medically inappropriate treatments, personhood, and quantity vs. quality of life. (shrink)

This thesis presents a communicative account of personhood that argues for the inseparability of the metaphysical and the practical concepts of a person. It connects these two concepts by coupling the question “what is a person” with the question "how does one become a person". It argues that participation in social interactions that are characterized by mutual recognition and giving-and-taking reasons implied by the practical concept of a person is in fact an ecological and developmental condition for an entity to (...) possess the kind of characteristics and capacities such as reflexive self-consciousness addressed by the metaphysical concept. The chief theoretical contribution of the dissertation research lies, accordingly, in demonstrating that an adequate metaphysical concept of a person has to make reference to the kind of social processes that are necessary for the emergence and development of the distinguishing attributes of persons among other moving, perceiving, desiring and cognizing agents. Methodologically, it undertakes an original philosophical analysis that is enriched by an interdisciplinary investigation of several notions and insights from semiotics, comparative and developmental psychology, cognitive science and anthropology. The main argument of the thesis is that one becomes a person through internally recreating a social, communicative process; namely, that of dialogical transformation of habits. We find the paradigmatic case of this social process in mutual persuasion. The internalization of this process in the form of an inner dialogue cultivates a social self that is in ongoing communication with the embodied, organismic self of uncritically habituated attitudes, convictions and desires. This inner dialogue can be conceived as a temporally extended process of self-persuasion, which is characterized by an ongoing strive for attaining higher degrees of self-control; that is, for achieving a more coherent alignment between our habits and the kind of person we would like to be. It starts with self-interpretation and self-evaluation, and culminates in the formation of higher-order desires that facilitate habit-change and novel habit formation in accordance with certain social, moral, aesthetical or intellectual categories and norms one comes to endorse. For this reason, self-induced, deliberate habit-change is also a process of appropriation or self-appropriation, through which we strive to cultivate habits of feeling, thinking, acting that we can deem more truly ours. The thesis demonstrates that the capacity for engaging in this kind of self-persuasion consists chiefly in the capacities for metasemiosis, perspective-taking, and for cultivating habits of reflexivity. It explicates how all these capacities have a social origin and ultimately a social function by showing that they all presuppose certain higher-order communicative patterns that arose through an evolutionary and cultural history, and develop through the internal reconstruction of these patterns as cognitive-semiotic processes. The thesis concludes that becoming a kind of being who can engage in self-persuasion, thus a person, consists ultimately in internalizing the patterns of communicative social interactions in the form of an ongoing auto-communication. (shrink)

Many people seem to understand the term 'dignity' as applying to all human persons regardless of their race, creed, sex, or religious beliefs. As to what the concept 'dignity' means is a difficult and complex problem. Is the concept 'dignity' an empty concept, void of meaning? What does it mean when we say that this or that person has dignity? Most of the current philosophical literature has very little to say as to what dignity is. I will argue that what (...) we need to find is a concept of dignity that accounts for both the infinite and the irreplaceable value of the human person. Following Kant and Linda Zagzebski, we can say that to be irreplaceable is to be above all comparison and to be of infinite value is to be above all price. This paper will explore how to understand the two aspects of dignity; infinite and irreplaceable value as being necessary components in understanding our intuitions that we have about human persons having 'dignity'. To show how both aspects of dignity are necessary, this paper will explore intuitions of the irreplaceability and infinite value of human persons by looking at the concrete experiences that we have of friendship and love. We will look at Gabriel Marcel's definition of the human person and methodology to see if we can better understand the irreplaceable aspect of the human person. In the last few pages of this thesis we will see how to metaphysically tie the knot between these two aspects. (shrink)

Loss of self is widely regarded to be a consequence of dementia, and this perceived loss presents a variety of problems - not least because a clear understanding of the concept of self is elusive. This paper suggests a way to cut through problems that arise because we rely on conceptions of self in our understanding of the effects of dementia. It is proposed that we can avoid reliance on the concept of self through an approach based in in bio-phenomenology. (...) Such an approach would help us better understand the inner life of those with dementia and assist us to recognize that even in late stage dementia they are semiotic subjects with unique value. (shrink)