Advocates of the Person-Centered Healthcare (PCH) approach say that PCH is a response to a failure of caring for patients as persons. Nevertheless, there are many human subjects falling to fulfill the requirements of a traditional philosophical definition of personhood. Hence, if we take, PCH seriously, a greater clarification of the key terminology of PCH is urgently needed. It seems necessary, for instance, that the concept of the person should be extended in order to include those individuals with insipient or (...) immature levels of consciousness, as well as those who are severely and permanently mentally handicapped. In this article, we will depart from some well-known philosophical concepts of what it means to be a person and try to offer a broader and more inclusive meaning. We suggest that persons are human beings with a socially recognized biography, which implies to recognize as persons individuals with necessities, but also with narratives about their interests and claims, expressed sometimes by other people related to them. This is particularly the case of individuals that suffer from severe disorders of consciousness. For those, is not only care that matters; respect matters too. Caregivers should therefore not only sympathetically care for the well-being of these people; they should also be concerned to respect their interests and claims by interpreting them empathetically, in the light of their biographical story. Our conclusion is that, in order to be coherent, PCH must consider individuals with severe disorders of consciousness as persons and we think that our revised concept of personhood fits with this requirement. (shrink)

Fulford’s chapter discusses the conceptual challenges facing person-centred care and the role of philosophy in addressing these challenges. He is right that this role - to investigate underlying meanings and reveal assumptions - need not and should not be restricted to the search for definitions of key terminology. The methods of “ordinary language philosophy” enable us to understand the meanings of terms by systematically examining their use in context, with a view to mapping a term's “logical geography”. He makes effective (...) use of this methodology to show that alternative accounts of what it means to be “person-centred” need not be contradictory and can indeed be fully complementary. The approach of mapping the usage of the key terms is necessary if we are to understand the discourse, but it is by no means sufficient in gaining a coherent understanding of the meaning and value of PCC - let alone one that could provide the basis for its effective implementation. While it is true that distinct accounts can reveal different and compatible “aspects” of PCC, the language of PCC - like that of “evidence” and “ethics” - is not simply diverse, it is contested. Fulford argues that “genuine” PCC provides a proper balance between the “extremes” of paternalism and consumerism. This language is clearly normative, going beyond what he characterises as the “empirical” exercise of mapping usage. A broader inquiry, based on the distinction between philosophy as a body of theory and as dialogue, and incorporating a direct engagement with normative questions, is necessary if we are to address the challenges Fulford identifies. The exercise of “mapping logical geography” reminds us that health discourse has no clear borders such that, by following its links to their logical limits, we will find ourselves inevitably in the midst of broader dialogues about the social nature of persons, the nature of value, agency and the basis for our obligations to one another. (shrink)

The ideas and terminology of person-centred care have been part of health discourse for a very long time. Arguments that in healthcare one treats the whole person, not her/his component parts, date back at least to antiquity and the need to treat the patient as a person is articulated persuasively by clinical authors in the early twentieth century. Yet it is only in recent years that we have seen a growing consensus in health policy and practice literature that PCC, and (...) associated ideas including patient expertise, co-production and shared decision-making, are not simply “fine ideals” or “ethical add-ons” to sound scientific clinical practice, but rather they represent indispensable components of any genuinely integrated, realistic and conceptually sound account of healthcare practice. The underlying conviction of this volume - one belief that, despite their differences, unites all of its contributors - is that PCC should not become the latest “revolutionary” concept to be “operationalised” before being “conceptualised”. It is imperative that we develop an open and inclusive dialogue about what we do and do not mean by “person-centred” to inform our attempts to implement PCC. (shrink)

Philosophy of medicine encompasses a broad range of methodological approaches and theoretical perspectives—from the uses of statistical reasoning and probability theory in epidemiology and evidence-based medicine to questions about how to recognize the uniqueness of individual patients in medical humanities, person-centered care, and values-based practice; and from debates about causal ontology to questions of how to cultivate epistemic and moral virtue in practice. Apart from being different ways of thinking about medical practices, do these different philosophical approaches have anything in (...) common? Are they committed to incompatible assumptions about the nature of science and its relationship to experience, value, and the art of medicine, or are different approaches nonetheless complementary? The chapter examines the questions these different approaches and perspectives raise and considers why so many theorists of medicine seek to find a “base” or “center” for medicine—as though there is, or should be, some general conceptual thread linking the things we call “usual clinical practice” in the real world. It further considers whether there are alternative approaches to the philosophy of medicine, which do not embody this philosophical assumption; and it suggests that a key tool for evaluating approaches must be their ability to contribute something of genuine value to clinical medicine. (shrink)