As the world population is rapidly aging, stakeholders must address the care of the elderly with great concern. Also, loss of dignity is often associated with aging due to dementia, mobility problems and diminished functional autonomy. However, dignity is a polysemic term that is deemed useless by some ethicists. To counter this claim, we propose four concepts to define it better and make use accurately of this notion. These are human dignity, dignity of identity, dignities of excellence and attributed (...) dignities. Finally, we explain the importance of solicitude and human dignity in the care of the elderly. This will ensure the respect, friendship and dignity of the elderly in providing geriatric ethical care. (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)

This chapter investigates older people’s needs in contemporary Ghana using the analyses of quantitative and qualitative data sets. The findings identified eight distinct patterns of needs, namely basic needs, care, and domestic help; sociability, emotional and affective support; information; counseling; spiritual needs, free bus rides, and rights. These needs highlight older adults’ social and personal requirements regarding daily living and healthcare in their desire to age with dignity. Their provision may avert problems related to population ageing, including (...) old-age dependency. These needs can be addressed through the following measures. First, the facilitation of the informational needs of older people is attainable through the introduction of initiation for adults and/or older people into the social structure and/or life course. Second, the provision of houses through the mediation of government on behalf of pension contributors, payable in installments. These may ensure appropriate adjustment to life in old age, albeit longevity. The life-sustaining needs of older people have existed since time immemorial. However, these needs are now taking a new dimension in the era of population ageing and increased life expectancy, economic hardships, and weakening extended family support system. We, therefore, argue that these require interventions at both the family and institutional or state levels or formal and informal levels, particularly needs satisfying programs and policies should be instituted by the government in addition to the existing ones. (shrink)

The policies of socioeconomic protection of older adults in most parts of the world are being redesigned in the scope of value-added targets, such as active ageing, successful ageing, or creative ageing. The main purpose here is, of course, enabling older adults self-sufficient and beneficial both for themselves and their social environment, instead of being simply the passive beneficiaries of the public support mechanisms. Turkey has a population which is still young but ageing very rapidly and will reach (...) to the same point as Europe today in a relatively much shorter time. However, the country still seems to be away from conducting systematic and holistic measures, except for a few ineffective strategy papers and legal regulations. Therefore, Turkey must immediately design a new policy agenda in conformity with its traditional and historical advantages. Revitalizing the intergenerational solidarity bonds, in this regard, may be the best cost-effective solution to complement formal measures in the provision of social protection and in the process of active ageing. However, this traditional protection net is under attack of increasingly transforming socioeconomic conditions. Consequently, as one of the most rapidly ageing countries in the world, Turkey should immediately stimulate studies and debates over a healthy, functional, and effective ageing period and caring issues. Otherwise, governments will be blindsided by the socioeconomic, psychological, cultural, and physiological problems related to the ageing process. In the light of these facts, the main purpose of this study is to discuss policy recommendations to create a self-sufficient ageing period for older adults in the context of Turkish case. (shrink)

Care ethicists have long insisted that Kantian moral theory fails to capture the partiality that ought to be present in our personal relationships. In her most recent book, Virginia Held claims that, unlike impartial moral theories, care ethics guides us in how we should act toward friends and family. Because these actions are performed out of care, they have moral value for a care ethicist. The same actions, Held claims, would not have moral worth for a (...) Kantian because of the requirement of impartiality. Although Kantian moral theory is an impartial theory, I argue that the categorical imperative in the Formulation of Humanity as an End and the duty of respect require that we give special treatment to friends and family because of their relationships with us. Therefore, this treatment does have moral value for a Kantian. (shrink)

In this paper, we explore the conceptual problems arising when using network analysis in person- centered care (PCC) in psychiatry. Personalized network models are potentially helpful tools for PCC, but we argue that using them in psychiatric practice raises boundary problems, i.e., problems in demarcating what should and should not be included in the model, which may limit their ability to provide clinically-relevant knowledge. Models can have explanatory and representational boundaries, among others. We argue that we can make more (...) explicit what kind of questions personalized network models can address in PCC, given their representational and explanatory boundaries, using perspectival reasoning. (shrink)

A society is said to age when its number of older members increases in relation to its number of younger members. The societies in most of the world’s industrialized nations have been aging since at least 1800. In 1800 the demographic makeup of developed countries was similar to that of many Third World countries in the early 1990s with roughly half the population under the age of 16 and very few people living beyond age of 60. Since that time, (...) increases in life expectancy, combined with declines in fertility rates, have dramatically increased the proportion of older persons in developed nations. The rapid increase in the number of older persons relative to younger ones carries important societal implications. In the domain of healthcare, societal aging will increase costs and exert greater pressure to ration services. It will, thus, bring to the fore questions, regarding a just distribution of healthcare between young and old age groups. This paper considers some of the most influential arguments to date for age-based rationing of health care. I show that these arguments fall short, and that the theoretical assumptions underlying them do not withstand careful scrutiny. (shrink)

An ageing population is a global phenomenon that takes place in Latvia, too. The active ageing policy is a social response to social challenges caused by demographic changes. Growing generational gap is a challenge to all “greying societies‘ in Europe and Latvia in particular. The active ageing policy is oriented to provide possibilities for older adults to live independently. However, long-term care institutions remain necessary, especially for those who live alone and have serious health problems. LTCIs are mostly (...) orientated to provide primary needs and health care. People regardless of their age also need a social and cultural life, but for older people who live in LTCIs, it is insufficient. The study shows those who are residing in LTCIs settings are subject to everyday routine. LTCIs care provision is very much dependent on the authorities of the institution. The insufficient level of interaction between older people and the more active part of society prevents the finding of effective ways of achieving that the care in LTCIs is in accordance with the active ageing policy. The study aims to find out ways how intergenerational cultural programs of professional and amateur activities are implemented in LTCIs. The study uses a qualitative approach to explore how LTCIs intergenerational cultural programs are helping to keep our youngest and oldest generations connected. (shrink)

We argue that contemporary conceptualizations of “persons” have failed to achieve the moral goals of “person-centred care” (PCC, a model of dementia care developed by Tom Kitwood) and that they are detrimental to those receiving care, their families, and practitioners of care. We draw a distinction between personhood and selfhood, pointing out that continuity or maintenance of the latter is what is really at stake in dementia care. We then demonstrate how our conceptualization, which (...) is one that privileges the lived experiences of people with dementia, and understands selfhood as formed relationally in connection with carers and the care environment, best captures Kitwood’s original idea. This conceptualization is also flexible enough to be applicable to the practice of caring for people at different stages of their dementia. Application of this conceptualization into PCC will best promote the well-being of people with dementia, while also encouraging respect and dignity in the care environment. (shrink)

This paper explores the relationship between dignity and robot care for older people. It highlights the disquiet that is often expressed about failures to maintain the dignity of vulnerable older people, but points out some of the contradictory uses of the word ‘dignity’. Certain authors have resolved these contradictions by identifying different senses of dignity; contrasting the inviolable dignity inherent in human life to other forms of dignity which can be present to varying degrees. The Capability Approach (...) (CA) is introduced as a different but tangible account of what it means to live a life worthy of human dignity. It is used here as a framework for the assessment of the possible effects of eldercare robots on human dignity. The CA enables the identification of circumstances in which robots could enhance dignity by expanding the set of capabilities that are accessible to frail older people. At the same time, it is also possible within its framework to identify ways in which robots could have a negative impact, by impeding the access of older people to essential capabilities. It is concluded that the CA has some advantages over other accounts of dignity, but that further work and empirical study is needed in order to adapt it to the particular circumstances and concerns of those in the latter part of their lives. (shrink)

The Austrian system for pensions and care is dated back to the monarchy and was established in the year 1848 when the future empire ensured the whole country. In the settlement with Hungary, the Hungarians got their own system, and now there is a guarantee for the wellbeing of older persons in Austria. As most of the people remember, the only introduction was after the First World War in Austria, between 1918 and 1920 the social assurance system (...) was created by persons such as Ferdinand Hanusch or members of the social-democratic party. Now the whole system has three pillars: the assurance of health; the assurance of accidents; and the assurance for older persons and care, which is covering the risks after the age of 60. It was a class-struggle when people go into a pension, but as far as we can see, the development was similar in the whole of Europe. The changes were done after the Second World War when some of the countries became communist regimes, while Austria became a flower of diversity in the systems of social assurances. There were no private assurances, those who existed were plus-payers, so the state allowed the assurance according to professions and qualifications. As we see, the results are different from the communist states of the Warsaw Pact, and this chapter focuses on explaining the social system of today and the changes of it as it is perceived. (shrink)

Health services internationally struggle to ensure health care is “person-centered” (or similar). In part, this is because there are many interpretations of “person-centered care” (and near synonyms), some of which seem unrealistic for some patients or situations and obscure the intrinsic value of patients’ experiences of health care delivery. The general concern behind calls for person-centered care is an ethical one: Patients should be “treated as persons.” We made novel use of insights from the capabilities (...) approach to characterize person-centered care as care that recognizes and cultivates the capabilities associated with the concept of persons. This characterization unifies key features from previous characterisations and can render person-centered care applicable to diverse patients and situations. By tying person-centered care to intrinsically valuable capability outcomes, it incorporates a requirement for responsiveness to individuals and explains why person-centered care is required independently of any contribution it may make to health gain. (shrink)

Personal recovery entails the idea of learning to live a good life in the face of mental illness. It takes place in a continuous dynamic between change and acceptance and involves the existential dimension in the broadest sense. With cognitive self-regulation and empowerment as central elements, however, current models of recovery mostly have an individual focus instead of a relational one. Furthermore, there seems to be an emphasis on the component of change. Little attention is payed to the role and (...) integration of dealing with loss in personal recovery. In this paper, the role of loss in mental illness will be elaborated from an existential perspective. This will be done by relating existential changes to possibly disruptive experiences of loss in wider experience. With the help of several perspectives on dealing with loss it will be argued this can be integrated in processes of recovery. Then, it will be elaborated how reexperiencing a state of being surrounded, or being included, being held is a necessary part of recovery. The result consists of a refinement of the view on personal recovery. The aim of this paper is therefore twofold: (1) to arrive at a better understanding of what existential loss and loss in wider experience in the context of psychopathology entails, and (2) to further develop perspectives on recovery in mental health care. (shrink)

New technologies such as smart sensors improve rehabilitation processes and thereby increase older adults’ capabilities to participate in social life, leading to direct physical and mental health benefits. Wearable smart sensors for home use have the additional advantage of monitoring day-to-day activities and thereby identifying rehabilitation progress and needs. However, identifying and selecting rehabilitation priorities is ethically challenging because physicians, therapists, and caregivers may impose their own personal values leading to paternalism. Therefore, we develop a discussion template consisting of (...) a series of adaptable questions for the patient–physician encounter based on the capability approach. The goal is to improve geriatric rehabilitation and thereby increase participation in social life and well-being. To achieve this goal, we first analyzed what is considered important for participation on basis of the capability approach, human rights, and ethics of care. Second, we conducted an ethical analysis of each of the four identified dimensions of participation: political, economic, socio-cultural, and care. To improve compliance with rehabilitation measures, health professionals must align rehabilitation measures in an open dialogue with the patient’s aspiration for participation in each dimension. A discussion template based on the capability approach allows for a proactive approach in patient information and stimulates a critical assessment of treatment alternatives while reducing the risk of imposing personal values. (shrink)

Organ transplantation centers set criteria for candidate qualification, which has led to disparate healthcare resource allocation practices affecting those with a substance use history. These individuals are denied organ transplants by committees and healthcare providers who assign them lower priority status. The lower priority argument claims that healthcare resources should not be provided equally to individuals who fail to share responsibility for not doing enough to address the diseases associated with substance use. The purpose of this paper is to explore (...) the interrelatedness between the ethics of a merit-based system of moral responsibility and the lower priority setting involved in healthcare resource allocation pertaining to those with substance use histories. An interdisciplinary approach to the argument against the lower prioritists is taken with a focus on the relationship between different organ allocation practices affecting substance users and the justification for resource allocation practices of healthcare and transplant committees. Lower priority setting is challenged, and an argument is offered in which substance users are assigned higher priority when relying on "doing enough" in a merit-based system of moral responsibility. It is determined that one cannot substantiate assigning a lower priority status since a lack of success in rehab does not imply a lack of effort. Additionally, neither to confirmatory behavior nor to non-conforming behavior may freedom be justifiably ascribed in a merit-based system of responsibility because freedom to choose can neither be established a priori nor a posteriori concerning meritorious behavior. (shrink)

It is a matter of fact that Europe is facing more and more crucial challenges regarding health and social care due to the demographic change and the current economic context. The recent COVID-19 pandemic has stressed this situation even further, thus highlighting the need for taking action. Active and Assisted Living technologies come as a viable approach to help facing these challenges, thanks to the high potential they have in enabling remote care and support. Broadly speaking, AAL can (...) be referred to as the use of innovative and advanced Information and Communication Technologies to create supportive, inclusive and empowering applications and environments that enable older, impaired or frail people to live independently and stay active longer in society. AAL capitalizes on the growing pervasiveness and effectiveness of sensing and computing facilities to supply the persons in need with smart assistance, by responding to their necessities of autonomy, independence, comfort, security and safety. The application scenarios addressed by AAL are complex, due to the inherent heterogeneity of the end-user population, their living arrangements, and their physical conditions or impairment. Despite aiming at diverse goals, AAL systems should share some common characteristics. They are designed to provide support in daily life in an invisible, unobtrusive and user-friendly manner. Moreover, they are conceived to be intelligent, to be able to learn and adapt to the requirements and requests of the assisted people, and to synchronise with their specific needs. Nevertheless, to ensure the uptake of AAL in society, potential users must be willing to use AAL applications and to integrate them in their daily environments and lives. In this respect, video- and audio-based AAL applications have several advantages, in terms of unobtrusiveness and information richness. Indeed, cameras and microphones are far less obtrusive with respect to the hindrance other wearable sensors may cause to one’s activities. In addition, a single camera placed in a room can record most of the activities performed in the room, thus replacing many other non-visual sensors. Currently, video-based applications are effective in recognising and monitoring the activities, the movements, and the overall conditions of the assisted individuals as well as to assess their vital parameters. Similarly, audio sensors have the potential to become one of the most important modalities for interaction with AAL systems, as they can have a large range of sensing, do not require physical presence at a particular location and are physically intangible. Moreover, relevant information about individuals’ activities and health status can derive from processing audio signals. Nevertheless, as the other side of the coin, cameras and microphones are often perceived as the most intrusive technologies from the viewpoint of the privacy of the monitored individuals. This is due to the richness of the information these technologies convey and the intimate setting where they may be deployed. Solutions able to ensure privacy preservation by context and by design, as well as to ensure high legal and ethical standards are in high demand. After the review of the current state of play and the discussion in GoodBrother, we may claim that the first solutions in this direction are starting to appear in the literature. A multidisciplinary debate among experts and stakeholders is paving the way towards AAL ensuring ergonomics, usability, acceptance and privacy preservation. The DIANA, PAAL, and VisuAAL projects are examples of this fresh approach. This report provides the reader with a review of the most recent advances in audio- and video-based monitoring technologies for AAL. It has been drafted as a collective effort of WG3 to supply an introduction to AAL, its evolution over time and its main functional and technological underpinnings. In this respect, the report contributes to the field with the outline of a new generation of ethical-aware AAL technologies and a proposal for a novel comprehensive taxonomy of AAL systems and applications. Moreover, the report allows non-technical readers to gather an overview of the main components of an AAL system and how these function and interact with the end-users. The report illustrates the state of the art of the most successful AAL applications and functions based on audio and video data, namely lifelogging and self-monitoring, remote monitoring of vital signs, emotional state recognition, food intake monitoring, activity and behaviour recognition, activity and personal assistance, gesture recognition, fall detection and prevention, mobility assessment and frailty recognition, and cognitive and motor rehabilitation. For these application scenarios, the report illustrates the state of play in terms of scientific advances, available products and research project. The open challenges are also highlighted. The report ends with an overview of the challenges, the hindrances and the opportunities posed by the uptake in real world settings of AAL technologies. In this respect, the report illustrates the current procedural and technological approaches to cope with acceptability, usability and trust in the AAL technology, by surveying strategies and approaches to co-design, to privacy preservation in video and audio data, to transparency and explainability in data processing, and to data transmission and communication. User acceptance and ethical considerations are also debated. Finally, the potentials coming from the silver economy are overviewed. (shrink)

The idea that healthcare should become more person-centred is extremely influential. By using recent English policy developments as a case study, this article aims to critically analyse an important element of person-centred care, namely, the belief that to treat patients as persons is to think that care should be ‘co-produced’ by formal healthcare providers and patients together with unpaid carers and voluntary organizations. I draw on insights from political philosophy to highlight overlooked tensions between co-production and values (...) like equality and liberty. Regarding equality, I argue that co-production compounds both problems of gender inequality in the distribution of care labour and the challenges associated with securing equal access to care. Turning to liberty, I identify important commonalities between co-production and republicanism in political philosophy, given their shared insistence on common citizens’ civic virtue. Then, I use against co-production some liberal arguments against republicanism, to highlight a problem of over-demandingness. In bringing my argument to a close, however, I wish to caution against hastily rejecting co-production as a policy programme. (shrink)

This paper offers an ethical framework for the development of robots as home companions that are intended to address the isolation and reduced physical functioning of frail older people with capacity, especially those living alone in a noninstitutional setting. Our ethical framework gives autonomy priority in a list of purposes served by assistive technology in general, and carebots in particular. It first introduces the notion of “presence” and draws a distinction between humanoid multi-function robots and non-humanoid robots to suggest (...) that the former provide a more sophisticated presence than the latter. It then looks at the difference between lower-tech assistive technological support for older people and its benefits, and contrasts these with what robots can offer. This provides some context for the ethical assessment of robotic assistive technology. We then consider what might need to be added to presence to produce care from a companion robot that deals with older people’s reduced functioning and isolation. Finally, we outline and explain our ethical framework. We discuss how it combines sometimes conflicting values that the design of a carebot might incorporate, if informed by an analysis of the different roles that can be served by a companion robot. (shrink)

Organ transplantation centers set criteria for candidate qualification, which has led to disparate healthcare resource allocation practices affecting those with a substance use history. These individuals are denied organ transplants by committees and healthcare providers who assign them lower priority status. The lower priority argument claims that healthcare resources should not be provided equally to individuals who fail to share responsibility for not doing enough to address the diseases associated with substance use. The purpose of this paper is to explore (...) the interrelatedness between the ethics of a merit-based system of moral responsibility and the lower priority setting involved in healthcare resource allocation pertaining to those with substance use histories. An interdisciplinaryapproach to the argument against the lower prioritists is taken with a focus on the relationship between different organ allocation practices affecting substance users and the justification for resource allocation practices of healthcare and transplant committees. Lower priority setting is challenged, and an argument is offered in which substance users are assigned higher priority when relying on "doing enough" in a merit-based system of moral responsibility. It is determined that one cannot substantiate assigning a lower priority status since a lack of success in rehab does not imply a lack of effort. Additionally, neither to confirmatory behavior nor to non-conforming behavior may freedom be justifiably ascribed in a merit-based system of responsibility because freedom to choose can neither be established a priori nor a posteriori concerning meritorious behavior. (shrink)

The personal identity relation is of great interest to philosophers, who often consider fictional scenarios to test what features seem to make persons persist through time. But often real examples of neuroscientific interest also provide important tests of personal identity. One such example is the case of Phineas Gage – or at least the story often told about Phineas Gage. Many cite Gage’s story as example of severed personal identity; Phineas underwent such a tremendous change that Gage “survived as (...) a different man.” I discuss a recent empirical finding about judgments about this hypothetical. It is not just the magnitude of the change that affects identity judgment; it is also the negative direction of the change. I present an experiment suggesting that direction of change also affects neuroethical judgments. I conclude we should consider carefully the way in which improvements and deteriorations affect attributions of personal identity. This is particularly important since a number of the most crucial neuroethical decisions involve varieties of cognitive enhancements or deteriorations. (shrink)

The main theory at the core of this monograph is that the person is an entity ontologically new, since she is able to perform an act of self-transcendence, which is meant as her critical distancing from her own “self”, understood as subject of social recognition (Anerkennung), in order to open to the encounter with the world (Weltoffenheit). This allows us to consider a person in a new way, different both from confessional interpretations that see her only as a center of (...) the spirit and from reductivistic views. Schelling examines the act of self-transcendence through the concept of ecstasy, whereas Scheler associates it with the phenomenological reduction. The act of self-transcendence, that Schelling sees as originated by the “hunger of being”, is at the roots of the formation process of a person (Bildung): the person takes her shape by exiting from her own self-referential dimension and encountering otherness. If considered from this viewpoint, Plato’s “epimeleia heautou” exceeds an intimistic perspective: the “care” is no more a solipsistic self-care, but rather becomes the care through which the person transcends her own self to open to the relationships with otherness. It turns, therefore, into a care for world-openness (care for Weltoffenheit). The transformation of the individual and of society so becomes the double-faced aspect of the same process. The development of this set of problems occurs through a dialogue with Schelling’s and Scheler’s positions, but it is also supported by a historical-philosophical investigation, that for instance provides evidence of the influences of Schelling’s Berlin period on Scheler’s last theories and on the philosophical anthropology of the 20th century. Schelling was the first to conceive the concept of “eccentricity” in an anthropological sense, since until then the term had been confined to Kepler’s astronomy. Consequently, the planets’ elliptic (eccentric) movement heightens to an emblematic metaphor of human nature and freedom. The monograph also examines a possible convergence between Plato’s epimeleia heautou and Scheler’s phenomenological reduction. The book ends with a chapter on the topic of Vorbild. The exemplary testimony, that is Vorbild, becomes witnessing evidence immune from any pedagogical-moralistic intent: in fact, if it should relapse into the rhetoric of the “wish to give a good example”, it would immediately conform to the opposite logic of the model. A model is universal in so far as it makes everyone more like the others, nullifying the diversity, whereas exemplariness is universal in so far as it makes everyone more unique and motivates each one to follow her own characteristic path of existential trans-formation. Exemplarity doesn’t convey any contents, but rather encourages a kind of solidaristic involvement. Yet there are also negative exemplarities (Gegenbild) that place obstacles in the formation and block the existence of the personal center. (shrink)

The COVID-19 (Coronavirus disease of 2019) pandemic has led to intense conversations about ventilator allocation and reallocation during a crisis standard of care. Multiple voices in the media and multiple state guidelines mention reallocation as a possibility. Drawing upon a range of neuroscientific, phenomenological, ethical, and sociopolitical considerations, the authors argue that taking away someone’s personal ventilator is a direct assault on their bodily and social integrity. They conclude that personal ventilators should not be part of reallocation pools and (...) that triage protocols should be immediately clarified to explicitly state that personal ventilators will be protected in all cases. (shrink)

Phineas Gage’s story is typically offered as a paradigm example supporting the view that part of what matters for personal identity is a certain magnitude of similarity between earlier and later individuals. Yet, reconsidering a slight variant of Phineas Gage’s story indicates that it is not just magnitude of similarity, but also the direction of change that affects personal identity judgments; in some cases, changes for the worse are more seen as identity-severing than changes for the better of comparable magnitude. (...) Ironically, thinking carefully about Phineas Gage’s story tells against the thesis it is typically taken to support. (shrink)

Persons care about their future selves. They reason about their future selves’ interests; they plan for their future selves’ happiness and they worry about their future selves’ suffering. This paper is interested in the interplay between diachronic prudential reason and certain accounts of the metaphysics of personal identity that fall under the broad umbrella ‘conventionalist’. Some conventionalists conclude that under certain conditions there are intractable decisions for there is no fact of the matter regarding whether a person-stage ought (...) (prudentially) to ϕ. This paper will suggest otherwise. These decisions are not intractable if we allow that it is sometimes rational for a person-stage to discount the utility of certain future person-stages. The paper then goes on to explore an alternative position that conventionalists might occupy which does not involve any such discounting: prudential relativism. According to prudential relativism it is impossible to offer a single, correct, answer to the question: should person-stage, P, ϕ at t? For according to prudential relativism there is no stage-independent stance from which to evaluate whether a person-stage ought to ϕ. Yet it is not, for all that, intractable, from P’s perspective, whether or not to ϕ. (shrink)

The UN Convention against Torture defines torture as “any act by which severe pain or suffering, whether physical or mental, is intentionally inflicted on a person” by someone acting in an official capacity for purposes such as obtaining a confession or punishing or intimidating that person.1 It is unethical for healthcare professionals to participate in torture, including any use of medical knowledge or skill to facilitate torture or allow it to continue, or to be present during torture.2-7 Yet medical participation (...) in torture has taken place throughout the world and was a prominent feature of the US interrogation practice in military and Central Intelligence Agency (CIA) detention facilities in the years after the attacks of 11 September 2001.8-11 Little attention has been paid, however, to how a regime of torture affects the ability of health professionals to meet their obligations regarding routine clinical care for detainees. -/- The 2016 release of previously classified portions of guideline from the CIA regarding medical practice in its secret detention facilities sheds light on that question. These show that the CIA instructed healthcare professions to subordinate their fundamental ethical obligations regarding professional standards of care to further the objectives of the torturers. (shrink)

-/- Caring for loved ones with dementia can sometimes necessitate a loose relationship with the truth. Some might view such deception as categorically immoral, and a violation of our general truth-telling obligations. I argue that this view is mistaken. This is because truth-telling obligations may be limited by the particular relationships in which they feature. Specifically, within caregiving relationships, we are often permitted (and sometimes obligated) to deceive the people with whom we share them. Our standing to deceive follows from (...) certain features of caregiving relationships. Specifically, they are relationships that involve obligations to promote a person's interests and values (and not simply their autonomy), that often permit us to assume the hypothetical consent of the person with whom we share them, and in which we are often entitled to act out of self-interest. Once we appreciate these features, we will be able to recognize that the truth-telling norms governing our relationships with loved ones with dementia do not represent a radical departure from our general truth-telling obligations, but are instead consistent with truth-telling norms that feature in other caregiving relationships. In addition, we will be able to understand why we may feel conflicted about lying to loved ones with dementia, even when lying is permissible. (shrink)

Much of the discussion of the role of emerging technologies associated with AI, machine learning, digital simulacra, and relevant ethical considerations such as those discussed in the target article, take a relatively narrow and episodic view of a person’s healthcare needs. There is much speculation about diagnostic, treatment, and predictive applications but relatively little consideration of how such technologies might be used to address a person’s lived experience of illness and ongoing care needs. This is likely due to the (...) greater weight or priority given to acute care needs and the role of medical treatment in care provision, but it may also reflect the limitations of current technologies and our limited vision of their potential application. Such limitations are not surprising given that we are still grappling with the complexities and nuances of achieving the ethical and humanistic ideals of care, namely, care that addresses the hermeneutical, relational, contextual, temporal, and agential dimensions of a person’s health and wellbeing. (shrink)

Both Martin Heidegger and Harry Frankfurt have argued that the fundamental feature of human identity is care. Both contend that caring is bound up with the fact that we are finite beings related to our own impending death, and both argue that caring has a distinctive, circular and non-instantaneous, temporal structure. In this paper, I explore the way Heidegger and Frankfurt each understand the relations among care, death, and time, and I argue for the superiority of Heideggerian version (...) of this nest of claims. Frankfurt claims that we should conceive of the most basic commitments which practically orient a person in the world and define his identity (“volitional necessities”) as naturalistic facts, foundational for and located completely without the normative space of reasons. In support of this he appeals to the supposedly foundational role played in human life by the instinct for self-preservation, what Frankfurt calls the “love of living.” The claim is that in questions of practical identity there is a definite priority of the factual over the normative. Frankfurt’s naturalistic model of volitional necessity is motivated by a misunderstanding of the temporal structure of care, a misunderstanding that helps lead him to an implausible conception of the basic structures of human identity. Heidegger advances an anti-naturalistic conception of caring, one bound up with his way of understanding how human beings relate to their own future. I argue that the existential, temporal, and normative significance that Frankfurt attributes to the naturalized “love of living” is better captured by the Heideggerian claim that human identity is defined by being “for-the-sake-of” certain projects and commitments, a way of being lived out in the way Heidegger calls “being-towards-death.”. (shrink)

The purpose of this paper is to provide a justification of punishment which can be endorsed by free will skeptics, and which can also be defended against the "using persons as mere means" objection. Free will skeptics must reject retributivism, that is, the view that punishment is just because criminals deserve to suffer based on their actions. Retributivists often claim that theirs is the only justification on which punishment is constrained by desert, and suppose that non-retributive justifications must therefore (...) endorse treating the people punished as mere means to social ends. Retributivists typically presuppose a monolithic conception of desert: they assume that action-based desert is the only kind of desert. But there are also personhood-based desert claims, that is, desert claims which depend not on facts about our actions, but instead on the more abstract fact that we are persons. Since personhood-based desert claims do not depend on facts about our actions, they do not depend on moral responsibility, so free will skeptics can appeal to them just as well as retributivists. What people deserve based on the mere fact of their personhood is to be treated as they would rationally consent to be treated if all they had in view was the mere fact of their personhood. We can work out the implications of this view for punishment by developing a hypothetical consent justification in which we select principles of punishment in the Rawlsian original position, so long as we are careful not to smuggle in the retributivist assumption that it is under our control whether we end up as criminals or as law-abiding citizens once we raise the veil of ignorance. (shrink)

In their strife for designing a moral system where everyone is given equal consideration, cosmopolitan theorists have merely tolerated partiality as a necessary evil (insofar it means that we give priority to our kin opposite the distant needy). As a result, the cosmopolitan ideal has long departed from our moral psychologies and our social realities. Here I put forward partial cosmopolitanism as an alternative to save that obstacle. Instead of demanding impartial universal action, it requires from us that we are (...) equally responsive in all the relationships we stand in. That goes from the local to the cosmopolitan sphere, since I defend that we are related with strangers as co-members of the global community. Thus, partiality not only is accommodated by cosmopolitanism, but actually supports it: only by having meaningful personal relationships we become able to care for distant strangers. (shrink)

If one can get the targets of one's current wants only by acquiring new wants (as in the Prisoner's Dilemma), is it rational to do so? Arguably not. For this could justify adopting unsatisfiable wants, violating the rational duty to maximize one's utility. Further, why cause a want's target if one will not then want it? And people "are" their wants. So if these change, people will not survive to enjoy their wants' targets. I reply that one rationally need not (...) advance one's future wants, only current ones. Furthermore, rational choice seeks not utility (the co-obtaining of a want and its target), but satisfaction (the eventual obtaining of what is now wanted) -- otherwise, it would be irrational to care now about what happens after one dies. Finally, persons survive "rational" changes of values. Thus reflection on the rational revision of values illuminates the conditions on personal identity and the bases and aims of rational choice. (shrink)

Transactive memory theory describes the processes by which benefits for memory can occur when remembering is shared in dyads or groups. In contrast, cognitive psychology experiments demonstrate that social influences on memory disrupt and inhibit individual recall. However, most research in cognitive psychology has focused on groups of strangers recalling relatively meaningless stimuli. In the current study, we examined social influences on memory in groups with a shared history, who were recalling a range of stimuli, from word lists to personal, (...) shared memories. We focused in detail on the products and processes of remembering during in-depth interviews with 12 older married couples. These interviews consisted of three recall tasks: (1) word list recall; (2) personal list recall, where stimuli were relevant to the couples’ shared past; and (3) an open-ended autobiographical interview. We conducted these tasks individually and then collaboratively two weeks later. Across each of the tasks, although some couples demonstrated collaborative inhibition, others demonstrated collaborative facilitation. We identified a number of factors that predicted collaborative success, in particular, group-level strategy use. Our results show that collaboration may help or hinder memory, and certain interactions are more likely to produce collaborative benefits. (shrink)

In his paper, ‘What moral work can Nussbaum’s account of human dignity do in the context of dementia care?’, Soofi seeks to modify Nussbaum’s conception of dignity to deal with four key objections that arise when appeals to dignity are made in the context of dementia care. We will not discuss the first of these, the redundancy of dignity talk, since this issue has already been much discussed in the literature. Instead, we will focus on the remaining three (...) issues raised, that of the exclusion of persons with advanced dementia from having dignity, unjustified speciesism as a ground of human dignity, and the unclear practical implications that follow from having dignity. (shrink)

Narrated in the first person, Peter Carey’s novel about the life of Australian bushranger Ned Kelly incorporates other aspects of speech derived both from Carey’s personal experience and from the editorial process. Kelly's voice is toned down to some extent by virtue of the latter, introducing expressions Kelly himself would not have used. Identifying these elements, along with the specific attributes of Kelly’s own speech, enjoins a diversity of cultural and social groupings that intersect and, in some instances, compete with (...) or contradict one another. Shifts in speakers might be signalled by textual markers or by adopting different expressive qualities and speech patterns, which may or may not include a change in grammatical person. In this novel, at one instance, a shift in person is apparent, but I want to argue, not necessarily a shift in the identity of the speaker because, although the grammatical voice shifts, its qualitative features are largely unaltered. The shift nonetheless introduces a significant change. Paradoxically, as far as literary theory is concerned, the subjective qualities produced through voice mean that stylisations of speech may be indicative of character point of view, rather than what is understood to be narrative voice, because they might function in narrative as inflections of speech that do not correspond to the established voice of the grammatically instanced speaker—offering a focalised perspective instead. The shift in True History presents problems in these terms, however: the point of view instanced here is clearly that belonging to the speaker, though the voice is Kelly’s, for the narrator’s point of view determines the generality of the descriptive terms where once these were specific and personal. Had the novel been narrated wholly in third person, an unproblematic reading of Kelly’s point of view, suggested by the use of his voice, would be possible. But the shift undermines this—Kelly’s point of view gives way to another, instanced in the shift that takes place in narrative voice. Carey, in other words, inverts the convention. This is not an instance of free indirect style or discourse, where grammatical mood is at odds with the speaker’s position and tenses align with the implicated subject position of another. The same features of voice that might identify character point of view must, in absence of any disparity of mood or tone, function in respect to narrative voice to convey something of its speaker’s subjectivity, and this seems apparent here: the speaker shares Kelly’s subjective emotional and intellectual perspective, but no longer occupies the subject position. Carey’s voicing of the bushranger therefore complicates distinctions between voice and point of view by revealing qualitative features of voice to be important to the question of who is speaking the narrative. (shrink)

The problem of standard of care in clinical research concerns the level of treatment that investigators must provide to subjects in clinical trials. Commentators often formulate answers to this problem by appealing to two distinct types of obligations: professional obligations and natural duties. In this article, I investigate whether investigators also possess institutional obligations that are directly relevant to the problem of standard of care, that is, those obligations a person has because she occupies a particular institutional role. (...) I examine two types of institutional contexts: (1) public research agencies – agencies or departments of states that fund or conduct clinical research in the public interest; and (2) private-for-profit corporations. I argue that investigators who are employed or have their research sponsored by the former have a distinctive institutional obligation to conduct their research in a way that is consistent with the state's duty of distributive justice to provide its citizens with access to basic health care, and its duty to aid citizens of lower income countries. By contrast, I argue that investigators who are employed or have their research sponsored by private-for-profit corporations do not possess this obligation nor any other institutional obligation that is directly relevant to the ethics of RCTs. My account of the institutional obligations of investigators aims to contribute to the development of a reasonable, distributive justice-based account of standard of care. (shrink)

Personal Health Monitoring (PHM) uses electronic devices which monitor and record health-related data outside a hospital, usually within the home. This paper examines the ethical issues raised by PHM. Eight themes describing the ethical implications of PHM are identified through a review of 68 academic articles concerning PHM. The identified themes include privacy, autonomy, obtrusiveness and visibility, stigma and identity, medicalisation, social isolation, delivery of care, and safety and technological need. The issues around each of these are discussed. The (...) system / lifeworld perspective of Habermas is applied to develop an understanding of the role of PHMs as mediators of communication between the institutional and the domestic environment. Furthermore, links are established between the ethical issues to demonstrate that the ethics of PHM involves a complex network of ethical interactions. The paper extends the discussion of the critical effect PHMs have on the patient’s identity and concludes that a holistic understanding of the ethical issues surrounding PHMs will help both researchers and practitioners in developing effective PHM implementations. (shrink)

In the film classic Blade Runner, the story explores the notion of personal identity through that of carefully crafted androids. Can an android have a personality; can androids be persons? The title of the original story by Philip K. Dick is Do Androids Dream of Electric Sheep? The story suggests that our sense of being a person depends on our having memories that connect us with our childhood. In the movie, the androids are only a couple of years old, (...) but have adult bodies. To complete them as persons they are given simulated memories of childhood. Some psychiatrists have decided that even humans dream only of electric sheep. I explore how Popper’s world 3 can help to defend a notion of personhood that can be used to criticize the thesis that persons are simply complex physical processes and that all their serious life-problems can be conceptualised as a form of physical illness. (shrink)

Since Chenyang Li’s (1994) groundbreaking article there has been interest in reading early Confucian ethics through the lens of care ethics. In this paper, I examine the prospects for dialogue between the two in light of recent work in both fields. I argue that, despite some similarities, early Confucian ethics is not best understood as a form of care ethics, of the kind articulated by Nel Noddings (1984, 2002) and others. Reasons include incongruence deriving from the absence in (...) the Chinese texts of a developed account of need, and doubts about whether the parent-child relationship in Confucian thought is best characterized by ‘care’. More importantly, care is merely one value directing the Confucian commitment to family and personal bonds, with different kinds of relationship, including the five relationships presented in the Mencius, entailing different idealized modes of relating to others. (shrink)

Health care systems can positively influence our personal decision-making and health-related behavior only if we trust them. I propose a conceptual analysis of the trust relation between the public and a healthcare system, drawing from healthcare studies and philosophical proposals. In my account, the trust relation is based on an epistemic component, epistemic authority, and on a value component, the benevolence of the healthcare system. I argue that it is also modified by the vulnerability of the public on healthcare (...) matters, and by the system’s credibility. I apply my proposed analysis of public trust in health care systems to the phenomenon of vaccine hesitancy, a tendency to question vaccine policies, and to seek alternative vaccine schedules or to refuse vaccination. Understanding the role of trust and its components can be key to understanding the phenomenon. (shrink)

Digital phenotyping will potentially enable earlier detection and prediction of mental illness by monitoring human interaction with and through digital devices. Notwithstanding its promises, it is certain that a person’s digital phenotype will at times be at odds with their first-person testimony of their psychological states. In this paper, we argue that there are features of digital phenotyping in the context of psychiatry which have the potential to exacerbate the tendency to dismiss patients’ testimony and treatment preferences, which can be (...) instances of epistemic injustice. We first explain what epistemic injustice is, and why it is argued to be an extensive problem in health and disability settings. We then explain why epistemic injustice is more likely to apply with even greater force in psychiatric contexts, and especially where digital phenotyping may be involved. Finally, we offer some tentative suggestions of how epistemic injustice can be minimised in digital psychiatry. (shrink)

Thought experiments that concoct bizarre possible world modalities are standard fare in debates on personal identity. Appealing to intuitions raised by such evocations is often taken to settle differences between conflicting theoretical views that, albeit, have practical implications for ethical controversies of personal identity in health care. Employing thought experiments that way is inadequate, I argue, since personhood is intrinsically linked to constraining facts about the actual world. I defend a moderate modal skepticism according to which intuiting across conceptually (...) incongruent worlds constitutes ‘invalid intuitioninferences’—i.e., carrying over intuitions gathered from facts about possible worlds that are at odds with facts about the actual world, for the purpose of making claims about real-life persons and their identity, leads to conceptual incongruences. Such a methodological fallout precludes accurate, informative judgments about personal identity in the actual world, calling into question the adequacy of thought experimental considerations for potential real world applications in medical ethics. (shrink)

Through careful interpretive analysis, the piece argues that the Christian cosmic vision reveals the wrongness of industrial animal agriculture and that taking up more intentional eating practices is a morally significant spiritual discipline for Christians. It also testifies to our claim in the introduction [to the "Food and Religion" chapter of *Food, Ethics, and Society*] that religious food ethics have practical advantages over purely secular ethics insofar as the latter usually tries to begin from a neutral perspective that has very (...) little power to compel a person, whereas religious food ethics hooks into one's deepest commitments. (shrink)

The growing proportion of elderly people in society, together with recent advances in robotics, makes the use of robots in elder care increasingly likely. We outline developments in the areas of robot applications for assisting the elderly and their carers, for monitoring their health and safety, and for providing them with companionship. Despite the possible benefits, we raise and discuss six main ethical concerns associated with: (1) the potential reduction in the amount of human contact; (2) an increase in (...) the feelings of objectification and loss of control; (3) a loss of privacy; (4) a loss of personal liberty; (5) deception and infantilisation; (6) the circumstances in which elderly people should be allowed to control robots. We conclude by balancing the care benefits against the ethical costs. If introduced with foresight and careful guidelines, robots and robotic technology could improve the lives of the elderly, reducing their dependence, and creating more opportunities for social interaction. (shrink)

Imagine you are the CEO of a hospital [. . .]. Decisions are constantly being made in your organization about how to spend the organization's money. The amount of money available to spend is never adequate to pay for everything you wish you could spend it on, therefore you must set spending priorities. There are two questions you need to be able to answer . . . How should we set priorities in this organization? How do we know when we (...) are doing it well? When people seek to achieve good public policy, the result will tend to be good public policy. In a collective choice process, public‐spirited individual participants produce good public policy by deliberating—talking with each other, listening to each other's arguments, and being willing to learn and change their minds based on such dialogue. –Steven Kelman (1992: 181) Public policy scholars agree that those persons (or agencies) vested with the authority to establish health care priorities should elicit public input before making rationing decisions. The two most common approaches are (i) consultation and (ii) deliberation. Though deliberation has obvious advantages over consultation, it falters in the face of the objection that ordinary citizens lack the cognitive resources for the extended, rigorous inquiry required of them in undertaking the priority‐setting task. To overcome this objection, I propose that deliberative forums for health care rationing should be designed so that they imitate the natural pattern of human experience. The experience of deliberation should encompass both prolonged periods of less‐demanding cognitive activity, in which citizens passively receive information, and briefer periods of more‐demanding cognitive activity, in which they engage in active problem‐solving. In arguing for this thesis, I rely on two theoretical sources and one practical case study, in the following order: (i) John Dewey's metaphysics of experience, (ii) cognitive science research on schemas and frames, and (iii) the Health Care Council in São Paulo, Brazil. (shrink)

A ‘should’ question normally signals work for an ethicist but this ethicist’s task is complicated by the normative dimension of all the chapters in this volume. Each author was asked to come up with three recommendations from their own subject area – ’should’ statements deriving from the ‘is’ analysis that they present. If those prescriptions cover the relevant topics, what more is there for an ethicist to do? I have had a personal interest in obstetricians’ relationship with ‘older women’ (...) since being classified as an ‘elderly primigravida’ at the superannuated age of 26 years. Apart from that, however, what original contribution can I make? The convenors of the 56th RCOG Study Group gave me plentiful suggestions – perhaps a little too plentiful: How should the RCOG approach its constituencies, medical ethics, regulation and its relationship to government and the rest of the medical profession, i.e. the NHS and the market, vested interests, individuals or consumers, families, the unborn, doctors, drug companies, surrogacy, the unborn, trafficking, global adoption, law, research? I have to admit this was just too much for me. Instead, I want to argue for what may seem a self-evidently simple point. The RCOG describes its mission as ‘setting standards to improve women’s health’ – presumably all women. In the 6 years that I have served on the RCOG Ethics Committee, however, we have almost always been concerned with that minority of the female population who are of reproductive age. (shrink)

Shared decision-making involves health professionals and patients/clients working together to achieve true person-centred health care. However, this goal is infrequently realized, and most barriers are unknown. Discussion between philosophers, clinicians, and researchers can assist in confronting the epistemic and moral basis of health care, with benefits to all. The aim of this paper is to describe what shared decision-making is, discuss its necessary conditions, and develop a definition that can be used in practice to support excellence in maternity (...) care. Discussion between the authors, with backgrounds in philosophy, clinical maternity care, health care management, and maternity care research, assisted the team to confront established norms in maternity care and challenge the epistemic and moral basis of decision-making for caesarean section. The team concluded that shared decision-making must start in pregnancy and continue throughout labour and birth, with equality in discourse facilitated by the clinician. Clinicians have a duty of care for the adequacy of women's knowledge, which can only be fulfilled when relevant knowledge is offered freely and when personal beliefs and biases that may impinge on decision-making (defeaters) are disclosed. Informed consent is not shared decision-making. Key barriers include existing cultural norms of “the doctor knows best” and “patient acquiescence” that prevent defeaters being acknowledged and discussed and can lead to legal challenges, overuse of medical intervention and, in some areas, obstetric violence. Shared decision-making in maternity care can thus be defined as an enquiry by clinician and expectant woman aimed at deciding upon a course of care or none, which takes the form of a dialogue within which the clinician fulfils their duty of care to the client's knowledge by making available their complete knowledge (based on all types of evidence) and expertise, including an exposition of any relevant and recognized potential defeaters. Research to develop measurement tools is required. (shrink)

Background Bronchial asthma is one of the most common chronic conditions among children. Despite the improvement in asthma treatment regimens, its prevalence and related morbidity are increasing, especially among underserved, minority children. There are barriers in the management of asthma, which may impact the quality of outcomes. The goal of this study is to explore these barriers. Methods A cross-sectional study was conducted on interview data collected through 2019 from mothers of children (aged 6 - 12 years) with asthma visiting, (...) for convenience, a public shopping mall. The interviewees were randomly selected, because they met the inclusion criteria. Participants were considered if the mother answered “yes” to the following questions: Has your child had physician-diagnosed asthma? Is your child currently taking asthma medications of asthma? Two community nurses conducted the interviews. Data was obtained using administrative questionnaires. Data were analyzed using SPSS version 21.0 (IBM Inc., Chicago, IL, USA). Descriptive statistics of percentage, mean, frequency and standard deviation were applied for categorical and continuous variables. Results Three hundred mothers participated in this study. Their average age was 36.8 years, 55% were housekeepers by profession, and 34% had obtained less than high school education. The majority of children (61%) were males, 45% had moderate asthma, and 42% had mild asthma. The most frequent types of barriers identified by parents were environmental factors (67.7%), followed by health care providers (63%), the health care system (48%), and patient or family characteristics (43%). Mothers were specifically concerned about the use, safety, and long-term complications of medications, the impact of exercise limitation on their child’s quality of life, and their own quality of life. Conclusion This study showed several barriers against asthma care in Saudi Arabia, which mainly related to environmental or personal characteristics. This highlights the need to enhance current policies within the health care system in Saudi Arabia to overcome these barriers. (shrink)

Many criminal offenders come from disadvantaged backgrounds, which punishment entrenches. Criminal culpability explains some disadvantageous treatment in state-offender interactions; yet offenders remain people, and ‘some mother’s child’, in Eva Kittay’s terms. Offending behaviour neither erases needs, nor fully excuses our responsibility for offenders’ needs. Caring is demanded in principle, recognising the offender’s personhood. Supporting offenders may amplify welfare resources: equipping offenders to provide self-care; to meet caring responsibilities; and enabling offenders’ contribution to shared social life, by providing support and (...) furthering the choices of others seeking to engage with them. The desistance paradigm (viewing desistance from offending as a process, following from an offender’s active choice in the context of stabilising social structures and personal circumstances), implies that a supportive environment may facilitate reduced recidivism. While decisions about criminal culpability need justice, we may use state resources most effectively by also including care ethics in our thinking about punishment. (shrink)

The topic of this paper is the question of in virtue of what first-person thoughts are about what they are about. I focus on a dilemma arising from this question. On the one hand, approaches to answering this question that promise to be satisfying seem doomed to be inconsistent with the seeming truism that first-person thought is always about the thinker of the thought. But on the other hand, ensuring consistency with that truism seems doomed to make any answer to (...) the question unsatisfying. Contrary to a careful and enticing recent effort to both sharpen and escape this dilemma by Daniel Morgan, I will argue that the dilemma remains pressing both for broadly epistemic and broadly causal-acquaintance-based accounts of the aboutness of first-person thought. (shrink)

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)