Personhood and Health Care

Personhood, it’s a crucial concept in our everyday lives and in health care. Yet, to a significant extent in the area of secular bioethics it has been under-theorised. Into this gap steps and enormously important contribution, Personhood and Health Care, a collection of thirty chapters by a variety of international contributors.

Edited by David C Thomasma (Loyola University Chicago Medical Centre), David N Weisstub (University of Montreal School of Medicine) and Christian Hervé (Université Paris René Descartes, Paris). This collection draws upon a variety of theoretical insights from a variety of disciplines and contributors. It even manages to move beyond being a collection of solely Western conceptions of personhood. The book is divided into four parts, namely: (1) Concepts of the Person (2) Theories of Personhood in Medicine and Bioethics, (3) Person and Identity and (4) Personhood and its Relations. Each chapter in the collection is an important contribution in itself.

In Chapter 1 Jean Delumeau explores “the development of the concept of personhood”, providing an important historical exploration as an important start to the collection. Based upon this foundation Lenn E Goodman explores “persons” claiming that “Our powers as actors, the magnitude of our projects as self-consciously, self-choosing subjects, set the basic claims of persons on a moral plateau.” (p. 19) This raised for me one of the issues taken up by some of the other writers in this collection: what obtains when we do not have such consciousness.

David Novak provides an important contribution with regard to “the human person as the image of God” and a short contribution by Jean Bernard explores issues to do with genetic personhood and the personhood of the embryo, an all too short chapter. Tom L Beauchamp then goes on to explore “the failure of theories of personhood”, an exploration which is built upon by Edmund L. Erde in his aptly entitled chapter regarding “The Vain and Pointless Quest for a Definition” with regard to personhood. Clearly influenced by Wittgenstein, he explores a variety of “failures” in ways of defining persons. One of the best examples he draws upon is in what the writers of the Declaration of Independence actually meant and whether or not they truly encompassed all of the aspects of personhood. As he concludes: “Better than the originating question is: ‘What shall we value about each sort of thing: persons, fetuses, the brain-dead-pregnant women, sexuality, etc., and why?’ – not whether fetuses or the brain-dead, etc., are persons”. (p 89)

Tuija Takala has an important chapter which explores “genetic knowledge and our conception of ourselves as persons”, an unnecessarily short chapter for such an important topic. On the other hand, a more traditional if utilitarian analysis is provided by John Harris regarding “the concept of the person and the value of life”, noting that personhood is “intimately connected with questions about killing and letting die.” Harris argues for a developmental perspective from fertilization of an egg with such a biological entity becoming “…an actual person when she becomes capable of valuing her own existence. And if, eventually, she permanently loses this capacity prior to death, she will cease to be a person. (p.110) Readers with an interest in disability and mental illness will no doubt here reflect on the challenge of those who lose such capacity, either temporarily or permanently. I find it difficult to accept that such loss necessarily removes personhood.

In Part 2, (“ Exploring Theories of Personhood in Medicine and Bioethics”) , Paul Ricoeur explores “the just and medical ethics”. Hiubert Doucet also names an inpass with regard to the concept of the person in bioethics, suggesting in a perceptive way that “… biomedicine’s pressure to attain its objectives leads to a form of contradiction, excluding some of the beings it expressly wishes to protect. “( p127) Ruud H. J. ter Neulen seeks to move beyond the biological in his “towards the social concept of the person” and Simonne Plourde explores concepts of personhood and dignity. An important perspective is provided by Jiwei Ci with regard to a “Confucian relational concept of the person and its modern predicament”, a non-western perspective which is complemented by Godfrey B Tangwa’s “the traditional African perception of a person: some implications for bioethics”. The chapter by Ulrike Kostka explores “the anthropological concept of modern medicine in the perspective of theological ethics” exploring Biblical concepts in the way that moves beyond simplistic stereotypes.

Part 3 (“Person and Identity”) provides insights that will be of crucial importance to readers of Metapsychology. Judith Lee Kissell explores “the procedural morphing of the person” in a chapter, whereby she points out:

“These developments in biotechnology …. Thereby make possible the kind of empirical dualism by which body parts take on the character of commodities or resources, irreversibly linked to considerations of distributive justice. This transition is accomplished in this brave new world, I contend by substituting procedures such as informed consent for profound reflection on the human, on person and on subject”. (p.192)

Eric Matthews explores “personal identity and mental health”. This provides some important insights. For example pointing to the way in which paternalism cannot be justified by reference to irrationality, making reference to Jehovah’s Witness beliefs about blood transfusion as an example of contested notions of rationality. He bases his analysis upon the importance of a “unified reasonably coherent identity that is a pre-condition for moral agency…” (p.210)

This analysis is complemented by Jean Guyotat’s chapter “the person, filiation, possession” concerning dissassociative identity disorder (DID). As he notes “personality” is ambiguous and this chapter utilises an exploration of psychopathology. David C Thomasma then explores multiple personality disorder in a chapter which amongst other things is an important contribution on the limitations of autonomy, suggesting that “…the diagnosis and treatment of multiple personality disorder (MPD) has a rocky history and an even rockier future.” (p.231) Thomasma’s chapter explores the social context of not only this disease but disease in general.

In a chapter that draws upon his role as an ethics educator and consultant, Jeffrey Spike advocates a course of action whereby there is a positive bias for the narrative provided by patients in exploring the problematic concept of “capacity”. This is complemented by Michael Quante’s exploration of autonomy and personal identity and Helga Kuhse’s explorations of the problems of advance directives, personhood and personal identity.

In Part IV (“Personhood and its Relations”), the issue of cloning is explored by Matti Hayry and Tuija Takala, who offer a striking conclusion:

“If scientists ever think that they can produce human beings out of simple elements, then it is time to remind them that none of us is omnipotent or omniscient, and that the human soul, whichever way we define it, cannot be implanted in inanimate objects.” (p.296)

Michel Silberfeld then explores “vulnerable persons” as do David N Weisstub and David C Thomasma with regard to “human dignity, vulnerability, personhood”. The naming of such vulnerability in such a collection is important, however I couldn’t help reflect that the perspective of a consumer of mental health services might also offer an important perspective in this area.

Constance K Perry then reminds us of the individualized way in which we can regard personhood and yet it has a much richer more communal sense as well. M. Gregg Bloche and Kevin P. Quinn explore professionalism in terms of personhood and John Nessa explores the patient-doctor relationship, while Guillermo Diaz Pintos explores “the medical interpretation of pain and the concept of a person”. The conclusion of this collection comes with Lazare Benaroyo’s exploration of suffering in terms of narrative and the self. As he concludes: “…caring may be construed as the art of making again possible through dialogue the existential unity of time by restoring the narrative identity of an imperilled self.” (p.380)

Certainly, this is an impressive collection of essays. However, as I read them and found similarities and difference, I found myself yearning for the next step. We need not just formal papers, but evidence of the dialogue between these perspectives as we seek to make concrete decisions about personhood in the context of healthcare. Without that, we face the inevitable reality that the dominant accounts of personhood will very much rely on dominant power relations and discourses.

Accordingly, this is a collection which will be of interest to undergraduate and postgraduate students, ethicists, philosophers, and practitioners who wish to go beyond their daily practice to explore some of the underlying concepts found in healthcare, especially in terms of personhood and dignity.

© 2003 Christopher Newell

Christopher Newell, PhD is Senior Lecturer in Medical Ethics, School of Medicine, University of Tasmania.