Losing the Marks of Personhood:
Discussing Degrees of Mental Decline
SYNOPSIS:
Personhood is an important concept for medical
ethics
because we grant different rights and privileges to full persons
than to individuals who have lost most of their mental powers.
Full persons might be defined by the following four capacities:
consciousness, memory, language, & autonomy.
If and when we lose such marks of personhood, what should happen?
From infancy, we slowly develop our capacities
of personhood.
Every day of our adult lives, we exercise all of them.
And if we suffer mental decline before death,
we might spend some period of time as less than full persons.
How should we discuss the rise and fall of human personhood?
OUTLINE:
INTRODUCTION
A. The Difficulty of Drawing Bright Lines:
When Does
Childhood End and Adulthood Begin?
B. Who Draws the Lines? And Why?
1.
CONSCIOUSNESS
2. MEMORY
3. LANGUAGE & COMMUNICATION
4. AUTONOMY
WHEN DOES PERSONHOOD EMERGE?
RESULT:
Most people begin with a simple
belief that everyone is a person.
It would be disrespectful to call someone a "non-person".
But if this chapter changes the thinking of any readers,
they might acknowledge different
degrees of personhood.
And if any readers have family members in mental
decline,
they might find a useful framework in this chapter
for considering the various dimensions of personhood
and the ways that individuals can lose the capacities
that once made them full persons.
Bit-by-bit over several years they might lose
the mental powers that once made them vital persons.
Losing the Marks of Personhood:
Discussing
Degrees of Mental Decline
by James Leonard Park
INTRODUCTION
A.
The
Difficulty of Drawing Bright Lines:
When
Does Childhood End and Adulthood Begin?
We all understand what a child is and what an adult
is,
but we cannot as easily say
when an individual passes
from childhood to adulthood.
Should we draw this line at age 7, 12, 16, 18, 21?
When do we develop the capacities that make us full
persons?
And if we are struck by Alzheimer's disease or some other
senility,
how should others around us evaluate our loss of mental powers?
This chapter offers four human capacities—the marks of personhood—
that
might help in the difficult task of drawing lines of distinction.
B.
Who
Draws the Lines? And Why?
We should resist any tendency to set up abstract
standards
that might be applied to all individuals of questionable status.
Even before we think of making distinctions,
we should ask who is drawing the lines and for
what reasons?
The same caution applies to separating
childhood from adulthood.
The people who know the child best are well equipped to know
when this child is ready for adult
responsibilities.
And some responsibilities can be accepted earlier than others.
For example, we allow people to drive at an earlier age
than we allow them to marry
without parental permission.
As infants move toward
personhood,
the obvious individuals to ask are the parents.
When does this baby develop
consciousness, memory, language, &
autonomy?
When discussing degrees of mental decline,
the people who have known the individual for the longest time
are best prepared to notice changes
in the capacities that define personhood.
We can ask the same questions: Does this individual still
have
consciousness, memory, language, &
autonomy?
If some of these capacities are diminishing,
when is the best time to support the individual
who is experience a decline of mental capacities?
1. CONSCIOUSNESS
The earliest and most important mark of personhood
is
consciousness.
We are conscious of the world when our five senses are working:
sight, hearing, smell, taste, & touch.
We note that animals have
these same five senses
because they have the same sense-organs as humans.
So merely being awake
and aware does not
make one a
person.
Beyond awareness of the surrounding world,
human persons are conscious of themselves.
We not only notice
the world around us,
but we have the capacity to notice that we notice.
We can 'step back' and become aware
of our thoughts and feelings.
A baby that is aware of itself
is able to wink back
when it observes someone winking at him or her.
But an animal does not possess enough self-awareness to wink back.
Someone in a persistent vegetative state also cannot
wink back.
Perhaps the eyes are open, but the brain is not conscious.
We all know the difference between being awake and
being asleep.
This is the basis of all common-sense discussion of
consciousness.
In order to be full persons,
we must be capable of conscious thoughts
and feelings
and also have some reflective capacity
to understand our conscious
functions.
When
consciousness has become impossible for us,
we are either in a coma or in a
persistent
vegetative state.
Consciousness and self-consciousness are the
foundations
of the other capacities of personhood: memory, language, &
autonomy.
2. MEMORY
Human persons have remarkable powers of memory.
Not only can we remember what happened to us earlier today,
but we can usually remember things that happened years ago.
In a very serious sense, when we forget who we used
to be,
we have lost such a precious part of our personhood
that we have become either different
persons or former
persons.
The capacity to remember important matters of daily
life
develops slowly in children.
Thus for the first several years,
their lives must be directed by their
parents,
who do possess full
and accurate memories:
Adult persons know how the world works
and how individuals fit into the on-going processes.
But if we become like children again
—not able to remember how to
conduct our own lives—
then we have lost a
capacity
that made us the particular persons we used to be.
Just how much of our former memories have we lost?
Unlike all other records such as writing and
computer memory,
human memories are contained
in living cells in our brains.
We do not remember as completely and accurately
as written and visual records.
And we might notice when our memories develop gaps and holes.
Do we notice the absence of some memories that used to be clear?
If we ever
lose so much memory that we do
not
remember
who we are or who the people around us are,
then our lives as functioning persons are over.
And we should leave instructions (written during full personhood)
that say how we should be treated
if and when we lose so much
memory
that we can no longer conduct our own lives without help.
3. LANGUAGE & COMMUNICATION
Full human persons have the capacity to use
abstract symbols
as a means of communicating with other persons.
Of course, language ability emerges slowly in children.
But if no ability to
understand and use human language emerges,
then this child never becomes a full person.
Most of what makes us interesting persons
involves the capacity to understand and use human language.
Our work and play revolve around listening and speaking,
reading and writing—in short, communicating with other persons.
If we permanently lose the capacity to understand
and use language,
are we still persons? Or have we become former persons?
Former persons can still be respected for the persons they used to be.
But when it comes to interacting with them, language no longer works.
So we might have to resort to using the same methods of interaction
we use with domestic animals.
Guiding by hand, showing a certain behavior, making
particular sounds
can communicate our wishes to dogs and cats,
but we should not expect them ever to understand
anything we say that depends on abstract human symbols.
And if a human individual never acquires a language
to interact with full persons,
perhaps that individual never
becomes a person.
Likewise, if we lose the capacity
to understand what
other are saying to us,
and if we can no longer express ourselves using abstract symbols,
perhaps we have ceased to be
full persons.
As medical science and technology can keep people
alive longer,
more human beings will spend significant periods of time
without their former capacities for human communication.
If we foresee this happening to us,
we can write instructions now—while we are still full
persons—
explaining how we want to be treated if ever we lose
all capacity
for human language and communication.
4. AUTONOMY
The highest mark of full personhood is
autonomy.
We slowly become self-governing persons
after we already have the first three
capacities:
consciousness, memory, & language.
To be autonomous means to have purposes and plans
for our lives
and to find ways every day to pursue these life-goals.
When we were infants, we did not have our own personal goals.
Rather we merely tried to survive and be happy.
Gradually over many years, we become our own
persons,
guiding ourselves by pursuing our own specific meanings and values.
As we become more autonomous, we develop a full
sense of time:
We have a remembered past,
an active present,
& a projected future.
We remember events
from the past.
We are actively engaged in
shaping our lives today.
We learn to anticipate
future events by a few days or weeks.
And as we become more fully adult,
we can embrace several years
ahead in a single thought.
As autonomous persons, the future no longer flows
over us
as one surprise after another.
Rather we shape our own
futures
by establishing our own goals and pursuing them.
We take moral responsibility for our own
lives.
We take charge of ourselves; we begin to 'own' our selves.
We make long-term plans intended to reach meaningful goals
—and we put these plans into action
every day.
We make promises to other persons expending into the distant future.
Some of our goals take a whole life-time to achieve.
And some will never be
achieved,
but we show ourselves to be persons
when our behavior is organized
and purposeful,
when we take full
responsibility for what we do with our lives.
If we enter 'second childhood' in old age, we lose
our life-goals.
We have no more purposes than we had as infants.
Autonomy is the last mark of personhood to emerge
—and the first to
disappear.
But during our best years, we can explain our
life-goals.
And we are able to pursue these purposes with some effectiveness,
altho there is never any guarantee that we will achieve our goals.
One aspect of being an autonomous person is the realistic recognition
of what we can accomplish
and what is beyond our reach.
When (perhaps in the last years of our lives)
we are beginning to lose our autonomy,
we might not realize this ourselves
as clearly as it might be evident to the people around us.
Others might notice that
we are no longer self-starting persons.
What used to be our passion no longer matters to us.
We begin to withdraw from projects we once found meaningful.
And we fall back into doing whatever
is necessary for survival
and whatever activities
still make us happy.
If we lose too much of the ability to handle our own
affairs,
others must make our decisions for us—at least important
decisions.
Such changes might be slow or sudden.
But because we will live longer than the previous generation,
we are more likely to lose our capacities to conduct
our
own lives.
The meanings we used to pursue might slowly
disappear.
We should prepare for this possible loss of autonomy
by explaining—perhaps in an Advance
Directive for Medical Care—
how we should be treated if we can no longer make our own
decisions.
WHEN DOES PERSONHOOD EMERGE?
We began this chapter by discussing adult
persons
because we seem to be more rational and wise
when evaluating when we ourselves (and other adults close to
us)
might lose the
capacities that make us full persons.
If and when we lose the marks of personhood
—consciousness,
memory, language, & autonomy—
have we become former persons?
The same questions can be asked about the beginning
of human life:
Does a fetus in the womb have:
consciousness, memory, language, &
autonomy?
Historically speaking, most systems of morality and
law
do not give fetuses the same rights and responsibilities as adult
persons.
When a baby is born with serious birth-defects,
the parents must
decide what to do.
Because a newborn lacks the most of the capacities of personhood,
the adults responsible for the infant must make all decisions.
Where would you draw the lines?
How much
consciousness, memory, language, & autonomy
must an individual possess in order to be regarded as a
person?
drafted September 2005; revised 10-4-2005; revised
5-29-2006; 11-8-2006; 4-13-2007;
2-11-2009; 6-12-2009; 5-6-2010;
10-8-2010; 11-6-2010; 6-11-2011;
1-4-2012; 1-13-2012; 2-10-2012;
2-28-2012; 3-21-2012; 7-7-2012; 8-31-2012; 10-30-2012; 11-3-2012;
1-7-2013; 3-13-2013; 6-7-2013; 12-29-2013; 8-1-2014; 1-2-2015;
4-4-2015; 7-11-2015;
6-8-2016; 11-26-2017; 3-31-2018;
AUTHOR:
James Park is an independent philosopher
with deep interest in medical ethics.
This chapter was adapted from a small book by James Park:
When
Is A
Person? Pre-Persons & Former Persons.
The small book includes about 200 questions
that can be asked by health-care proxies
for individuals who might have passed over
from being persons
into being former
persons.
He is also the author of another book in medical
ethics:
Your
Last
Year: Creating Your Own Advance Directive for Medical Care.
This book also contains the same 200 questions
for discussing degrees of mental decline.
The above discussion of personhood and mental decline
is also Chapter 50 of How
to Die:
Safeguards for Life-Ending Decisions:
"Losing the Marks of Personhood: Discussing Degrees of Mental Decline".
Another chapter of the same book discusses
Alzheimer's disease:
Life-Ending
Decisions for Alzheimer's Patients.
Would
you like to join a Facebook Seminar
discussing How to Die?
See
the complete description for this seminar:
https://s3.amazonaws.com/aws-website-jamesleonardpark---freelibrary-3puxk/ED-HTD.html
Join
our Facebook Group called:
Safeguards
for Life-Ending Decisions:
http://www.facebook.com/home.php#!/groups/107513822718270/
Much more information about James Park
will be found
on his website:
James
Leonard Park—Free
Library
If you would like to read
other essays by James Park,
go to this List
.
See especially the section on Medical Ethics.