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




You might be especially interested in MEDICAL ETHICS.



Go to Discussing Degrees of Mental Decline
.
This is another exploration of the meaning of personhood,
especially asking about the right-to-die for individuals of questionable personhood.



Because such discussions of mental limitations
might be misused to deny medical care,
another essay offers 13 safeguards to prevent devaluing strangers:
Protecting Vulnerable Patients from Discrimination.



Click here for a Right-to-Die portal.




If you would like to read other essays by James Park,
go to this List .
See especially the section on Medical Ethics.




Read other free books on the Internet.


   
 Go to the beginning of this website
James Leonard Park—Free Library