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          When is a person?
     We are persons when we have the following four functions:
     consciousness, memory, language, and autonomy.

I. INTRODUCTION

          If you are reading this essay
     or understanding it while it is being read to you,
     then it is fairly certain that you are a person right now.
     And the fact that I am writing the essay
     proves that I am a person.

          Only we human beings who are presently persons
     are capable of raising the question of what it means to be a person.
     As embodied personhood we ask
     what makes us different from all other objects and creatures.

          But there was a time in the life-span of each of us
     when we were not yet persons in the full sense.
     We cannot remember this time,
     since one of the marks of personhood is being able to remember.
     As full persons in the present,
     we can look back upon our biological development
     and identify a period of time when we were not yet persons.

          And even before our period of pre-personhood,
     we can name the date before which each of us did not exist at all.
     Most of us know the exact day we were born.
     And if we subtract 9 months from that date,
     we can estimate the date when we were conceived.

          But we can never be as exact about the date
     when we moved from pre-personhood to personhood
     or when we made the transition from childhood to adulthood.
     And if we decline mentally before we die physically
     ---if we slowly lose the capacities that now make us persons---
     then observers of this decline
     will not be able to name the exact date
     when we passed from being persons into being former persons.

           The same criteria by which we presently affirm
     that we are persons apply at both ends of life:
     The four marks of personhood can help us to identify the period
     when we moved from pre-personhood to personhood
     and the period when we may move from being full persons
     into being considered former persons by others.

          This essay will suggest four criteria or four sets of questions
     that will help us to draw the line between
     ourselves in our pre-personhood phase and ourselves as persons
     and later to draw the line between
     ourselves as full persons and the former persons we might become.
     We will ask these questions about ourselves
     and the people who are closest to us.
     No attempt will be made here to establish tests of personhood
     that might be applied by a group of strangers
     such as an institutional ethics committee,
     an insurance company, or a government agency.

          (Medical ethics is the context in which the question
     "When is a person?" is raised,
     but if our criteria are careful and comprehensive,
     they should also be philosophically valid
     for distinguishing persons from animals and from computers.)

          In the practice of medical ethics,
     the question "Is So-and-So still a person?"
     will be asked by persons responsible for making
     medical decisions for others who cannot decide for themselves.
     For example, is a human fetus a person?
     How that question is answered affects one's choices about abortion.
     And the millions of women who have had abortions since 1972
     (when it became legal in the United States)
     might ask themselves "what did I abort?"

          Is a newborn a person?
     Clearly most newborns will grow into persons,
     but some are born defective physically and/or mentally.
     In choosing for a defective newborn,
     should the parents consider it to be a person or a pre-person?

          And if we slip out of personhood before we die,
     others will be called upon to make all decisions for us,
     including our medical decisions
     ---which might include decisions that will end our lives.

          How do we draw the line between persons and former persons?
     In all medical decisions, keep strangers out of the loop.
     Only those persons most closely related to the human in question
     should have the responsibility to decide for that individual.
     Professional experts from all disciplines can offer their opinions,
     but the final decisions must rest with the lay persons
     who are responsible for the future of the human being in question.

          In the case of fetuses and newborns,
     the obvious persons to make medical decisions are the parents.
     And they may decide to invite other family-members or friends
     to help them make difficult choices.

          At the other end of life, the decisions-makers are not so obvious.
     Thus, I suggest that each of us (while still a full person)
     appoint a proxy, two proxies, or a committee of proxies
     to make medical decisions for us when we are no longer capable.

          The most formal way to do this
     is to appoint a Medical Care Decisions Committee (MCDC)
     in one's advance directive for medical care ('living will').
     In some states this is accomplished by designating an individual
     as one's health-care agent by giving that person
     a durable power of attorney for health care.
     ("Durable" here means that it lasts beyond the competence
     of the person who appoints the agent.)

          When we appoint our proxies or establish our MCDCs,
     we should also give them written guidance
     concerning how to make medical decisions for us.
     Since we cannot foresee all possible medical problems
     and their proposed treatments, we must rely
     on the compassionate judgment of the proxies we choose.

A. When Does a Child Become an Adult?

          Before we attempt to draw the lines between
     pre-persons/persons and between persons/former persons,
     let us turn to a more familiar distinction
     ---drawing the line between child/adult.
     If we are now adults, we were once children.
     But when did this transition occur?

          And if we become parents, we will confront the question again
     when our children claim the rights and responsibilities of adulthood.

           How we handle this more familiar distinction
     may help us to face the more difficult and unfamiliar question
     of drawing the line between pre-persons/persons
     and between full persons/former persons.
     This new distinction has become necessary
     only since the advent of modern medicine and technology.
     Only in the 20th century did it become necessary to ask
     when a human becomes a person or ceases to be a person.
     This is because many pre-persons and former persons
     can be kept 'alive' indefinitely by life-support machinery.
     In earlier centuries, most would have died
     because there was no way to sustain them
     if their bodies could not sustain themselves.

          In the process of deciding when a child becomes an adult,
     we immediately find ourselves asking two background questions:
     1. Who is drawing the line?
     2. For what purpose is the line being drawn?

          (These same questions will reappear
     when we attempt to distinguish between pre-persons/persons
     and between full persons/former persons:
     1. Who is responsible for drawing the line?
     2. Why is the distinction required?)

          Unless we know who is drawing the line and why,
     we will not be able to decide when children become adults.
     In every known culture,
     children have different rights and responsibilities from adults.
     But children enter adulthood at different ages,
     depending on the rights and responsibilities being considered.

          Here are some historical examples of drawing the line
     between the end of childhood and the beginning of adulthood:

          The end of innocence, the beginning of moral responsibility:
     When does a child become morally responsible for his/her acts?
     In the Roman Catholic tradition,
     a child is capable of committing a mortal sin at 7 years of age.
     In Judaism adulthood begins at age 13.
     Generally, we think of children becoming responsible for their acts
     somewhere between 7 and 12 years of age.

          Driving age:
     Depending on the state, we regard children as old enough to drive
     automobiles and farm machinery when they reach 15-18 years of age.

          School-leaving age:
     Children are adult enough to drop out of school at about age 16.

            Age of consent for sex:
     Children are adult enough to decide their own sexual behavior
     somewhere between 15-18 years of age.
     Thus under most state laws,
     when a child below the age of consent has sex with an adult,
     it is entirely the responsibility of the adult.
     This is "statutory rape" or child sexual abuse,
     even if the child verbally gave 'consent'.

          Drinking and smoking age:
     Each society that controls the consumption of alcohol and tobacco
     defines the age at which a person is responsible enough
     to make informed decisions about the use of these substances.
     In the United States, the drinking age is controlled by the states.
     And state legislatures have frequently changed the age,
     depending on the mood of the citizens and other social factors.
     Generally, it has been between 18 and 21 years of age.

          Voting age:
     Persons become old enough to vote when they reach 18 to 21,
     depending on the country and the period of history.

          Age of marriage without parental consent:
     Children are old enough to enter the adult institution of marriage
     when they reach 18-21, depending on the jurisdiction.
     And in some cultures (especially those with arranged marriages)
     children can be married at much younger ages,
     but they still do not become full adults until somewhat later.

          Draft age:
     Males have been deemed old enough to fight at about 18.

          Adult criminal responsibility:
     When persons are still children,
     their Parents are often held responsible for their misbehavior.
     And the criminal acts of children are dealt with in different courts
     with different rules of procedure and different penalties.
     (But sometimes the crime itself is serious enough
     for the child to be certified as an adult and tried in adult court.)
     Children found guilty are sent to juvenile correctional facilities.
     And when they become adult (at 18), they are often released.
     Newer laws keep juveniles found guilty of serious crimes
     behind bars a bit longer, even after they have become adults.

          Contract capacity:
     Generally persons are able to enter into contracts
     for work and borrowing, etc. when they reach age 18.
     (For many years in the United States, the age of majority was 21.)
     Contracts for children below the age of majority
     must be co-signed by a parent or guardian.

           Age for borrowing without a co-signer:
     When lending institutions lend large sums of money
     (for a car or a house, for instance), they generally require
     a co-signer if the borrower is younger than 20-25.
     Experience has shown lenders that young adults are poor risks.
     So they require other adult signers to back up such loans.

          Age for adult auto insurance rates:
     Insurance companies have learned that young adults are bad risks,
     because they have more accidents than older adults.
     Thus (especially males) must pay higher insurance premiums
     until they reach about age 25.

          Age for being President:
     The writers of the US Constitution decided that a man
     (later women were also allowed to vote and hold office)
     had to be 35 years of age to be mature enough to govern the country.

          The fact that the line between child and adult has been drawn
     anywhere between age 7 and age 35 shows lack of consensus
     about just when a person ceases being a child and becomes an adult.
     Much of this variation can be accounted for by the fact
     that different responsibilities are being assumed by these people.
     A child of 7 may be responsible for making personal moral decisions.
     But that person would not be trusted to make Presidential decisions.

          Each family has its own, informal turning points in a young life:
     When is a child old enough to stay out after midnight?
     When is a child old enough to wash the dishes
     and take responsibility for other household tasks?
     When is a child old enough to have sex?
     When old enough to drive the family car?
     When is a girl old enough to put on make-up and wear a bra?

          In most of these parent/child struggles,
     the parents make the final decisions.
     But they should take the maturity of each child into account.

          Courts of law also hear status questions.
     Lawyers often ask courts to make exceptions to general rules
     defining when minors become adults,
     for instance, concerning large legacies.
     At the other end of life, the mental competence of someone
     who makes a will may be challenged
     by relatives who do not agree its contents.
     The detractors may argue that the drawer was incompetent,
     under undue influence, did not know what he or she was signing, etc.

           And the state legislatures are constantly asked to change the age
     at which children become adult for various purposes.

          Seeing the difficulty of defining when a child becomes an adult,
     we should not be surprised to discover that it is even more difficult
     to draw the line between pre-persons/full persons
     and between full persons/former persons.

          Medical decisions are often more permanent than
     decisions to grant an individual adult rights and responsibilities.
     Status as an adult may be postponed if the individual does not seem
     quite mature enough for the responsibility considered,
     but such line-drawing almost never results in death.

          But when we consider whether a certain individual
     is a person or a former person,
     how we draw the line could result in a medical decision
     that will result in death rather than continued treatment.

          Various opinions about when personhood begins and ends
     probably should not be written into any guidelines or laws.
     This question is highly individual
     and deeply affected by cultural differences
     ---just like the question of when a child becomes an adult.
     Such questions will always be open to significant debate.
     And with respect to each individual,
     all relevant views should be heard.
     This is a moral rather than a legal discussion.
     And the law should remain neutral about moral matters,
     allowing each family to create its own definitions
     and to apply them to their own family members.

          Laws and formal guidelines can set the broad limits
     concerning mandatory behavior and prohibited behavior,
     but the wide area between these two
     is the area of individual medical discretion.
     All laws and guidelines are based on a broad consensus
     of the society that created them.
     But an open society such as our own
     will leave a wide range of options between the outer limits.
     (A closed society may be defined as one with no choices:
     Everything that is not mandatory is prohibited.
     But sometimes advocates of certain moral position in our own society
     would like to enshrine their own moral choice in the laws
     so that everyone would be required to behave that way.
     But open societies have successfully resisted legislating morality.

          We should also guard against the assumptions of
     generic medical ethics.
     Largely because most of us were raised with a belief
     that there must be a right or a wrong in every situation,
     we may assume this applies to medical decisions as well.
     And many writers of medical ethics assume the same thing:
     They look for a consensus among ethical thinkers
     and take that to be the correct choice for everyone.

          But as our society becomes more pluralistic and multi-cultural,
     the consensus that used to uphold generic medical ethics disappears.
     Now people approach life-and-death questions
     with diverse personal, philosophical, and religious beliefs.

          And even religious organizations that used to have rigid positions
     now realize that there should be a range of freedom within that faith.

          So the criteria to be suggested in the rest of this essay
     are presented to a pluralistic and multi-cultural world.
     Once we have received all the scientific facts and medical opinions
     relevant to the choices we must make,
     we must make our own medical dedisions
     based on our own values and beliefs.

          In each culture, the written law defines the limits of choice.
     But within these limits of what is required or prohibited,
     each group of decision-makers operates by its own moral principles.
     And precisely because of this diversity of opinion on medical matters,
     it is very important for each of us
     to create our own Medical Care Decisions Committee,
     which will have the power to make medical decisions for us
     when we are no longer able to decide for ourselves
     or when we can no longer communicate our choices.

II. CONSCIOUSNESS

          When is a person?
     We are persons when we are conscious of the world
     and conscious of ourselves.

          The consciousness that defines persons recognizes itself.
     Only when we are conscious can we ask about consciousness.
     You are conscious as you read these words.
     And I am conscious as I write them.
     Neither of us is asleep.  And neither of us is dead.

          The first level of consciousness is sense experience.
     We see what is visible around us.
     We hear whatever is loud enough to be detected by our ears.
     We smell things when enough molecules enter our noses.
     We taste things that we put into our mouths.
     And we feel whatever we touch with our skin.

          Each of these five senses happens
     because we have specialized sense organs connected to our brains.
     And our brains organize our sensory input into intelligible patterns.

          All animals have the same five senses.
     And some animals have more acute senses than we have.

          Thus when we say that consciousness is a mark of personhood,
     we must mean more than sense perception and organization.
     If being aware of the world were a sufficient definition of a person,
     then every living dog and cat would be a person.

          What marks off personal consciousness from animal awareness
     is sensitivity to ourselves---self-consciousness.
     Not only do we notice the world around us,
     but we notice that we notice.
     We experience ourselves as receivers of sense impressions
     and organizing centers for interpreting that sense data.

          We do not need to be very intelligent to respond to the world
     in ways that show that we are aware of ourselves.
     As soon as we experience our selves
     as centers of experience that can be affected by the world
     (and later as centers of activity that can affect the world)
     we have begun to emerge as self-aware personal beings.
     Our earliest manifestations of self-awareness are feelings.
     When we become aware that we are hungry, cold, hot, in pain, etc.,
     we notice ourselves as organisms separate from the rest of the world.
     Later we can experience ourselves as happy, bored, fearful, jealous.

          We have sense experiences before we understand them
     and before we have any control over what happens to us.
     But as babies we learn to cry as a way of changing the world.
     When we learn that crying is communication with others,
     we are beginning to become self-conscious.

          Later we will develop a better-organized sense of ourselves.
     We will be able to identify ourselves, to say "I am I".
     We will be able to name ourselves
     and respond when others use our names.
     We will know who we are at some rudimentary level.

A. The Wink Test for Infant Self-Consciousness.

          When does self-consciousness emerge in babies?
     Even before birth a fetus is aware of its surroundings in various ways.
     But just when a baby becomes aware of itself is not immediately clear.

          However, anyone can try this simple experiment---the wink test:
     When you have a baby's attention, wink at it.
     If the baby attempts to wink back, it must be aware that it exists
     and that it is another person like the one winking at it.

          Usually the baby will close both eyes at once,
     since it has not learned how to close one eye at a time.
     But the fact that the child has tried to wink
     shows that the baby has recognized you
     as another creature like itself, with eyes just like its own.
     The baby's mind has made the connection between
     the holes thru which it sees the world and other people's eyes.
     And the infant is attempting to imitate a behavior it has seen.

          The imitation of winking is essentially different
     from most other forms of imitation.
     When an infant attempts to imitate the actions of human hands or feet,
     it does so by seeing the hands and feet of other people
     and seeing it own hands and feet.
     The similarities of form and function soon become obvious.

          But the infant cannot see its own eyes.
     Few infants spend much time gazing into mirrors.
     And if we want to be completely scientific about this test,
     we will check infants who have never seen themselves in a mirror.
     If they still have the impulse to wink back,
     they must be aware that they also are creatures with eyes that can wink.

            If we try the wink test on household pets, we get no response.
     The dog or the cat will continue to blink spontaneously,
     but there will be no effort to respond with a wink.
     (If a movie-maker causes an animal to wink,
     the effect would be uncanny.
     We would immediately recognize self-consciousness in the animal.
     The story might be that a human person was turned into a frog.
     And the frog retains self-consciousness,
     which it communicates by winking.)

          Animals, even after many years of visual experience,
     never realize that their eyes enable them to see the world.
     Animal consciousness seems to be only consciousness of the world,
     never consciousness of itself as a self.
     (Some people will dispute this observation.
     Let them devise experiments to show that animals may be self-aware.)

          When animals see themselves in mirrors,
     they usually attempt to go behind the mirror to find the other animal.
     If an animal notices that the image in the mirror its itself,
     this shows some level of self-awareness.
     An animal might become aware that its behavior
     (as experienced from the inside as the agent of that behavior)
     is the same as the observed behavior of the animal in the mirror.
     Higher primates do understand their reflections in mirrors.
     This has been shown by putting a dab of paint on their foreheads
     (without them knowing it)
     and then watching to see how they respond
     when they see themselves in a mirror.
     If they 'instinctively' touch their own foreheads,
     we know that they have made the connection between
     the image of the animal in the mirror and their own foreheads.

          It is possible that such higher animals could be trained
     to pass the wink test by getting them to close just one eye
     when they observe such a signal from a human being,
     but this would be very different
     from an infant attempting to wink without any training.

          To understand the full significance of the wink test,
     we must make explicit the difference between winking and blinking.
     Blinking is a spontaneous reflex action,
     which takes place in all animals with eyes like ours.
     It is nature's way of keeping our eyes clear of dust, etc.
     Babies have observed blinking for as long as they have seen eyes.
     Human eyes automatically blink about once a second.
     You may have blinked at least once while reading this line.
     But because blinking happens all the time,
     you did not notice it until I brought it to your attention.

            A baby sees thousands of blinks before it sees its first wink.
     And the baby notices something different is happening:
     This time only one eye closed, not both together.
     Winking is a new and unusual phenomenon in its world.
     And if the infant is beginning to emerge as a self-aware person,
     it will attempt to do the same with its eyes.

          Animals have no such self-awareness.
     They do not notice the difference between a blink and a wink.
     You can wink at your cat all day.
     And it will only become bored and move on to something else.
     But a self-aware infant immediately recognizes the difference
     between a wink (a voluntary action)
     and a blink (an involuntary reflex).

          Passing the wink test by attempting to wink back
     shows that the infant is aware of these basic facts about itself:
     I am a being with eyes just like the person who is winking at me.
     And if this other person can close just one eye at a time, so can I.

          For most animals, winking remains just another event to observe.
     winking faces are no more notable than blinking faces.

          Since infants are blinking all the time spontaneously,
     we must be careful to observe
     if the infant is voluntarily attempting to close one eye at a time.
     Even tho it may not be able to manage to close only one eye,
     we can usually tell that it is trying
     because the effort manifest in attempting to wink
     is different from spontaneous blinking.

          Parents must be especially on their guard against self-deception.
     Most parents hope that their children will be very intelligent.
     And some pet-owners believe that their pets are very smart.
     Parents and pet-owners may see non-existent signs of intelligence.

          At first every baby is an organism, like any other animal.
     It reacts to its environment with ever-increasing complexity.
     After a while it begins to distinguish between world and me.
     For instance, when the baby plays with its fingers and toes,
     it is surprised at first to discover that these other moving objects
     are parts of the same sensory system, itself.
     The baby feels its toes from both sides.
     Thru random movements of its limbs,
     the baby gradually discovers what is me and what is not me.
     If a baby fails to develop this capacity
     to distinguish itself from others, we should be seriously concerned.
     Some babies are born defective or are later injured
     so that they never gain significant self-consciousness.

          In some extreme cases, babies are born anencephalic
     ---without most of their brains.
     They never experience a moment of consciousness.
     And such babies will never develop the other capacities of personhood,
     which depend on consciousness---memory, language, and autonomy.

          The wink test may also be useful at the other end of life
     ---when an individual may have sunk into a post-personal existence.
     Because our eyes are located in our heads,
     even if we become paralyzed below the neck,
     we will still be able to blink and wink.
     Blinking shows that we still have reflexes coming from our brain-stems.
     But if we are still able to wink,
     it means that we are still conscious and self-conscious.

          In fact, our ability to wink voluntarily
     may be one of our last means of communication.
     A former person in a persistent vegetative state
     will spend part of each day with his or her eyes open and blinking.
     But there will be no responsive winks to the winks of other persons.
     Individuals in PVS are not self-conscious.
     So they will not even be able to wink back
     when a wink takes place right in front of their eyes.

          But if a patient still has the capacity to wink voluntarily,
     then the two eyes can become a new means of communication.
     The right eye can mean "yes"; and the left eye "no".

          The patient could even learn Morse Code,
     the right eye being used for dots and the left for dashes.
     Care-givers and family would also have to learn Morse Code.
     But even this slow communication would be better than none.
     And the message should be written down as it is sent
     to confirm or correct it as it is being transmitted.

          And if the patient becomes skilled at winking communication,
     a Morse Code reader or interpreter might be needed
     for receiving and de-coding longer messages.

B. Computers Are Not Persons.

          Just as animals never become as self-conscious as persons,
     so computers do not meet the test of self-awareness either.

          A computer is an electronic machine
     that contains millions of bits of information.
     It can rearrange and deduce certain conclusions from this information.
     In fact, computers generally perform such calculative functions
     much better and faster than the human minds that invented them.

          But is a computer conscious or self-conscious?
     To be self-conscious means to be able to grasp one's being whole,
     to comprehend oneself in a moment.
     Thus understood, a computer has no self;
     it is just the sum of the information and functions it contains.
     It cannot have attitudes or feelings about itself.
     It cannot identify or name itself.
     It has no whole sense of itself that it can grasp in an instant.
     It has no emotional responses to situations in which it finds itself.
     It cannot predict its own results.
     Instead of jumping ahead to a conclusion intuitively,
     it must just go ahead with its calculations as programmed.
     A computer is not essentially changed
     when information or functions are added or taken away.
     But persons are changed by their thoughts and experiences.
     (Reading this paragraph may have changed you in some small way.)
     A computer can 'learn' from the facts that are fed into it.
     But it will never graduate from being a computer.
     Persons can rise to ever higher levels of personhood.

          A computer has no core identity as a person has.
     It is only the wiring and electronic components that make it up
     ---and the electronically encoded instructions in its memory.
     When it 'thinks', it processes one piece of information at a time,
     sometimes using parallel processors to do several things at once.
     But its 'thought' processes lack creativity and purpose.
     Its only function is to complete the project assigned.
     When that calculation is completed, it is only a machine, waiting.

          A computer has no will of its own
     to go off in different directions to explore unexpected connections,
     as happens when you read this essay.
     These side-trips happen because you are a person.
     You come to this essay with interests and purposes of your own.
     And you find connections of ideas worth pursuing
     that were not put before your eyes by these words.

C. What about a Sleeping Person?

          When we call consciousness the primary feature of personhood,
     we must insert the exception for sleeping persons.
     Normally we human beings spend 1/3 of our lives unconscious.
     Every night all of the processes of consciousness are suspended.
     Sense experience ends; all mental organizing ceases.
     But when we awake in the morning,
     we can continue the same thoughts we had the day before.
     We remember who we are and what day of the week it is.
     And we begin to think of the activities of the forthcoming day.

          However, if a person falls asleep and never awakens,
     then that permanent unconsciousness will eventually be considered
     as the death of that person for all practical purposes.

          I have instructed my Medical Care Decisions Committee
     to regard me as permanently dead
     if I have been unconscious for a year.
     And if it is clear even before a year has passed
     that I will never regain consciousness,
     I should be declared dead even sooner.

          If I have become unconscious
     and I cannot be awakened to resume my purposes in life,
     then I should be considered dead as a person,
     whatever the condition of my other bodily functions.

          Or if I am constantly in a dream-like state,
     where I cannot tell the difference between
     my internally-created images and the facts of the real world,
     then also my status as a full person is seriously in doubt.
     Perhaps I have become a former person.

          When I am awake, I recognize myself and remember my purposes.
     I know how to get myself out of bed and get dressed.
     I know how to resume my daily activities.

          But toward the end of my life
     ---if I lose my mental capacities before death---
     I may drift in and out of consciousness.
     There may be times when I know who I am
     and other times when my self-consciousness is confused.
     If I can no longer understand the patterns of the familiar world,
     then I am losing my normal capacities of consciousness.
     While I am fully awake, others easily interact with me.
     We all appreciate the connections we have made as persons.
     But if my powers of consciousness begin to fail,
     others who have known me when I was a person
     may rightly say that I am "out of it".
     They will be able to say that I have become a former person
     when the activities we used to share are no longer possible.
     It might feel like a dream-state from which I cannot fully awaken.

D. Common-Sense Definitions of Consciousness.

          We all know what it means to be conscious or unconscious.
     When a patient does not wake up,
     doctors may be able to explain why the patient remains in a coma.
     But everyone will agree that the patient is unconscious.

          Thus I have assigned to my Medical Care Decision Committee
     the responsibility for deciding whether I am conscious.
     They will obviously seek the best medical advice and opinion
     about what might have caused my unconsciousness
     and about what might happen to me in the future.
     But it should be obvious to all that I am not awake.
     And if there seems little chance that I will recover consciousness,
     I should be declared dead
     and my remains should be used as I have instructed.

          Here are a few simple, practical tests that anyone can use:
     (1) Is the patient aware of pain?
     (2) Does the patient appear to hear and respond to sounds?
     (3) Does the patient turn away from strong, unpleasant smells?
     (4) Does the patient react to substances placed on the tongue?
     (5) Does the patient notice bright lights and respond to them?
     If these five senses are not working, then the patient is unconscious.

          On the interpersonal level, we can ask the following questions:
     (1) Does the patient know himself or herself?
     (2) Does the patient recognize other persons known for many years?
     (3) Is the patient pleased when others show care and concern?
     (4) Does the patient notice whether others are present or not?
     Doctors also know about all of these tests for consciousness.
     And they have many others which are more sophisticated
     ---some involving complex machinery
     that will determine if anything is happening in the patient's brain.
     Neurologists have several ways to measure and map blood-flow
     to various areas of the brain.
     If parts of the brain are deprived of blood, they quickly die.
     No further functions can be expected from those areas.
     Other instruments can measure and map the brain's electrical activity.
     An electroencephalograph will show where the brain is working
     and where it may have ceased working, perhaps because of a stroke.
     Different brain-waves can show the difference between
     a sleeping brain and a thinking brain.
     Such technical means can show whether or not a brain is conscious.
     If there is no blood-flow to the cerebellum, the patient is unconscious.
     And if the neurologist can determine that blood-flow will not return,
     then the patient will not regain consciousness.
     The electrical tests may also enable the neurologist
     to predict whether consciousness will ever return.

          If everyone agrees that the patient is unconsciousness,
     and if the doctors say there is little hope of consciousness returning,
     then that patient has become a former person
     because the other marks of personhood
     (memory, language, & autonomy) depend on consciousness.

QUESTIONS FOR PROXIES
ABOUT CONSCIOUSNESS AND SELF-CONSCIOUSNESS

          Beyond what a neurologist can determine
     by various tests of the functions of the brain,
     the people who have known the individual in question for a long time
     may recognize changes in personality or consciousness
     that indicate the loss of mental powers.

         The following questions should be asked by people
     who have known the individual for a number of years.
     These friends and family members will be in the best position
     to notice changes in levels of conscious functioning.
     If the individual was clearly a person during most of his or her life,
     some elements of that person's mental life may have disappeared.
     When such losses become extensive enough,
     we say that the individual in question has become a former person.
     Just where to draw the line will always be subjective.
     And the others who have known the individual in the fullness of life
     are best prepared to evaluate these losses.
     When reading the following questions for proxies,
     we might put our own names in the blanks and adjust the pronouns.
     We might imagine these questions being read and discussed
     by the members of our own Medical Care Decisions Committees (MCDCs).
     The questions should stimulate meaningful discussion,
     rather than be given simple yes/no answers.
     The bold face question introduce major sub-divisions.

     1.  Has _____'s thinking become rigid and inflexible?
     2.  Does _____ seem to be 'closing down' as a person?
     3.  Do we notice increased reluctance to experience new things?
     4.  Does _____ decline invitations
          he/she would have been accepted in an earlier phase of life?
     5.  Does _____ wish to turn off the TV or radio
          because new information is always upsetting?
     6.  Is novelty no longer welcome because it is traumatic?
     7.  Does _____ resist change in all forms?
     8.  Does _____ require routines to proceed in the same order?
     9.  Does _____ only welcome familiar thoughts and experiences?
     10. Is there a loss of a former richness of thought and experience?
     11. If _____ used to welcome new events and experiences,
           has this openness been replaced by closedness?
     12. Does _____ become upset
           by unexpected input and communications from other people?
     13. Does _____ cling to familiar and comfortable routines?
     14. Does _____ resist change even tho some suggested changes
           would clearly be in his/her best interest?
     15. Has _____'s mind become set into rigid patterns
           suggesting unwillingness ever to change again?
     16. If _____ was an avid reader, has this practice been given up
           because new ideas are no longer welcome in his/her mind?
     17. Have our conversations with _____ fallen into a repeating pattern,
           the same basic conversations takes place over and over again?
     18. Does _____ remember saying the same things before?

          These questions about openness to new experiences
     must be asked by others who have known the individual for some years
     because some people have been rigid all their lives.
     Even if they were closed-minded and dogmatic, they were still persons.
     If they have always resisted change,
     then many of the above questions would not indicate
     a deterioration of their mental lives.

          Only a change in a once open, flexible, and curious person
     into a closed-minded, inflexible, and non-curious individual
     might be a sign of the hardening of a formerly rich mental life.
     Such a change in myself, for instance, would definitely be a sign
     that my mind was beginning to deteriorate and shut down.
     That would indicate that I am moving toward becoming a former person.

     19. How well is _____ oriented in time?

     20. When _____ awakens,
           does he/she know what day of the week it is?
     21. What month of the year?
     22. What season of the year?
     23. What year?
     24. Does _____ know how old he/she is?
     25. Does _____ sometimes forget whether it is morning or afternoon?
     26. Does _____ have a reasonable sense of the passage of the day?
     27. Is _____'s personality continuous and consistent?
     28. Does _____ experience himself/herself
           as the same person who lived many years ago?
     29. Is there a continuity of memory or do some of the memories
           seem to be events that happened in a movie---to someone else?
     30. When moved to a different living arrangement, does _____
           seem to be the same person who existed in the former location?
     31. Does _____ have a continuing concept of himself/herself?
     32. Does _____'s sense of self today connect clearly with a self
           that existed at some time in the past in a different place?
     33. Is _____'s self independent of time and place?
     34. Or does _____ seem to be a new or different self over time
           or when moved to a new location?
     35. Has _____'s distinctive personality disappeared?
     36. Has _____'s personality flattened out?
     37. Has _____ lost some of the characteristics
           that used to make him/her different from other people?
     38. Has it become difficult for health-care workers
           to distinguish _____from the other patients?
     39. Has _____ faded into the "patient population"?
     40. Has _____ become anonymous---lost his/her name---
           and become better known by a room number?
     41. Is _____ aware of being different from other individuals?
     42. Does _____ know his/her difference from others from the inside,
           not merely different in external facts and appearance?
     43. Does _____ recognize himself/herself as different
           from every other individual who has ever lived?
     44. Or has _____ begun to identify himself/herself
           as part of a group rather than as an individual?
     45. Has _____ begun to forget who he/she was, remembering
           "the past" as events that might have happened to others?

III. MEMORY

          When is a person?
     We are persons when we possess the power of memory.

          Memory---being able to recall past experiences and learning---
     distinguishes persons from all other creatures.
     As our memories become fuller and more useful,
     we become more complete persons.
     And as our memories begin to fade,
     we lose the characteristics that made us interesting persons.

          Almost all of us can remember what we did in the last five minutes.
     You were probably reading this essay five minutes ago.
     And if you can't remember at least some ideas from the previous page,
     then you might as well give up reading now:
     The ideas are leaking out the bottom of your brain
     as fast as they are coming in at the top.

          And we probably all remember what we did in the last 24 hours.
     Human memory goes even farther back, of course:
     We remember last week, last month, last year,
     and probably several years back into the past.

          As we go farther back, memory dims.
     We may remember only important or traumatic events from childhood.
     And we may re-discover memories in dreams
     that we had forgotten in our waking moments.
     Our human memories differ from computer memories.
     A computer can remember even the most trivial information forever.
     But we human beings must have reasons for remembering things.

          Also, we remember in different ways from computers.
     The computer keeps all the raw data just as it was fed in.
     But we persons remember events as meanings.
     And we almost never retain the details of the raw data.
     If the experience was not interpreted and processed at the time,
     it is probably lost forever from our memories.
     But, of course, we now have many other ways besides memory
     for retaining important facts from the past.

          Another proof that human memory works by meanings
     is the impossibility of remembering something
     we heard in a foreign language.
     A tape recorder could record every syllable.
     But our human minds remember only the sound of foreign speech.
     And when we were first born, all languages were foreign to us.
     Until we acquired our first language, our minds retained nothing verbal.
     Likewise, when we first opened our eyes,
     we were assaulted with millions of rays of light
     ---all meaningless to us since we could not make sense of them.
     And without organizing patterns for understanding visual impressions,
     we forgot whatever came into our brains thru our eyes.
     When our memories began to work,
     we recognized repeats in what we saw and heard.
     These formed patterns in our brains so that we could recognize
     such sights and sounds when they came around again.

          And because this capacity for recognizing patterns
     must develop very early in life,
     babies born blind or deaf who gain these senses later in life
     sometimes never become as adept at remembering and understanding
     as those who started to form these patterns shortly after birth.

          Babies born blind but not deaf, of course,
     develop better-than-normal memories for voices and sounds,
     since that is the way their minds were first organized.

          Likewise, babies born deaf but not blind
     usually develop more acute visual discriminations,
     since that was the first way their minds were organized.

          Important memories are also found in animals,
     but, interestingly enough, their memories are often organized by smell.
     Even years later, they can remember a person or a place by its smell.
     For example, fish find the stream where they were spawned
     when their olfactory nerves tell them "this is home".

          However, the family dog will have no response
     to a picture of its long-dead master.
     But we humans are often flooded by memories
     when we see a picture from childhood.

          Our personal memories make us special persons.
     In large part, we are the sum of our memories
     ---the collection (in our brains) of everything
     we have learned and experienced since we were born.
     And if we lose these memories,
     we become either other persons or former persons.

A. Memory in the Life-Cycle:
             The Dawning and the Darkening of Memory.

          After birth, a baby's brain develops very quickly.
     Very soon the baby notices similarities between what it sees now
     and something that happened earlier in the day or some previous day.
     Recognizing the special people in its life
     may be one of the first signs of memory in a child.

          (If the previous paragraph made you remember something
     from your childhood or the first years of your children,
     this shows how words can evoke memories.)

          In the first few months of life, infants are easily distracted
     because they lack purposeful attention and memory.
     Before we became full persons, our memories were rather random.
     Odd bits of information stuck in our minds,
     but other events sliped thru our memories as quickly as they happened.
     Why do we remembered some events from childhood and not others?

          As children we were easily distracted from whatever we were doing.
     Something new always seemed more interesting than something old.
     Older children sometimes take advantage of younger children
     because they are so easily distracted from whatever they are doing.
     When the baby is offered a new toy,
     the old toy drops to the floor as if it did not exist.

          And young children have difficulty
     foreseeing the importance of putting toys away in their proper places
     so that they can be found when they are wanted again.
     When memory is poorly developed, the child lacks continuity thru time.
     Life comes to the baby as a series of moments
     ---perhaps the way life happens to animals even in their adult years.
     But as the baby gains the power of memory,
     its life becomes more organized and purposeful.

          Organized memory emerges slowly in infants.
     For instance, we do not expect infants
     to remember stories read from a book.
     An infant lacks the necessary system of concepts in its mind
     to make sense of what it hears and hence to remember it.
     The infant's sensory organs may be working perfectly,
     but the storage and retrieval system is still under development.

           Memory works only when sensory input makes sense to us
     ---when we have some reason for remembering something.
     Even as adults, most of what we perceive every day is forgotten.
     We have no reason to store everything that happens to us.
     But an infant remembers even less because it has
     no means of distinguishing the trivial from the important.

          Much of what a baby remembers is short-term memory,
     what it needs for its survival.
     As adults we may remember little from our childhood years.
     But while we were there, we clearly did remember what was important.

          But if there were a baby that did not remember any experiences,
     we would decide that it is extremely retarded.
     Animals are expected to remember only a few rudimentary things.
     But since we human beings remember so much,
     we naturally expect persons to have functioning memories.

          By the time we become adults,
     we have taken in and remembered uncountable bits of information,
     most of which is stored in our brains with instant access.
     When we are called upon to remember the value of pi,
     we remember instantly that it is 3.14,
     even if we have never used this value.
     That is an example of rote memory,
     perhaps not related to anything meaningful in our experience.

          And as we lose our abilities to call up information as needed,
     we remember that we used to remember the facts that are now lost.
     We may notice and mourn the loss of our quick memories when young.
     And if we lose a large part of our functioning memories,
     others may question whether we are still full persons.

          Victims of amnesia do not forget most of what they learned in life.
     They remember how to talk, how to understand their native language,
     most of the abstract things they learned in school, etc.
     But they have forgotten specific periods of their lives.
     They may forget who they are.
     This may have been caused by a psychological trauma,
     which made it painful to remember that period of their lives.
     Later they may regain access to the closed parts of their memories.

          If we suffer a stroke or some other brain injury,
     we may forget large parts of what we felt we knew forever.
     But because human memories are stored everywhere in the brain
     ---rather than filed chronologically or categorically,
     as in a computer or library---some pieces of memory always remain.

           But if an injury or disease causes us permanent memory loss,
     then we may be diminished as persons so severely
     that we no longer remember what was important to us earlier in life.

          For instance, if a stroke rendered me incapable
     of understanding and using English,
     then my life as a philosopher would be completely over.
     I would then have lost everything I learned thru the medium of language.
     And in a deep sense, I would be a different person---or former person.

          If we live long enough, all of us will experience some memory loss.
     We should notice it ourselves first, but if it becomes severe enough,
     those around us who know what we used to remember
     will be able to notice just how much we have forgotten.
     Sometimes such memory losses are temporary.
     Maybe there are certain times (such as later in the day or evening)
     when our memories dim.
     But when our full powers of memory return,
     we feel relieved that memories temporarily lost
     have now become accessible to us once again.

          Until recent years, it was usual for memories to last until death.
     For most of the years of the human species,
     physical death followed quickly after mental death.
     But now medical technology empowers us to keep a body 'alive'
     after the person has ceased to be.

          Most of us may hope that our bodies will not be kept 'alive'
     after our memories (and perhaps other mental powers) are gone.
     Instead of needlessly extending the process of dying,
     when the mind and its memories are gone,
     we should probably let go of the body.

          Each of us should leave instructions in an advance directive
     stating how we would want to be treated if we lose our memories, etc.

          And as a whole society we need to be more accepting of death,
     more ready for the natural termination that will come to us all.
     Others will be able to accept our deaths as well
     if we have set up procedures in advance
     that will enable others to manage our deaths.
     Usually, managing death means postponing it as long as possible.
     But perhaps that emphasis should shift toward accepting death,
     now that we have become so successful in extending life.

B. If I Lose My Memory, I Will Be a Former Person.

          Right now as I look back on more than half a century of life,
     I do not remember most of the things that happened to me.
     But I have no problems remembering the most important events.

          I spent some years in college, for instance,
     studying mathematics, chemistry, physics, etc.
     But since I have not used most this learning for more than 30 years,
     I have forgotten almost all of it.
     I have no idea how to solve a differential equation,
     even tho I studied how to do that for at least one quarter.
     I suspect that I could re-learn such subjects easily,
     but I have no inclination to pursue them.
     I leave such matters to those interested in science and mathematics.

          When I turned from science to philosophy,
     I no longer kept up with scientific developments,
     but I think that I am a better philosopher
     because of my solid grounding in the natural sciences.

          If and when I begin to forget matters important to me now,
     then I may be declining as a person.
     And others who observe this decline
     may be in better position to evaluate me because
     I may lose perspective on myself as I lose my mental powers.
     I may even enter a 'second childhood'.

          I will be like a child again
     if I lose my organizing memory and personality.
     The self that now writes these words may disappear before I die.
     Life may just roll over me as a series of disconnected experiences.
     My mind may shift from one subject to another
     like 'surfing the channels' on a television set.
     And if I forget what is important to me now,
     there will be no reason to remember one thing rather than another.

          If I enter 'second childhood', my memories will be mostly out of date.
     Even now, my dreams are usually set in my childhood home.
     If I become senile, is dreaming the way I will feel even when awake?
     Will I become lost on the street because the old landmarks are gone?
     Will I forget where I live, attempting to return to a childhood address?

          Children must be cared for by responsible adults
     because they cannot get their information in proper order.
     If I become like a child again, others will have to take care of me.
     I may not be able to find my own way in this world.
     Or I may have only a few moments of mental clarity each day.
     If I start to get the sequence of events mixed up in my mind,
     if I cannot remember who I am or what purposes I was pursuing,
     then my life as a full person may be drawing to a close.
     Certainly nothing more can be expected of me
     in the form of original, creative thinking.

          If I can no longer remember the person I was,
     if I am no longer interested in pursuing the purposes of James Park,
     I will have ceased to be that person.

          This could happen suddenly, as the result of a stroke,
     or I could gradually lose my memory and my purposes.
     Perhaps someday I will look at pictures of myself at an early age
     and not remember what the person in those pictures remembered.
     I may have access to information about the person I used to be.
     I might even be able to read the books I wrote during my best years.
     But if I have no personal memory of those thoughts,
     it will be as if someone else had written my books.

          (I have already experienced this odd sensation
     of distance from my own works,
     since I cannot remember what I wrote years ago.
     I am even having this experience right now
     as I re-write the draft of this essay,
     which is dated just 2-1/2 years ago.
     I do not remember writing these ideas.
     So it is lucky I wrote them down when I had them.
     I would not be able to recreate them as well today.
     And when I read passages of books that I wrote many years ago,
     I often enjoy coming across them as a reader does
     ---discovering them for the first time.)

          If I lose my personal memory of myself
     as the person I was during most of my life,
     I might be said to have become a new person.
     In a way this is happening all the time,
     as I revisit past phases of my life
     and see them in a different light now than I did then.

          Even physically, we are changing all the time.
     The old cells are dying off and being replaced.
     But there is usually enough continuity
     for us to be sure that we are the same persons
     who lived in these bodies so-and-so many years ago.

          But if my memory and the rest of my mind is so changed
     that I do not even seem to be the same person to myself,
     then I have probably become a new person in the old body
     ---if I still have enough of the capacities that make anyone a person.
     And if the new person who lives in my old body wants to live,
     then perhaps that wish ought to be honored and respected.
     That will have to be decided by the people around me at the time,
     whom I have chosen to make such decisions for me
     when my own mental capacities might be in doubt.
     And perhaps I will have deteriorated in other ways as well,
     so that I can hardly be expected to pursue any purposes at all.
     If my most important memories are gone,
     that might signal the disappearance of me as a person.

          I will remain a full person while I remember and recognize myself.
     Also, I must remember other persons who have been important in my life.
     One of the saddest notations found in nurses' notes
     is that the patient had a visitor but did not recognize who it was.

          If and when I fail to recognize myself and others close to me,
     that will be strong evidence that I have become a former person.
     If my own identity is slipping away with my failing memory,
     it will be hard to remember who I was.
     And it may be even harder to remember the other people in my life.

          If I can no longer interact with the people
     who used to be important to me,
     then I may still be worthy of respect as a former person,
     but it would be foolish and perhaps impossible
     for them to treat me as the same person I used to be,
     because I will lack my old responses.
     Those who respected me as the person I was during my best years
     may come to visit my body in a long-term care facility,
     but they will no longer be able to visit me as a person.
     It may be impossible for us to discuss subjects,
     such as the contents of this essay,
     even tho such issues would be very relevant to discuss at the time.

          If and when I begin to lose my memory, I hope those who know me
     will still respect me for the person I was during my best years.
     And I hope to be remembered and respected after my death.
     I will be dead for a much longer period than I was alive.
     And I hope some of the thoughts I have had as a living person
     will be helpful in the lives of other living persons.

           But I do not want my body kept alive without my person inside.
     My body will have already fulfilled its primary purpose:
     It has been a very good home for my person.
     But if my period of personhood comes to an end
     some time before my body would normally be laid to rest,
     instead of attempting to preserve my body as long as possible,
     it would be much better to use the same money
     to further the purposes I found most meaningful as a person.
     For example, it would be a greater honor to me as a person
     to spend the money making my books more widely available
     to people who can benefit from reading them.

          If I were in a position to enforce my opinion
     (the values I now hold as a fully-functioning person),
     then my decision would be to let my body go
     after my life as a person has been completed.
     (Perhaps my life as a person will never be completed;
     it might be just over.)
     Anyone who keeps my body 'alive' after my memory has departed
     does nothing for the person James Park.
     Perhaps they will attempt such efforts
     because of their memories of the person I was.
     But such efforts are contrary to my values.

          If you who survive me want to remember me as a person,
     you should apply yourselves to reading my books
     and sharing my ideas with others who can benefit from them.
     My person will be much better encapsulated in my books
     after I have lost my memory than in my body.
     The memory now contained in my brain resides in living cells,
     which are inherently impermanent and subject to decay.
     But even when my brain no longer can recognize my own words,
     the various persons I have been during the several phases of my life
     will be better preserved in my written words than anywhere else.

          I, for one, would not hesitate to declare myself a former person
     if the body I now own and operate is ever (before my biological death)
     inhabited by some form of human life
     that does not recognize the purposes for which James Park lived.
     If my skull contains no memory of James Park as a person,
     then as a person my life is over.
     And I request that those around me take appropriate measures
     to insure the wise re-use of my body (or any parts thereof),
     rather than keeping my body 'alive' as long as possible
     as a kind of 'living memorial' to the person James Park.
     In a very important sense, if I have no memory,
     James Park will have ceased to be.

          If I ever lose much of my memory,
     others must take over my decisions for me.
     And I hope they will respect the person I was.
     It may be difficult to relate with me
     after I have forgotten who I am and who the people around me are.
     If and when that happens, I should be regarded as a former person
     and treated with the respect and dignity due a former person.
     If I no longer understand what people say,
     if I have no thoughts to offer,
     or if I cannot remember what was said to me just a minute ago,
     then such loss of memory would qualify me as a former person.
     My own past life might become a mystery to me,
     unless I retained the ability to read my own books and journals.
     And I might be reading them as if they were written by a stranger.
     If my short-term memory is still working,
     I might be able to re-discover some interesting things about my life
     from reading and from listening to other people's memories of me.
     But if my earlier life is known to me only thru reading and listening,
     if I cannot recall any of it, then I have become another person
     than the one who lived those years---and remembered them for a while.
     It would be as if James Park had died already
     and I was a new person learning about him second hand.

          In order to put this philosophy of life and death into action,
     I have established my Medical Care Decisions Committee (MCDC),
     whose members have known me for many years.
     These people will decide when I have ceased to be a person.
     They will remember what I used to remember,
     what sort of a person I used to be.
     Thus, they will be in a better position to make decisions for me
     than any medical people taking care of me at the end of my life.
     Those doctors and nurses might not have met me
     until after I had deteriorated into being a former person.
     Only those who have known me for a long time
     will truly be able to gauge the degree of my loss of personhood.

          My Medical Care Decisions Committee will, of course,
     take advantage of all the information modern medicine can provide,
     but ultimately my medical decisions will rest with them.
     And because they will all have read this essay years in advance,
     they will be ready to apply my criteria of personhood to me.
     So even tho they may grieve the loss of the good times we shared,
     they will at least be intellectually ready to say
     that James Park has crossed the line into former personhood.
     They will not attempt to preserve their memories of me
     by preserving my body after my life as a person is over.

QUESTIONS FOR PROXIES ABOUT MEMORY

          The people who have known
     the person (or former person) in question for the longest time
     will be able to notice how much memory has been lost.
     Discussing the following common-sense questions
     can help them explore the degree of memory loss.

     1.  Does _____ remember himself/herself and other people?
     2.  Does _____ recognize and remember other people
           who have been important in his/her life?
     3.  Does _____ recognize himself/herself in a mirror?
     4.  Does _____ recognize himself/herself from recent pictures?
     5.  Can _____ recognize himself/herself from pictures
           from various periods of his/her past?
     6.  Do only the oldest pictures, perhaps from childhood, evoke memories?
     7.  Can _____ identify other people from old photographs?
     8.  Does _____ sometimes confuse periods of his/her history?
     9.  Does _____'s mind sometimes slip from the present
           into some past period of his/her history without notice?
     10. Does _____sometimes confuse relatives from different generations,
         such as confusing a mother with her daughter?
     11. Does _____wish to return to a home that no longer exists?
     12. Has _____ reverted to using the native language of childhood
         ---if this is different from a language learned as an adult?
     13. Has _____ forgotten some parts of his/her history?
         If others remember what _____ said and did
         better than _____ does, then clearly his/her memory is failing.
     14. Does _____ seem to be a different person
           because the past has disappeared from memory?
     15. Does _____ remember his/her past life reliably?
     16. Is _____'s memory of recent events less reliable than old memories?
     17. Does _____ sometimes lose track of a conversation
         because of lack of short-term memory?
     18. Does _____ sometimes have difficulty telling the difference
         between memories of real events and stories and dreams?
     19. Does _____'s memory seem to fade and
         depending on various other factors of health and circumstances?
     20. If you wanted to know something for certain about the past,
         would you trust _____'s memory?

IV. LANGUAGE AND COMMUNICATION

          When is a person?  Personhood is marked by
     flexible language and interpersonal communication.

          As we develop the capacity to understand and use language
     in the first 18 months of our lives, we are beginning to become persons.
     And if there is a time before the end of our lives
     when we lose this wonderful capacity
     to understand and communicate with other persons,
     then we are losing one of the most important marks of personhood
     ---a capacity that sets us sharply apart from animals and computers.

          A human being who could not recognize and use symbols
     might look like a normal human being in all outward respects,
     but it would not be a person.
     We know of a few very rare instances of children raised by animals.
     If they reached the age of 5 or 6 without human language,
     without every hearing or speaking a human word,
     without ever using a symbol system,
     then those human beings were not persons.

          And after the critical period for language imprinting has passed,
     it seems next to impossible for a human being to acquire a language.
     This fact also has serious implications for children
     raised in language-poor households,
     where language is confused or somehow missing.

          Without language, a human being remains like an animal.
     Animals can certainly interrelate with others in the household,
     but they cannot really understand what the others are doing.
     Human noises do not signify for the animals of the household
     what they mean for the persons who understand that language.

          Children raised without the benefit of language
     may look like normal children, but they are not.
     Persons can only interact with them as they do with household pets.
     Some forms of mental retardation and mental disabilities
     also result in children lacking language ability.
     They can learn to respond to sounds and signals,
     as a dog or cat might, but without language,
     there is no way to communicate with them.

          Luckily even children born deaf can learn sign language,
     so that their minds can be as fully symbolic
     as children who can hear and speak.
     Most human beings naturally become persons
     because they are so easily imprinted with their native language
     in the first few months of life.

A. Language Development in Children.

          As soon as we were born into this world,
     we were exposed to language---people talking every day, all day long.
     They talked to one another.  And they even talked to us,
     altho we could not understand a word they said at first.

          When we were born, all languages were foreign to us.
     But we quickly observed that people made noises to communicate.
     And we attempted to imitate human sounds before we knew their meanings.
     However, in contrast to a parrot, which can also make language-sounds,
     we began to understand what these sounds meant
     in the lives of the people around us.

          With language all around us, we soon began to pick up
     the connections between human sounds and the objects they signified.
     We noticed that certain vocalizations went with certain experiences.
     And because our minds were prepared by evolution
     to be very receptive to language in these early months,
     we quickly and easily acquired the language we heard.
     No formal instruction was needed.
     The language around us was just imprinted on our brains.
     We picked up thousands of abstract symbols (words)
     and the often complex grammatical rules for putting them together.
     Thru trial and error, we gained the ability to speak
     and to make ourselves understood by others.

          Also we soon discovered
     that language can refer to past and future events.
     The persons around us constantly talked about yesterday and tomorrow.
     So language was not mere pointing to what everyone could see.

          The persons around us used language to communicate with others
     concerning the things that were happening inside them,
     their private thoughts and feelings, many subtle issues and concerns
     that could never be shown by pointing.
     Animals never figure out this function of language.
     So most of what they hear is meaningless sounds.
     Try to teach even the most intelligent animal to read this page.

          After years of merely listening and talking,
     we discovered that words can be transformed into symbols on paper:
     We were introduced to reading and writing.
     After that, there was no limit to what we could learn.
     Language opened up worlds of information about things
     that we could never experience directly by ourselves in one life-time.
     We may have decided to learn new languages
     ---the ways of speaking and understanding that developed
     on different parts of the globe among our species, homo sapiens.
     With the help of these symbol systems,
     we could acquire an almost limitless amount of information.

          Our language capacity can continue to develop thru-out our lives.
     Every day we can learn new words.
     And perhaps we lose a few words that we used to know
     because we never have occasion to use them.
     If we study specialized knowledge, we will learn technical words
     that apply only to that form of behavior or concern.
     Words can be used to explain the meanings of new terms.
     So our knowledge becomes an interconnected web
     of hundreds of thousands of words, all defined by other words.

          Language is the most distinctive mark of a human person.
     Those who miss the critical period for language imprinting
     can never quite catch up with the rest of the human race.
     They never become full persons in the ways that all people
     who can read and understand this essay are persons.
     In extreme cases we might say
     that they remain members of the animal kingdom
     even if they are kept among us as members of the family.
     They must be guided thru all of the activities of their lives
     the way we guide the behavior of animals.
     Humans without language can be trained to respond to signals,
     but they will never understand why they are being so directed.

          When human animals first developed the capacity to speak,
     they burst out of the animal kingdom.
     About 100,000 years ago, our ancestors became persons.
     Since then, all human cultures have created abstract symbols,
     which the persons of those cultures use every day
     in the complex process of interacting with other persons.
     Thus, language is essentially an interpersonal phenomenon.
     If there were only one human being on the earth,
     it would probably not have developed language,
     and hence it would not have become a person.

          So the concept of "language" must be stretched to include
     other forms of human interaction.
     We relate with other persons thru the medium of language.
     And if we do not share a common language,
     we still try to connect with different symbol systems
     by pointing to things for which we know we all have words.
     But pointing and making noises does not work with animals,
     because they lack abstract symbols for the elements of their world.
     We have probably taken our language ability for granted
     because it developed so early in our lives.
     We have no recollection of acquiring our native language.
     We just grew up knowing our mother tongue.
     And most of us continue to use and understand language until we die.
     But some people lose their capacity for language before death.
     So if language and communication are essential to being a person,
     what do we make of human beings who have no language?

          Some human infants, however, do not develop language.
     They are treated in every way as if they will become persons.
     We speak to them and about them
     assuming they will eventually understand what we say.
     Most infants so treated do in fact develop language,
     without any further attention to the matter.
     But some defective infants never develop any ability
     to understand and use a human language.
     No matter how completely we treat them as persons,
     they never become persons.
     They look and feel like all other human infants,
     but without the communication capacity given thru language,
     they never become full persons.  They remain pre-persons.
     Talking to them does no more good than talking to our pets.
     Both creatures remain non-persons if they cannot understand language.

B. Animals Lack Full and True Languages.

          Even tho many pet-owners speak to their pets
     as if they could understand, treating them as if they were persons
     or could become persons with enough attention,
     at best such pets gain some awareness of human sounds,
     when they relate to a particular situation.
     "No" is a common sound that pets can understand.
     Some can understand the sounds we make
     when we say "walk", "sit", "come", etc.
     But we never expect our pets to talk back to us.
     Animals thus cannot be said to have any abstract languages.

          The essence of every human language is abstract symbols,
     sounds or written signs that carry meanings
     not limited to the immediate situation.
     Language uses metaphor to compare one thing to another.
     When we look for anything close to language in animals,
     we discover no abstractions, no metaphors,
     and no ability to discuss anything beyond the immediate situation.
     Animal cries, songs, and signals always 'refer' to here and now.
     For instance, bees can tell each other where the flowers are---now.
     Or birds can warn one another of predators in the neighborhood.
     Animal sounds inform other animals that they are present
     and perhaps that this territory is already taken.
     They can signal one another that they are interested in sex---now.
     Their 'discourse' is limited to the present tense.
     They may call to their young in danger.
     They may challenge one another for food, status, and females.
     And they may join in singing or howling
     merely because they like to do it together.
     But they never discuss their experience from yesterday
     or what happened last year at this same place.
     They do not discuss their plans for next week
     or what they would like to do differently next year.
     As much as we have studied whales' songs or the wolves howling,
     no one has suggested that they are telling their histories
     or making plans for the next season.

          And the fact that all members of the same species make almost
     the same sounds no matter where they are found on the earth
     suggests that animal sounds are genetically-encoded, not learned.
     Sometimes the songs of a certain species of birds
     does evolve differently in different locations
     as the result of long and permanent separation.
     For instance, Americans are surprised to learn
     that starlings were once valued in Europe as song birds.
     They were imported to the Americas because of their beautiful songs,
     but somehow they forgot how to sing
     and now they only screech on this side of the Atlantic.
     And some seem to pick up sounds from other birds.
     So perhaps in this respect they are a bit like parrots,
     who do not have a genetically-given song
     but who have a powerful capacity to imitate sounds they hear,
     even tho they will never understand what they are 'saying'.

          Social insects such as ants, termites, and bees
     are sometimes said to have a 'language' in their dances.
     By the use of stereotyped gestures, touches, and movements
     they can tell one another the direction and distance to food.
     And these dances are not a direct imitation of the action suggested.
     But they are universal among that species of insect,
     which suggests that such 'languages' are encoded in their genes.
     The bees cannot arbitrarily change their language conventions.
     They cannot make up new words or put them into new combinations,
     which every human baby does all the time.
     The insects cannot express themselves metaphorically,
     by talking about other things that remind them of the issue at hand.

          In the late 20th century, quite a bit of attention
     was devoted to the language abilities of primates,
     the members of the animal kingdom closest to humans.
     Some apes learned a few words of American Sign Language
     and some could use geometric shapes to represent words.
     But even the most optimistic of such accounts
     admit that apes can learn only a few hundred words.
     In contrast, even a pre-school human knows thousands of words,
     which it has merely picked up without any formal instruction.
     When primates are raised in the same households as children,
     the children always get imprinted with the language around them,
     but the animals never understand how human language works.
     Only thru laborious repetition can the animals learn a few symbols.

          The pre-schooler can interact with others in the household
     following the elaborate word-patterns and rules of its language.
     The child can express its internal thoughts and feelings
     thru a spoken language---sounds that are quite arbitrary.
     A child raised in another language would not understand them.
     Perhaps the only universal human communication is crying,
     noises a child makes without any input from the environment.
     Maybe a child crying is our closest equivalent to animal noises.

          And when children are exposed to television or go to school,
     they encounter millions of new items of input,
     many of which they can record in their memories
     because their minds are already prepared
     to receive symbolically-encoded information.
     But if we put a chimp or an ape in front of the television set
     or send it to school with the child, no such learning will occur.
     No primate has ever acquired anything from a human lecture.
     No primate has ever learned to talk.
     No primate has ever learned to read,
     which would enable the ape to decode the words on this page.

          Dogs and cats raised in the same households with children
     are exposed to the same rich environment of human language.
     But they pick up only a few words of English.
     In fact, they are probably just getting the sounds of
     "good dog" or "bad dog", "no", "scat", "sit", or "walk".
     If you have pets in your home who have learned
     what you have assumed is a few words of English,
     try changing the words to their opposites ("good" for "bad" for instance),
     but speak the word in the tone of voice used for its opposite.
     Because animals have a genetic capacity to understand sounds,
     they can 'understand' human speech that resembles animal sounds.
     So, no human language is too exotic for an animal.
     Foreign languages that give humans extreme difficulty
     are easy for animals,
     because they pick out the sounds and ignore the symbols.

          These limitations in dogs, cats, horses, and chimpanzees
     reside in their brains, not in their intelligence.
     Many trained animals are able to learn hand signals
     more easily than human words (actually sounds)
     because their minds evolved with the capacity to understand
     the behavior of other animals around them.
     They can respond to facts that they observe in their world,
     either thru seeing or hearing, but their minds cannot process symbols,
     the essence of human language.

          In the 21st century, we will continue to study animal 'languages',
     but it now seems extremely doubtful
     that any animals will ever come close to human persons
     in understanding and using abstract symbols.

C. Computers Do Not Understand Metaphors.

          Even tho we have mostly failed to teach language to animals,
     we have been able to create machines to process language very well.
     Computers are able to recognize, remember, store, and manipulate
     many forms of abstract symbols, including every human language
     and the special mathematical languages of the sciences,
     which only a few human beings can understand.
     In fact, the words you are looking at right now,
     were put thru a machine which stored them electronically
     and which allowed, me the author, to manipulate them several times
     before they were finally printed out by another machine.

          But even tho all these words went thru an 'electronic memory',
     which kept every key-stroke for as long as I wanted,
     the computer never understood a word of this text.
     A computer does not comprehend what is stored in its 'memory'
     any more than a book in the library understands what it contains.

          Nevertheless computers can become quite clever with language.
     Human language can be broken down into its component parts
     ---phrases, words, and individual letters of the written form.
     And a computer can be taught to 'translate' a word
     into another human language by being told that they are equivalent.
     But this is all being done mathematically
     with ones and zeros in the processor of the electronic brain.
     The computer does not understand what it is doing,
     as all human translators do.
     Many examples of computer mistranslation
     show the limitations of this form of 'thought'.
     The computer does not understand the symbols it is manipulating.
     It cannot grasp the leaps of thought we call metaphors.
     (For instance, what sense would it make of a "leap" of thought?)
     Computers are limited because they are not persons.
     They have no human experience
     as a background for understanding what was said.
     Rather they must depend entirely on the mechanical structures
     put into their 'brains' by human beings.

          Ironically, once we have learned
     to recognize the errors of language created by computer 'thinking',
     we may also notice similar things happening
     in the language of children and the language of senile people.
     They may be able to repeat words they have heard,
     but the ways they put words together
     show whether they understand what they are saying.
     Merely being able to 'parrot' a correct statement in a human language
     does not prove that the speaker understands the utterance.

D. The Sudden Loss of Language---As by a Stroke.

          Thru-out my adult life, I have been a very verbal person.
     From my first moment of consciousness in the morning
     until my last moment of consciousness at night,
     I find that my head is full of words.
     Almost everything I do takes place thru the medium of language.
     I have about 50,000 English words stored in my brain.
     If I were suddenly to lose all of these tools of thought,
     I seriously wonder if I would still be a person.

          Sometimes a cerebral accident destroys language ability.
     This might be a stroke or some other damage to one's head
     that causes the language parts of the brain to cease functioning.
     In many cases, some or all of this language ability returns.
     But if I were to lose my ability to understand and use English,
     I think that I would be a completely different person.
     Perhaps I would even become a former person from this loss alone.
     That will be for others to decide.
     My Medical Care Decisions Committee must decide
     when I have become a former person, using this essay as their guide.

          If I could no longer understand what people were saying to me,
     it would be very difficult to relate with me as a person.
     I can even imagine having to be directed around like an animal,
     with physical pushes and pulls rather than instructions in English.
     That might be such a significant loss of dignity
     that further life would no longer be meaningful to me
     or to those who know me at the time.
     Those who enjoyed knowing me as a person
     would not be able to maintain anything like our former relationships
     if I could no longer understand or use English.
     Expressing myself in language
     has been central to my life as a philosopher.
     I now spend hours every day reading books, thinking about their content,
     discussing these ideas with other persons,
     teaching classes, and writing books and articles.
     Without language none of this would be possible.
     Without language all I could do would be walk around, eat, and sleep.
     I would be a mere shadow of the person I am now.

          I know that someday I will be completely dead.
     During the years after death,
     I will no longer be able to use language to do any further work.
     Thus I recognize at least that limit to my work as a philosopher.
     But if I have a cerebral accident,
     my life as a philosopher might end before I am completely dead.
     And then the question will arise
     whether what remains of my life ought to be peacefully terminated
     and my remains reused as I have directed,
     rather than keeping my body alive
     out of respect for the person I used to be.
     After I am dead,
     I hope people will remember me as the person I was.
     But I do not see much value in having a transitional period
     during which I can no longer be a person
     but when I am still not completely dead.

          Would I even be able to know myself without language?
     I understand that sometimes people who lose language ability
     are able to compensate by using other areas of their brains
     for processing their thoughts, such as singing to themselves.
     And maybe my loss of language would not be complete or permanent.
     I might have some capacity to relearn language.

          If I were to lose my capacity for language,
     perhaps this would feel like a return to childhood,
     before I knew any human language.
     As a child, my experiences of myself and others was mostly feelings.
     Perhaps I would revert to being completely a creature of emotion
     ---no thoughts, just moods and impulses.

          If I were to enter such a 'second childhood',
     then, of course, I would not be expected
     to conduct any of my own affairs as an adult.
     Others would have to take over those parts of my life
     that can only be done by an adult who uses language.
     (This verges on the loss of autonomy, discussed in Section V.)

          If I were robbed of language,
     I would not recognize my work as a philosopher.
     My books would have no more meaning to me than to a dog.
     Sometimes when I am reading at the lake,
     an insect lands on the page and walks across it.
     This reminds me how meaningless these black marks are
     to any creature that has no language ability.
     If I am ever reduced to the level of an uncomprehending being,
     all concerned should wonder whether I am still a person.

          The people around me after such a catastrophe in my brain
     may still respect James Park for the person he was.
     And this respect might not be very different from after-death respect.
     But it would be a sorry spectacle to anyone who knew me as a person
     to realize that I have been reduced to the level of a family pet,
     guided around by hand, having food put in front of me,
     being put to bed, being cleaned up after, etc.
     That certainly would not be a pleasant experience
     for anyone who knew me while I was still a full person.
     It might be better for strangers to take care of such a former person
     since they would have no memories of who I used to be,
     memories which would make such work more tragic and painful.

          Without language I could no longer pursue the purposes
     that were important to me during the best years of my life.
     So it might be better for my body to be donated to medical education
     while it can still be of some interest and use,
     rather than waiting for the last of my biological life to end.

          Keeping James Park around after he has lost all language ability
     does not seem a fitting memorial for my life as a person.
     I would not want to be remembered in such a reduced state.
     But if there is realistic hope that I might return to full personhood,
     then, of course, I should be given appropriate means of support.
     But if that hope is gone,
     and if it is only a matter of time before I will be completely dead,
     then an earlier death might be better than a later one.

          It is conceivable to me that I might be in an intermediate state,
     in which I might have lost almost all ability to use language,
     but I might still be able to understand language.
     I could have a good grip on what people were saying to me,
     even if I could never find the correct words to respond intelligently.
     So if I still seem to be "with it",
     able at least to understand English,
     then perhaps my continued existence could be meaningful to me
     and to the people around me at that time in my life.
     If I am still able to read and understand,
     that would show some verbal life somewhere in my brain.
     But if my language ability has been so damaged
     that I cannot remember what I read or what others say to me,
     then I may have fallen below the level of personhood.

          And certainly if I am in a coma or a persistent vegetative state,
     language ability will have disappeared.
     I do not understand things spoken in my presence when I am asleep,
     even tho my ears are open to sounds at the time.
     In sleep, my mind is not 'warmed up' enough
     to process most of the sounds that come to my ears.

          However, there are some remarkable stories of people
     who seemed to be in a coma
     but who later were able to report what happened to them
     and what people said around them.
     So we should not jump to conclusions
     about the capacities of individuals who seem to be asleep.

          Also the loss of language capacity
     should be distinguished from hearing loss.
     If I can still respond by turning my head toward loud sounds, etc.
     but I do not show any sign that I understand what others say to me,
     then I would have lost language capacity rather than hearing capacity.
     I would have lost that special ability in most human brains
     to process and interpret language.

          If I ever return to being a non-verbal creature (as I was in infancy),
     unable to understand or use language or any other symbol system,
     I might still be able to respond to human presence or to human touch.
     I might remain a member of a circle of human beings
     who were still interested in relating with me on that level.
     What would it be like to be a member of a group of human beings
     who must relate with me completely without words or symbols?

E. The Gradual Loss of Language---As in Alzheimer's.

          In contrast to the sudden loss of language ability,
     as in a stroke, which is always an obvious crisis
     that requires serious adjustments for everyone involved,
     it is more common for language ability to slip away gradually,
     a little each year as we grow older.

          I have already noticed that I cannot spell as well when I am tired.
     There are words that I have known and used all my life,
     the spelling of which completely eludes me for the moment.
     Later, when I am functioning a little better,
     I remember how to spell them.
     (At the top of this page, I could not remember how to spell "gradual".)

          If I were slowly to lose my language ability,
     it might be some time before I noticed it myself
     or others became aware that my mind was not functioning at its best.
     I have seen some philosophers disgrace themselves in their later books,
     which were only published because they were well-known thinkers.

          And some creative people in many fields acknowledge
     that they have done their most creative work before they turn 50.
     Our mental abilities may be adequate to all the normal tasks of life,
     even teaching college courses,
     but if we have no more creative bursts of insight,
     then we cannot be expected to produce any more original works.

          And as we are all living longer,
     more of us will decline mentally before our bodies give out.
     Our brains are the most delicate part of our bodies.
     And if the blood supply to our brains is reduced,
     we may discover that our thinking capacity diminishes.
     Perhaps this could be measured by how many words we have forgotten.

          If I slowly lose my language ability,
     I will no longer be a creative philosopher.
     I may be able to take care of the practical matters of everyday life.
     But I may no longer be interested in abstract ideas.
     I may use only simple words and concepts
     ---the tools of thought I have known since childhood.
     Complex concepts may elude my grasp.
     And the words that express feelings rather than ideas
     may become the primary way in which I express myself.

           One reason for compulsory retirement
     is that people who lose their creative and flexible mental powers
     do not always recognize what is happening to them.
     And if they hold powerful positions in a corporation, for instance,
     it may be difficult to remove them.

          If there were good ways to measure the decline of mental powers,
     then perhaps we could substitute these tests for an arbitrary age.
     But such tests might raise as many problems as they solve.

          The people who have known me for the longest time
     will be in the best position to notice any loss of mental powers.
     Of course, these people will also be getting older.
     And perhaps they will also be losing some of their mental sharpness.
     So they may not notice or not care about
     my loss of verbal or intellectual abilities.

          But if I assume that at least some of the people who knew me
     in my prime keep their mental abilities as we grow older,
     they may be the ones who will notice first
     if I being to lose my ability to understand and use language.
     They may notice that I no longer enjoy reading interesting books.
     This has been the major way that I have spent my adult life.
     Daily I have enjoyed the life of the mind.
     They may notice that I repeat myself,
     trying to make silly points that I cannot explain at a later time.

          If a tape recording of me in my prime
     were compared with me in my declining years,
     then the loss of verbal and intellectual ability may be more striking.
     If people who have known me for many years
     find that they can no longer hold intelligent conversations with me,
     that could be a sign that I am beginning to lose my language abilities
     ---and the other intellectual capacities that depend on language.
     They may rightly say that I do not seem to be the same person.

          And if my loss of language is permanent rather than temporary,
     it could mark the beginning of a decline into being a former person.
     One way to measure the deterioration of people with Alzheimer's
     is to notice the number of words they still recognize and use
     and the number that have dropped out of their active vocabularies.
     If my vocabulary were to drop from 50,000 to 1,000 words,
     that would be good reason for the members of my
     Medical Care Decisions Committee to meet
     in order to consider the next phase of my life.
     In some cultures, dotage was expected of all older persons.
     If they managed to survive into old age,
     they were allowed to live out their natural lives,
     being cared for thru their second childhoods
     by the more functional adults around them.
     Usually adult children take care of such persons in decline.

          But as medical science and technology
     are able to keep us alive for longer periods,
     more of us will experience periods of senility---and for more years.
     It used to be that physical death followed soon after mental decline.
     But that is not as automatic as it once was.
     So our culture may need to develop new ways
     to deal with a growing population of former persons.

          But even before any such changes in public policy,
     individually we can tell those who care about us
     how we would like to be treated if we get Alzheimer's disease
     or some similar condition that requires others to take care of us.
     I have done this in my own advance directive for medical care.
     And this essay itself explains my philosophy in detail.

          If my MCDC determines that I have become a former person
     according to my own definitions in this essay,
     then I have directed that my last consciousness be shut down
     and that the re-usable parts of my body be given to
     persons who can make better use of them.
     My body has supported me as a person for many years.
     But if it can no longer sustain me as a full person,
     I would be happy to know that at least some of my organs
     can support the lives of other persons.
     If my mind gives out before my body,
     then my body should be used for the benefit of other persons.
     Conversely, if I have an active mind while my body is giving out,
     I hope that I can receive the physical support that will enable me
     to continue living as long as my life remains meaningful to me.

QUESTIONS FOR PROXIES
ABOUT LANGUAGE AND COMMUNICATION

          As we saw with the other marks of personhood,
     medical experts can provide some important tests
     for the loss of language ability.
     And such expertise should be sought in all cases
     where important decisions depend on the analysis.
     But relatives and friends of longest acquaintance
     will be best able to compare the person they knew years ago
     with the individual now before them.

          The analysis of medical experts will be especially important
     in cases of defective newborns.
     Based on similar cases, they should be able to tell the parents
     what language limitations their newborns might have later.
     And if the baby will understand and use only a few words,
     then that child might never become a full person.
     But after the projections are made by the experts,
     the parents will still have to decide
     whether to treat or not to treat a defective newborn
     who may have severe language limitations.

          If we agree that language ability is a mark of personhood,
     and if we are in position to make medical decisions for others,
     here are some common-sense questions we can ask
     to see if the individual for whom we must decide
     has perhaps lost so much language ability
     that he or she has become a former person.
     (Of course, those who examine any individual's language ability
     must know which human language that individual knows best.
     Mere lack of ability in English does not make one a former person.)

     1.  Has _____ s language ability deteriorated significantly?
         from the time when he/she was a full person?

     2.  To what degree does _____ understand what we say or write?
     3.  When _____ attempts to communicate with us
         do we get a vision of what is happening inside him/her?
     4.  Or do _____'s utterances seem to lack meaning and sense?
     5.  How well does _____ understand the written, spoken, or signed
         language that used to be his/her medium of communication?
     6.  Has _____ lost the ability to understand comments
         and instructions that he/she used to understand easily?
     7.  Does _____ quickly forget the beginning of a conversation
         before it reaches its end?
     8.  Does the same conversation have to be started over and over again?
     9.  Has _____'s capacity to communicate declined
         over a period of months or years?
     10. If _____ used to be able to hold normal conversations
         has this capacity disappeared
         without an obvious explanation such as hearing loss?
     11. Does _____ have phases when communication returns for a time?
     12. How often and for what periods of time
         have we been able to communicate normally with _____?
     13. Has verbal communication broken down to such a degree
         that those who take care of _____ must use physical manipulation
         such as guiding by hand, carrying, or pushing in a wheel-chair
         to get _____ from one place to another?
     14. Does _____ seem to understand why he/she is being moved?
     15. Do the experts we have consulted tell us
         that some of the lost language ability will return later?
     16. Or will the problem become progressively worse?
     17. How long should we wait to make sure of the prognosis?
     18. Does _____ seem to understand what we say or write,
         even tho he/she cannot express himself/herself?

     (Professional opinion might help to answer this question also.)

     19. Has the loss of language ability
         made it impossible for us to relate with _____ as a person?
     20. If we were in a similar condition, what would we want done?
     21. Has _____ left any written instructions about such a condition?
     22. While still clearly competent, did _____ made comments
         in other ways than writing that express his/her wishes
         for the kind of situation in which he/she now lives?
     23. Has _____ lost his/her capacity for personal relationships?
     24. Does _____ seem to be so changed
         by the loss of language and relationship capacity
         that he/she seems to be a different person?
     25. Has _____ become a new personality in some respects?
     26. Has _____ reverted to a childish personality
         that is no longer pleasing to be with?

     (Sometimes spouses spend years caring for former persons
     who no longer can relate as the persons they once were.)

     27. Has _____ left any oral or written instructions
         concerning what should be done
         if he/she loses the capacity for interpersonal relationships?

     (If while still a full person, he or she had such foresight,
     then those who must decide will feel much better
     about carrying out any unconventional directives.)

     28. If _____ can no longer relate as a person,
         what would he/she want?
     29. Would _____ want his/her organs donated
         so that others whose bodies are failing
         but who still have language and interpersonal capacities
         will be able to have a few more years
         of meaningful interpersonal relationships?
     30. If _____ is married, has his/her spouse considered divorce
         because his/her personality has changed so much
         that he/she hardly seems able to love?

     (This is not a moral failure.
     Former persons may be mentally incapable of love.)

     31. Should a spouse be forced to remain married to a former person?
     32. Or should the partner who is still a full person
         be given permission to disconnect from the former person
         and to get on with his/her life,
         for instance, to be open to new relationships?
     33. Or should the fully-functioning spouse
         be forced to remain loyal to the memory
         of the still-living but now radically changed spouse?
     34. Should the fully-functioning spouse be expected to remain
         in a supportive relationship with the former person
         even tho little or no meaningful interaction is possible?

     (If the now former person had given approval in advance,
     merciful death might be a better alternative
     than divorce and institutionalization for the former person.
     What values are to be achieved (and for whom)
     by more years as a former person?)

          These questions need not be answered in detail, one by one,
     but they should lead to some meaningful discussion
     among the family and friends who have known the patient for years.
     Just how much change have they observed?
     Out of such discussions a consensus may emerge,
     which can be communicated to the smaller group of people
     (perhaps a Medical Care Decisions Committee)
     who are ultimately responsible for making medical decisions
     for the now former person.

V. AUTONOMY

          When is a person?  We are persons when
     we can form goals and meaningfully pursue them.
     Persons are those creatures who have purposes for living
     and who organize their daily lives in order to pursue those purposes.

          We are not required to succeed in what we pursue,
     but without some thrust to our lives, we would not be full persons.
     We become autonomous as we decide how to use our time.

          Animals, in contrast to persons, do not have purposes.
     They certainly do act and behave in specific ways,
     but their lives are directed by instinct rather than goals.
     During the course of a day or a life, an animal may do many things,
     but such activities are not autonomous because animals lack
     reasoning, responsibility, planning, and principles
     ---all of which are signs of autonomous behavior.
     Animal behavior can be understood as conditioned responses
     and stereotyped patterns given by their genes and hormones.

          (There are some thinkers who claim that persons are no different,
     that even human behavior can be reduced to instinct and learning,
     but we will not attempt to refute such reductionism here.
     See the chapter on freedom in my Spirituality for Humanists.)

          To be a full person includes having a sense of purpose,
     to be directed toward goals.
     If we ask persons what they are trying to do,
     they can explain the outcomes they have in mind.
     In many cases such purposes have been provided by society,
     but the persons have internalized and owned these goals.

          (Here we will deal with "autonomy"
     only in the broader sense of having internal governing principles,
     even if it can easily be seen that these purposes were enculturated.
     A higher meaning of "autonomy" points to a capacity of persons
     that enables them to transcend such culturally-provided goals
     and choose purposes in life that were not recommended.
     This higher meaning of "autonomy" is explored in James Park's
     Becoming More Authentic: The Positive Side of Existentialism.)

A. The Emergence of Autonomy in Children.

          As children become aware of themselves as separate beings,
     they assert their independence first in small ways,
     such as refusing the food that is put before them
     and demanding other foods they like better.
     Children soon learn to say "no" to their parents
     and to make their contrary wishes known.

         Until the emergence of these first signs of autonomy,
     much of children's behavior can be understood on the animal model,
     as responses arising from internal need and conditioned responses.
     But as they become more conscious of themselves
     as independent beings with their own wishes and dreams,
     they begin to express their personal identities in their choices.

          As children grasp the connections between cause and effect,
     and as they develop personal preferences based on experience,
     they begin to 'lay plans' to obtain what they want.
     A baby's first 'purposes' may be merely to be fed or changed.
     The reduction of suffering may be its first 'goal'.
     By trial and error, by crying and fussing,
     the baby learns to get what it wants from its parents.

          Later the child will develop a much more elaborate set of aims.
     And it will be able to pursue projects
     lasting several days, months, and eventually years.

B. Autonomy Includes a Meaningful Sense of Time.

          While we were still children, the present was very short.
     We had little past we could remember.
     And the future we projected was only a few minutes.

          But as we grew older, we developed a full sense of time
     ---having a remembered past, an active present, and a projected future.
     We remembered events in our lives from days or months ago.
     We learned to anticipate future events by a few days or weeks.
     And as we became more fully adult,
     we could embrace several years ahead in a single thought.

          Also by contrast, we note that animals have a short present.
     Normally they have no need to remember a distant past
     and no reason to plan for a distant future.
     For most of them today (or at most this season)
     is a large enough horizon of time.
     (Some animal 'preparations' for the next season
     are really instinctive behavior.
     The squirrel does not know why it hides nuts.
     It just keeps doing it because it is driven to collect nuts,
     even if it has far more than it could ever use.
     Likewise, bees store honey instinctively.)

          Our ability as persons to embrace the future
     requires another mark of personhood---memory---discussed above.
     We can plan for our futures because we remember our pasts.
     Instead of merely repeating patterns from the past,
     we can 'run ahead' of ourselves and pick a better path.
     With knowledge of what others have already tried,
     we can make modifications of the old ways
     or devise entirely new ways of inventing our lives.

C. As Adult Persons We Invent Our Own Goals
                     And Develop Moral Capacity.

          We become autonomous persons by devising goals for ourselves.
     Instead of experiencing the future as one surprise after another,
     we learn to take charge of our futures by establishing our own goals.

          These purposes for the future will be based in past experience.
     And our first goals will likely be purposes our culture recommends.
     We internalize these values and make them our own.

          Later, we may become autonomous in the higher sense
     of resisting the assumed values and purposes of our given culture
     and deciding to pursue meanings not provided by others.

          In either case, we take moral responsibility for our lives.
     We begin to 'own' our selves
     and to direct our lives toward our own meanings.
     We make long-term plans intended to reach meaningful goals
     and begin to put them into action.
     We make promises to other persons that extend into the distant future.
     We follow our plans step-by-step, from one day to the next,
     week-by-week, month-by-month, year-by-year.
     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.

D. Children Cannot Be Trusted to Handle Money.

          The emergence of personal responsibility
     may be observed in the ways children handle their money.
     When children first learn what money is,
     they have a poor grasp of various magnitudes of money.
     They are more likely to count the number of coins and bills
     than to calculate the total value.
     It takes some instruction for them to realize that 100 pennies
     adds up to the same value as 1 dollar
     and that five one-dollar bills equal one five-dollar bill.

          But children soon learn to exchange money for other things.
     And the objects they want seem more valuable than the paper money.
     So they can often be induced to exchange
     inappropriate amounts of money for something they want.
     The wishes of the moment may seem overwhelmingly important
     compared with something the same money can buy at a later time.
     So they see little sense in saving for the future.
     When given small amounts of money, they spend it immediately.

          (We may know adults who are even more irresponsible:
     They spend money even before they have it.)

          We illustrate our degree of responsible autonomy
     by how well we handle our finances.
     Responsible adults usually manage children's money
     until the children show they can handle their own money well.

          One of the passages from childhood to adulthood occurs
     when we become financially independent of our parents.
     When we make our own earning and spending decisions,
     we have become autonomous persons in the financial sense.

E. Some Retarded Individuals Never Become
                     Responsible, Autonomous Adults.

          However, some individual human beings never become capable
     of handling their own affairs, especially financial affairs.
     Some retarded individuals remain child-like in their decision-making.
     The abstract concept of money is beyond their grasp.

          Retarded individuals can often be trained to handle personal care,
     but with respect to the other activities of their lives,
     responsible adults must often guide them.
     Every day they have to be reminded what to do.
     They never form life-purposes of their own.
     Some retarded individuals can be guided by human language,
     but others never learn to understand human words,
     so they require intensive supervision and assistance.
     Unless something changes to correct their retarded condition,
     their whole lives will have to be controlled by responsible adults.

          Retarded individuals certainly have some level of consciousness
     (altho sometimes only a low level of self-awareness).
     They usually have some capacity of memory.
     They vary in their capacities to understand and use language.
     But almost none of them develops the capacity of autonomy.
     (This lack of adult autonomy is usually what defines them as retarded.)
     Thus they have two or three of the marks of personhood,
     but because they lack autonomy,
     they cannot take full responsibility for themselves as adults.

          As a society, we respect retarded individuals as human beings,
     but we do not give them all the rights and responsibilities of adults.
     We may find it difficult to relate with them as adult to adult
     if they have never developed the adult capacity
     to make their own plans in life
     and to pursue them in meaningful and effective ways.
     They may never become autonomous persons.

          In law and common sense, we relate with these individuals
     in different ways than we do with full persons.
     For instance, we allow them to vote
     only if they show some sense of who they are,
     where they live, and what voting means.
     In many ways, some retarded individuals remain children all their lives.

F. If I Enter a 'Second Childhood',
                     I Will Lose My Ability to Handle My Own Affairs.

          Autonomy is the last capacity of personhood to emerge
     and the first to disappear.
     We do not become fully autonomous until we become adults.
     And if the people around us notice
     that we have begun to lose the ability to run our own lives,
     we may be entering a 'second childhood'.

          As we noted with respect to children,
     the inability to handle money may indicate lack of adult autonomy.
     Society has formal ways of saving us from wasting our money
     if we become incompetent to handle our own financial affairs.
     A guardian or conservator can take over these functions for us.

          If I begin to make foolish financial decisions,
     such deterioration may suggest other forms of mental loss.
     I may also have problems remembering important matters.
     I may be losing some of my former ability to understand language.
     I may even begin to forget who I am.

          If these things happen to me, I suspect that I will resist
     losing my adults privileges and responsibilities.
     Children usually think they are ready to be adults
     before their parents give them adult rights and responsibilities.
     Likewise at the end of life,
     I will probably want to hold on to my driver's license
     longer than would be safe for myself and others on the road.

          Because it requires a degree of self-understanding
     to notice that I am losing my powers as an autonomous person,
     perhaps others will notice these losses before I do.
     Or maybe I will have some periods of lucidity
     in which I fully grasp how 'out of it' I was
     in an earlier moment when I made a foolish decision.
     This is why deciding my competence is a responsibility
     that must be taken by persons of unquestioned competence.
     The members of my Medical Care Decisions Committee
     are charged with this responsibility
     of deciding when I am no longer competent to handle my own affairs,
     both my financial affairs and the management of my medical care.

          If I begin to lose my mental powers,
     I may forget the relative value of different amounts of money.
     Dollars may become just numbers written on a check.
     I might even find it necessary to have others write the amount.
     If I merely sign checks, others may begin to take advantage of me.
     And that would be the time to turn my financial affairs over
     to someone who always understands what is going on
     and who can make fully-rational decisions about financial matters.

          If I can no longer remember how much various things should cost,
     if I only remember that I signed a check but not the amount paid,
     and if I forget to record the amounts of my checks,
     then it may be time for someone else to take over that part of my life.

          If handling my financial affairs is the only ability I have lost,
     then I might still be considered a person by those around me.
     I might well be able to relate with other persons in meaningful ways,
     even tho I no longer possess the ability to concentrate enough
     to make wise investment decisions, for instance.

          And if I have an extended period of 'second childhood',
     I can only hope that it will be as enjoyable as my first childhood.
     If I do not seem to enjoy my life in this diminished state,
     that should be taken into account by my MCDC in making the decision
     about just when and how my life should draw to a close.

          It will also be relevant to ask
     how I am being cared for in second childhood.
     I have written my personal views about living in a nursing home
     in my advance directive for medical care.
     And I think this is a question each person should address
     ---while still competent and well able to consider the alternatives.

G. If I Lose My Purpose for Living.

          Even before I lose my capacity to take care of my practical life,
     I may lose the more subtle (and more important) purpose for living.

          During the best years of my life,
     I have always had significant projects to pursue.
     In fact, I always had more projects than time in which to pursue them.
     But if my mental powers decline, I may lose interest
     in what I used to think were the most important goals in my life.
     This will not invalidate the purposes I pursued.
     It will mean that I have become a different person,
     perhaps a less autonomous and purposeful person,
     or that I have become a former person
     ---if I have lost all goals and purposes for my life.

          Or maybe my former sense of purpose will become intermittent:
     I may have days when I pursue the central values of my life
     and other days when such meanings no longer interest me.
     If my former purposes in life are sputtering out,
     perhaps that phase of my life will be like sleeping and waking.
     In my dreams lots of odd things happen.
     But when I awake, I recognize it was a dream.
     The things I was trying to achieve in the dream were often absurd.
     Once I am awake, I can resume my real purposes in life.

          Or perhaps I will develop odd behavior when I am awake
     ---activities that arise from the same place as my crazy dreams.
     Maybe my awake self will be replaced by my dreaming self.
     That could be like sleep-walking:
     I remember what I did when I was partly asleep,
     but the behavior makes no sense to me after I am awake.
     Perhaps sleep-walking is a preview of being senile.

          If I am no longer capable of making plans
     and carrying out meaningful projects,
     then I will have lost my capacity of autonomy.
     If the loss is temporary, I will return to my autonomous mode
     when I recover my mental powers more fully.
     But if I just give up trying to do anything at all,
     that could mark the beginning of the end of my life as a person.

          Again, I must leave such evaluations to my proxies
     because my ability to evaluate may disappear with my autonomy.

QUESTIONS FOR PROXIES ABOUT AUTONOMY

          Once again, proxies should consult with medical experts
     to get their professional opinions about the causes, possible cures,
     and general prognosis of a possibly-incompetent former person,
     but they should not depend on such professional expertise.
     Their own personal experience with the individual in question
     will probably lead them to a better judgment
     than depending on professional analysis alone.
     The common-sense and everyday observations by the people
     who have known the individual for several years
     will best indicate just how much autonomy that individual has lost.

          The following questions need not be answered in detail,
     unless some of them seem especially relevent or revealing.
     Those who have been closest to the individual may have
     specific illustrations of the issues raised by these questions.

     1.  Has _____ begun to lose the mental powers
         that formerly enabled him/her
         to make plans and carry them out?

     2.  Does _____ plan to make next year different from this year?
     3.  If _____ was formerly a responsible adult, does he/she now
           show signs of becoming more like a dependent child?
     4.  Has _____ abandoned his/her former goals and purposes?
     5.  Does _____ himself/herself recognize the loss of mental power?
     6.  Have we as the persons who are closest to _____
           found it necessary to argue long and hard
           to get him/her to change his/her mind about something?
     7.  Does _____ stick to arbitrary positions without justification?

     8.  Is _____ still able to handle his/her practical affairs?

     9.  Has _____ made some foolish financial or practical decisions
          that illustrate a loss of perspective on his/her life?
     10. Do we as the ones who are clearly responsible for _____
           find it easier to make the decisions ourselves
           rather than asking for a reasoned judgment from _____?
     11. Have we found it necessary to take over his/her financial affairs,
           at least perhaps the major financial decisions?
     12. Does _____ know the difference between $100 and $1,000?
     13. Has _____ allowed important decisions to be made by others?
     14. Does _____ have to be watched to prevent dangerous activities?
     15. Is _____ realistic about the amount of food to eat at one meal?
     16. Does _____ know how much it costs to live for one week?
     17. Does _____ know how much it costs to live for one year?
     18. Does _____ realize that he/she will die?
     19. Is _____ realistic about how many years remain in his/her life?
     20.  Has _____ made realistic plans for the distribution
            of his/her assets and other goods upon death?

     21. Does _____ seem interested in growing and changing?

     22. Has _____ made any significant changes in his/her life recently?
     23. Are there any realistic plans for change in the future?
     24. Or is _____ prone to just wait for things to happen?
     25. Does _____ resist change at all costs?
     26. Does _____'s life history seem mostly set now
           ---with no new phases of life yet to begin
           such as moving to a different place
           or starting a new relationship?

     27. Is _____ well grounded in the real world?

     28. Does _____ have a good grasp of cause and effect?
     29. Does _____ understand social possibilities and impossibilities?
     30. Has _____ attempted to carry out unrealistic plans?
     31. Even tho _____ has the will to do something,
           is this tempered by a sense of reality?

     (Children often have elaborate dreams and wishes,
     but their parents have to help them sort out what is really possible.
     Full persons can do their own reality-testing,
     but former persons may have to be guided by others once again.)

     32. Does _____ have a realistic grasp of time?

     33. Does _____ seem to have lost a comprehensive sense of time,
           a sense that embraces the past
           ---especially his/her own life-story---
           the present moment in which goals can be actualized,
           and the future as a time in which to invent new possibilities?
     34. Has _____ given up practical concern for the future,
           moving into a 'second childhood',
           in which the future just rolls over him/her as more present?
     35. Does _____ have specific plans for the future,
           definite projects that can be pursued and perhaps completed?
     36. Or does _____ do only what others tell him/her to do,
           perhaps not fully understanding
           the purposes behind the activities?
     37. Has _____ given up the process of planning, even for tomorrow?
     38. Has planning for _____'s future fallen to others by default?
     39. Has _____'s time-horizon shrunk to the immediate present?

     (A child cannot get excited about a project that begins next year.
     Likewise someone becoming a former person thinks only of the present
     ---or gets lost in memories of the past.)

     40. Does ____ get confused about what time of day it is?
     41. Does ____ get confused about what month this is? What year?
     42. Does ____ have to be guided thru the day and the week
           because he/she often gets confused about what time it is
           and what activities are appropriate right now?
     43. Does _____ remember where he/she is
           in a project that takes a few days to complete?
     44. Does _____  make plans  for a time that will never come?
     45. Does _____ become frustrated when results are not forthcoming
           as soon as he/she would wish?
     46. Has _____ lost the sense of how long it takes
           to travel from one place to another
           or how long it takes to prepare a meal
           or to complete other household activities?
     47. Does _____ know how many days there are in a year?
     48. Does _____ know how many weeks there are in a year?
     49. Does _____ know how many days there are in a week?
     50. Does _____ know how many hours there are in a day?
     51. Are there lapses in such awareness of time?
     52. Does _____ forget what year it is?
     53. Does _____ remember how old he/she is?

     54. Does _____ have the capacity to make medical decisions?

     55. Does _____ understand his/her current condition?
     56. Is _____ able to make independent decisions
           about his/her welfare and medical treatments?
     57. Is _____ able to balance the benefits and burdens
           of a proposed medical treatment?
     58. Does _____ understand what will happen
           if the current condition is not treated?
     59. Does _____ have unreasonable fears of some treatments
           that make him/her avoid them even tho serious harm may result?

     (A child understands only that an injection is going to hurt.
     The child cannot fully appreciate the benefits of inoculations
     because these benefits must be explained abstractly,
     in terms that have little connection with the experience of a child.
     Some adults similarly have irrational fears of doctors and treatments.
     If they always avoid needed medical attention,
     others must take responsibility for their medical care.)

     60. Does _____ understand the proposed treatment?
     61. Does _____ understand the complications, benefits, and risks
           of the proposed treatment?
     62. Can _____ communicate his/her views concerning treatment?
     63. Does _____ have a realistic grasp of the consequences
           for himself/herself both mentally and physically?
     64. Does _____ understand the impact of these decisions on others?
     65. In short, does _____ have the capacity to give
           informed consent for medical procedures?

     66. Has _____ shown some lapses in his/her reasoning power?

     67. Has _____ become irresponsible in some ways?
     68. Does _____ seem incapable of carrying thru with commitments?
     69. Does _____ remember commitments made earlier?
     70. If _____ was trustworthy as an adult,
           has that been lost in recent years?
     71. As a practical matter, do others need to supervise ____ ?
     72. If not given constructive suggestions, does _____ do nothing?
     73. Does _____ spend endless hours in meaningless activities
           such as watching television?
     74. Can ____ explain who he/she is
           and what his/her purposes in life are?
     75. Does _____ exhibit lapses of reasoning,
           such as following obvious facts of erroneous conclusions?
     76. Is _____ unable to evaluate advertising claims, and therefore
           prone to buy foolish, unneeded,
           or worthless products and services
           merely because of the convincing advertising?

     (This could be similar to a child's response to advertising:
     It looks wonderful on television, so I want it.
     Parents or other adults must protect children
     from such naive trust in advertising claims.
     When adults are similarly prone to waste their money
     on useless products and services,
     they need to be protected from their own naivete.)

     77. Does _____ hold stubbornly to beliefs without foundation?
     78. Is _____ impervious to evidence contrary to a cherished belief?
     79. Has _____ exhibited an inability
           to follow a logical argument to its conclusion?
     80. Or does _____ begin with the conclusion
           and hold fast to that belief no matter what contrary evidence
           and arguments are presented against it?
     81. Does _____ rigidly hold a position
           without being able to explain or defend that belief?
     82. Or can _____ be led to change his/her mind
           when the facts are fully explored and understood?

     (Rigid thought-patterns and imperviousness to facts and arguments
     is another characteristic sometimes found in children.
     And because they cannot reason very well for themselves,
     they must be supervised by adults.
     If former persons demonstrate the same defects of reasoning,
     they also need to be supervised by adults who still think clearly.)

     83. How well does _____ process information
           and reach rational conclusions?

     84. Can _____ hold several bits of information in mind at one time
           in order to weigh the factors and reach a logical conclusion?
     85. Or does _____ seem to ignore or forget some facts
           when new ones are presented,
           so that he/she goes along with the most recent suggestion
           rather than weighing all relevant facts appropriately?

     (Senile people can easily be manipulated,
     because they fall back on trusting individuals rather than facts
     when their own thought processes become feeble and untrustworthy.
     If important facts easily slip out of consciousness,
     their reasoning is impaired.)

     86. Does _____ depend on the opinions of others as a substitute
           for making rational decisions?
     87. Does _____ sometimes seem to be unduly under the influence
           of a particular person (or several persons) such that _____
           follows their advice rather than making reasoned choices?
     88. Is _____ able to assign appropriate weighted significance
           to various factors in order to reach a wise conclusion?
     89. Does _____ reject and deny certain facts
           because they might lead to conclusions he/she does not like?
     90. Does _____ seem to have a willful 'blindness'
           to facts and opinions contrary to the positions already taken?
     91. Does _____ later recognize that he/she was misled by others
           who supplied truncated 'information' in order to elicit
           a desired decision or a particular behavior?
     92. And if _____ recognizes such lapses of information processing,
           is he/she willing (in his/her more lucid moments)
           to leave some important decisions to other adults
           who are not subject to being so easily misled?
     93. Can we cite occasions when _____ was taken advantage of
           because of defects of reason
           or defects of information-processing?

     (It is easy to cite such examples among children
     ---when, for instance, older children take advantage of younger ones
     who have not yet developed their abilities to process information
     ---to weigh benefits and burdens---in order to reach wise conclusions.
     When the same thing happens to vulnerable adults,
     it may be time for others to supervise their most important decisions.)

     94. Does _____ have a stable and consistent personality?

     95. Does _____ make consistent choices
           in a direction that makes sense at least to himself/herself?
     96. Or has _____ lost a sense of being a stable person
           and become capricious and irresponsible in his/her 'decisions'?
     97. Does _____ show a pattern of decisions and behavior
           that can be understood by others?
     98.  Can _____ explain to others the reasons behind his/her choices?
     99.  Do these 'explanations' sometimes seem whimsical?
     100. To people who have known _____ for a long time,
             does he/she seem to have lost a sense of himself/herself?
     101. Has _____ lost a formerly coherent pattern of personality
             that made him/her a consistent person from one day to the next?
     102. Does _____ recognize former patterns and purposes
             of his/her life as his/her own?
     103. Or do these life-goals seem to belong to some other person?
     104. Has _____ lost interest in some dimensions of life
             that used to be very interesting?
     105. Do others have trouble relating with _____
             because he/she now seems to be a different person
             from the one they knew in former times?
     106. If _____ has new purposes in life,
             do they seem rational and realistic?
     107. Or do the new plans seem more like the dreams of a child,
             who has an unrealistic grasp of what is possible?

     108. Does _____ have problems of self-control?

     109. Does _____ engage in self-destructive behavior,
             such as drinking alcohol and/or taking drugs?
     110. Does one part of _____ wish to pursue healthful activities,
             whereas another part seems bent on self-destruction?
     111. Does _____ regret self-destructive behavior?
     112. Does _____ need to be protected from himself/herself
             because at times his/her self-destructive side takes over?
     113. Does _____ in his/her 'better self' agree
             that he/she needs to be supervised
             because of lack of control at certain times?

     (One of the most common situations that call for protection
     and supervision would be problems with drugs and/or alcohol.
     When sober, the individual would freely sign an agreement
     to be protected from himself/herself when the craving
     for the addictive substance becomes too great to resist.
     When adults become vulnerable and irresponsible in this way,
     sometimes they become like children again.
     And they need a paternal hand to guide them.
     Also the effects of the substance-abuse
     may have taken away some of their autonomy.
     This will be determined by asking the other questions in this essay.)

VI. PRE-PERSONS

          We began this essay by asking when a child becomes an adult.
     And we discovered in that discussion that the exact age of transition
     depends on who is drawing the line and for what purpose.
     The same will happen when we attempt to draw the line between
     pre-persons and persons:
     Just when we cease being pre-persons and become full persons
     will depend on who is drawing the line and for what purpose.

          The parents of a fetus (and later baby)
     are the logical ones to draw any lines that may be needed.
     Adults have more complicated relationships than children,
     which makes it more difficult to create their MCDCs.
     But very early in biological life,
     the only people really involved are the parents.
     The two people who created a new human being
     should make any decisions about that human being.

          The focus of this essay asking "When is a person?"
     has been on empirical, observable facts.
     The line between personhood and former personhood
     is drawn by looking for the four capacities of persons:
     consciousness, memory, language, and autonomy.

          But some people may prefer a metaphysical concept of person.
     This would depend more on definitions than on observations.
     For example, we could define a fetus as a person
     because it has the potential to develop into a full person.
     Such speculations will be left to others.

          Here we will ask about the personhood of fetuses
     with the same questions we used to examine the personhood of adults
     and of individuals who might have become former persons:
     Does the fetus have consciousness, memory, language, and autonomy?

          In the four major sections of this essay,
     we did mention the emergence of consciousness
     and self-consciousness in children,
     when children begin to show signs of memory,
     when they develop language abilities,
     and when they are autonomous enough to assume responsibilities.
     Every parent knows about the emergence of these capacities.

           When infants are born defective,
     missing some of these potentialities,
     the doctors and the parents will have to assess
     the likely level of future functioning for that child.
     Deciding whether or not to treat a defective newborn
     may be the context in which to ask: "Is this newborn a person?"
     And the ones who must answer are the parents,
     drawing on everything the doctors can tell them.

          The 200 questions listed earlier
     can easily be adapted to the situation of a fetus or a newborn.
     For example, Is the fetus conscious and/or self-conscious?
     Does the fetus show any signs of remembering anything?
     Does the fetus understand and use language?
     Does the fetus have plans it will later put into effect?

          We might decide after asking as many of these questions as we like
     that a fetus is similar in personhood
     to an adult who has fallen into a persistent vegetative state:
     It is not conscious of itself.
     If it has never been outside of the womb, it has little to remember.
     Its language ability must be at a very rudimentary level.
     And few would claim that a baby has autonomy.

          But the basic difference between grandma in a coma
     and a fetus in the womb is that the fetus has more potential
     to become a full and functioning person.
     Sometimes people do recover from comas.
     And we readily accept them back into the human community if they do.
     But more often we have to make their decisions for them
     for the rest of their biological lives.

          As this essay did not offer generic principles
     for distinguishing full persons from former persons,
     neither will it offer simple tests
     to separate pre-persons from full persons.
     This is a task for the parents to undertake,
     bringing in their own metaphysical views if they wish.
     This essay merely offers a couple of hundred empirical questions
     that might be helpful in making subtle distinctions if needed.

          The reason for discussing adults before babies
     is that we can be more reasonable about ourselves and other adults
     than we can be about babies.
     But once we have decided when to pull our own plugs,
     we can be more rational about pulling the plugs for our children.
     We can apply the Golden Rule:
     If we would not want to be kept 'alive' as former persons,
     perhaps we would not wish similar conditions on our children.

APPENDIX: SIMILAR ATTEMPTS TO DESCRIBE PERSONHOOD

     Rorty, Amelie Oksenberg
     Mind in Action: Essays in the Philosophy of Mind
     (Boston: Beacon Press, 1988) "Persons and Personae" p. 27-46.

          Rorty first offers 7 themes she has discovered
     in prior attempts to construct a concept of person:

     1. Beings worthy of respect by other persons as persons.
          Sometimes this has excluded 'barbarians' (foreigners) or slaves.

     2. The person as defined by law:
                having continuity thru time
            being the same body thru time
            being responsible for its acts
            having memory of its former stages of life.
          The insane and the senile do not quality as persons under the law;
     or they are diminished persons, with fewer rights and responsibilities.
          The law can also definite a corporation as a legal person,
     with many of the same rights and responsibilities as a natural person.
     But a corporation does not have all the rights of persons,
     for example, it has no right to marry.

     3. Being an autonomous agent:
                capable of defining itself
                capable of making plans
                capable of carrying them out.

     4. A being that takes part in social interactions.
          The interactions of persons are intentional, not merely accidental.
     The weather and animals also interact,
     but their interactions do not make them persons.
          Persons take others seriously.
     They can enter into meaningful relationships.

     5. A being with a shaped, structured life, a life-plan and -history.
          Persons have histories in a deeper sense than countries or canyons.
     If a being cannot devise and follow a life-plan of its own,
     then it is a not a person.

     6. Genetic individuation, having its own unique DNA.
          But this is not a satisfactory definition of a person,
     because plants and animals also have unique DNA.

     7. A person experiences himself or herself as I.
          We are more than disjointed series of experiences.
     We experience ourselves as the object and subject
     of a continuing series of experiences, some simultaneous.
          The I constructs its world and its coherent place in that world.
          Entities not capable of self-conscious reflection are not persons.
          On page 43 Rorty offers her own definition of a person, in Italics:

     "A person is a unit of agency, a unit that is
     (a) capable of being directed by its conception of its own identity
     and what is important to that identity, and
     (b) capable of acting with others, in a common world.
     A person is that interactive member of a community,
     reflexibly sensitive to the contexts of her activity,
     a critically reflective inventor of the story of her life."

     Feinberg, Joel
     "Abortion", a chapter in Matters of Life and Death, edited by Tom Regan
     (Philadelphia: Temple University Press, 1980)  p. 188-189.

     Feinberg offers this common-sense definition of personhood:

     "What makes me certain that my parents, siblings, and friends
     are people is that they give evidence
     of being conscious of the world and of themselves;
     they have inner emotional lives, just like me;
     they can understand things and reason about them,
     make plans, and act; they can communicate with me, argue, negotiate,
     express themselves, make agreements, honor commitments,
     and stand in relationships of mutual trust;
     they have tastes and values of their own;
     they can be frustrated or fulfilled, pleased or hurt....
     In the commonsense way of thinking,
     persons are those beings who are conscious,
     have a concept and awareness of themselves,
     are capable of experiencing emotions,
     can reason and acquire understanding,
     can plan ahead, can act on their plans,
     and can feel pleasure and pain."

     Tooley, Michael  Abortion and Infanticide

     (Oxford: Claredon, 1983)

          This is a careful philosophical exploration of the concepts and
     moral arguments concerning the practices of abortion and infanticide.
     Tooley takes the position that there is no moral offense
     in ending a human life up to about 3 months after birth
     because earlier than that the infant has not yet become a person.
     His exploration of personhood may be the most original part of the book.

     Engelhardt, H. Tristram, Jr.  The Foundations of Bioethics

     (New York: Oxford University Press, 1986) p. 107, 108.

          This book contains two chapters addressing the issue of personhood,
     at the beginning and end of human life.
     The author clearly believes that full persons should have higher status
     and more rights than pre-persons or former persons.
     The ability to make responsible decisions ("moral agency")
     is one of the most distinctive marks of personhood.

          The following two quotes are from pages 107 & 108 respectively:

     "What distinguishes persons is their capacity to be self-conscious,
     rational, and concerned with worthiness of blame and praise.
     The possibility of such entities
     grounds the possibility of the moral community.
     It offers us a way of reflecting on the rightness and wrongness
     of actions and the worthiness or unworthiness of actors.

          On the other hand, not all humans are persons.
     Not all humans are self-conscious, rational,
     and able to conceive of the possibility of blaming and praising.
     Fetuses, infants, the profoundly mentally retarded,
     and the hopelessly comatose provide examples of nonpersons.
     Such entities are members of the human species.
     They do not in and of themselves have standing in the moral community.
     They cannot blame or praise or be worthy of blame or praise.
     They are not prime participants in the moral endeavor.
     Only persons have that status."
     ....

          "For this reason it is nonsensical to speak of respecting
     the autonomy of fetuses, infants, or profoundly retarded adults,
     who have never been rational.
     There is no autonomy to affront.
     Treating such entities without regard
     for that which they do not possess, and never have possessed,
     despoils them of nothing.
     They fall outside the inner sanctum of morality."

          Engelhardt goes on to discuss further the difference between
     human personal life and human biological life.
     He acknowledges that zygotes, embryos, and fetuses
     are potential persons, but until they become full persons,
     they do not possess the rights of persons.
     He also acknowledges that animals have some rights
     because they have some level of consciousness.

     Fletcher, Joseph  Humanhood: Essays in Biomedical Ethics

     (Buffalo, New York: Prometheus Books, 1979)

          In the first chapter Joseph Fletcher,
     best known for his Situation Ethics,
     presents 15 marks of a person:

     1. Minimum intelligence: Below IQ 40 individuals might not be persons;
                below IQ 20 they are definitely not persons.
     2. Self-awareness: We note the emergence of self-awareness in babies;
                and we note when it is gone, for instance, due to brain damage.
     3. Self-control: Because a person understands cause and effect,
                he or she can effectively work toward fulfilling freely-selected goals.
     4. A Sense of time: Persons can allocate their time toward purposes;
                non-persons 'live' completely in the present moment, like animals.
     5. A Sense of futurity: Persons are concerned about their futures;
                persons lay plans and carry them out; they build their futures.
     6. A Sense of the past: Persons have memories of their pasts;
                they can recall facts at will; they honor the past.
     7. The Capacity to relate to others: Persons are social animals;
                they form bonds with others, both intimate and collective.
     8. Concern for others: Persons always reach out to others;
                non-persons draw into themselves, even pathologically.
     9. Communication: Persons communicate with other persons;
                if they become completely cut off, they become sub-personal.
     10. Control of existence: Persons take responsibility for their lives;
                those who do not guide their own behavior are sub-personal.
     11. Curiosity: Persons naturally want to know.
                If they lose this desire to know, they are less human.
     12. Change and changeability: Persons can grow into new phases of life;
                If they resist change completely and totally, they are sub-personal.
     13. Balance of rationality and feeling: Persons have both
                reason and emotion; one who is distorted either way is not whole.
     14. Idiosyncrasy: All persons are different from one another;
                the less individuality, the less personhood.
     15. Neo-cortical function: Personhood requires cerebration;
                if the higher brain is dead, there is no consciousness, no personhood.

     Dennett, Daniel "Conditions of Personhood"
     in What Is a Person? edited by Michael F. Goodman

     (Clifton, New Jersey: Humana Press, 1988) p. 145-167.

          Dennett describes six interlocking conditions
     that make human beings persons:
     1. Rational beings.
     2. Have intentional states of consciousness.
     3. Are regarded as persons by others.
     4. Capable of reciprocating with others.
     5. Capable of verbal communication.
     6. Self-conscious.

     Doerr, Edd & James W. Prescott  Abortion Rights and Fetal 'Personhood'

     (Long Beach, CA: Centerline Press, 1990) Second Edition  151 pages

          This is a pro-choice book of essays
     from a conference sponsored by the Americans for Religious Liberty.
     Personhood is understood here only in the legal sense.
     A fetus becomes a person
     when someone in power and authority declares it to be a person.
     There is some attention to 'viability',
     the point when a fetus could live independent of its mother's body,
     but this seems to be the closest the authors come
     to an empirical concept of personhood.

          Does a fetus have any rights?
     Under most systems of laws on earth, no.
     But a fetus could have rights if such were granted by law.

          What about brain development before birth?
     Other animals have pre-birth brain activity,
     but they never become persons.

          In most cultures the birth of a baby
     welcomes it into the human community.
     But infanticide was often permitted.
     Each culture defines the status and rights of the baby.
     Different cultures recognize personhood beginning at different points:
     When does an aborted fetus deserve to be buried as a person?
     Even in Roman Catholic hospitals,
     small fetuses are not buried with the rites and honors of a person.
     Historically, different cultures have different points
     at which the baby is recognized as a member of the community:
     baptism, naming, walking, clothing, doing certain actions, etc.
     And there may be many levels of personhood up to adulthood.
     In some cultures there is a 7 or 8 day waiting period
     between biological birth and presentation to the community,
     when the baby is brought outdoors.

          Usually the death of a fetus before social birth
     is not considered as great a tragedy as the death of a child.
     Here again, people are defining
     the moment a new-born becomes a person.
     Sometimes coming into personhood coincides with naming the child.
     In Western cultures, this generally takes place before baptism.

          This conference mostly omitted empirical questions
     about the personhood of the fetus, which is the focus of this essay,
     "When Is a Person? Pre-Persons and Former Persons".
     Perhaps the next such conference can ask questions
     like those embodied in this essay.