FAMILY MEMBERS DISCUSS
THE LEVEL OF PERSONHOOD IN THE PATIENT
Even while the patient still has some capacity for
medical decisions,
the family (perhaps members specifically designated as
proxies)
might find themselves discussing to what degree the patient
has lost some characteristics that made him or her a person.
These universal marks of personhood include:
(1) consciousness, (2) memory, (3) language, & (4) autonomy.
(1) If the patient is permanently unconscious,
then memory, language, & autonomy are obviously also missing.
And if there is strong medical certainty
that the patient will never
return to consciousness, that individual's life as a
person is over forever.
(2) Memory
is a mental capacity that might gradually fade away.
The patient is still conscious every day
but cannot remember important things about himself or herself
that used to constitute being that specific person.
And the patient might not recognize family members.
When memory is almost
completely absent,
the family might say that the
person they knew is now gone.
(3) Language
is also a capacity of personhood
that the family members might notice declining.
Is it difficult for the patient to express himself or herself?
Eventually the patient might lose the capacity
to understand words
that are spoken to him or her.
Alzheimer's disease might remove the ability to read and
write.
(4) Autonomy
could be the first mark of
personhood to disappear.
The patient who used to direct his or her life
might now become dependent on others for all decisions.
Does the individual still make
plans and carry them forward?
In some ways, such loss of autonomy makes the patient like a child.
These four marks of personhood are discussed
completely
in a small book called: When
Is a Person?
Pre-Persons and Former Persons.
This book contains about 200 questions
divided into the four marks of personhood described above.
These questions would be a comprehensive way to discuss personhood.
HOW DISCUSSING THE PERSONHOOD OF THE PATIENT
DISCOURAGES IRRATIONAL SUICIDE
AND OTHER FORMS OF PREMATURE DEATH
When the patient is just beginning
to lose the capacities that make anyone a person,
there might be some danger of irrational suicide,
since the patient's mental powers are declining.
If there were irrational urges toward self-killing
in the patient's thinking before the onset of Alzheimer's,
these might become more dangerous
if the patient loses perspective on his or her life.
If the patient's 'reasons' for choosing
death become questionable,
the decision-making power should shift to the proxies,
who presumably are operating with all of their mental powers.
Some objective actions such as better supervision
might be necessary to avoid the danger of an irrational suicide.
And if the patient definitely becomes suicidal,
then a 24-hour suicide-watch
might be necessary.
When the patient can no longer make
wise medical decisions,
the proxies gain the power to choose all future courses of action.
We would hope that the patient has appointed the best proxies
while the patient was still able to make medical decisions.
But if not, then family members might be asked less formally
to make all future decisions for the patient.
Since the proxies have the best interests of
their
patient in mind,
they will not approve or cooperate in any irrational suicide.
But they will have the power to make wise end-of-life decisions.
The proxies will ask themselves
when would be the best time
for this patient to die.
There might be some further marks of decline
that would be significant factors
for choosing between keeping
the patient alive
and allowing nature to take
its course.
The proxies want to choose a last day for the patient
that is not too soon
and not too late.
And besides considering the decline from full personhood,
the proxies will use several other safeguards
to decide the best day of
death for this patient.