**For more on the case of Nadya Suleman, the mother of the octuplets born last week, seen this op-ed piece by medical ethicist Art Caplan: “Ethics and octuplets: society is responsible,” http://www.philly.com/inquirer/opinion/39190377.html .

 

 

[5.4.] Personhood.

 

Terri Schiavo died 13 days after her feeding tube was removed. This was a case of passive euthanasia; she was allowed to die “naturally” rather than caused to die by the intervention of a doctor.

 

Some advocates for people with disabilities claimed that allowing Terri to die was unjustifiable discrimination against a disabled person. This claim depends in part on the assumption that, at the time her feeding tube was removed, Terri was actually a person. So one way of approaching the moral challenged posed by the Schiavo case is to ask, when does a genetic human being count as a person, and was Terri a person at the time her feeding tube was removed?

 

Furthermore, it is possible to evaluate this case from the viewpoint of any of the three normative theories we have been discussing so far (utilitarianism, Kant’s deontology, and virtue ethics). The viewpoint to which the question of Schiavo’s personhood is most relevant is that of Kant, since it is his Categorical Imperative, in its second formulation, that requires that we treat persons as “ends in themselves” and not merely as means to our own ends. To know whether or not this version of the Categorical Imperative even applies to the Schiavo case, it is essential to know whether she was a person.

 

 

[5.4.1.] Warren on Personhood.

 

Philosopher Mary Ann Warren has addressed the question of personhood in the context of the abortion debate.[1] We can apply her account of personhood to the case of patients in PVS.

 

She does not attempt a complete account of personhood. Nor does she attempt to provide an exhaustive list of all characteristics that are relevant to the question whether a being is a person.

 

Instead, she maintains that “[a]ll we need is a rough and approximate list of the most basic criteria of personhood, and some idea of which, or how many, of these an entity must satisfy in order to properly be considered a person.” (99, emphasis added)

 

In an attempt to figure out which traits are most essential to personhood, Warren conducts the following thought experiment:

 

Imagine that you are a space explorer and you come across a race of alien beings. How do you decide whether they are “members of the moral community,” the group of all entities our treatment of which is governed by morality? In other words, how would you decide whether these beings matter from the point of view of morality?

 

It seems unreasonable to expect a DNA test to decide this question. The fact that a being has very different DNA than our own should imply nothing about whether it is morally relevant.

 

It is much more plausible to base your reasoning upon whether they are persons. So what characteristics would we look for in trying to decide whether they are persons?

 

            I suggest that the traits which are most central to the concept of personhood, or humanity in the moral sense, are, very roughly, the following:

 

1.         consciousness (of objects and events external and/or internal to the being), and in particular the capacity to feel pain;***

2.         reasoning (the developed capacity to solve new and relatively complex problems);

3.         self-motivated activity (activity which is relatively independent of either genetic or direct external control);

4.         the capacity to communicate, by whatever means, messages of an indefinite variety of types, that is, not just with an indefinite number of possible contents, but on indefinitely many possible topics;

5.         the presence of self-concepts, and self-awareness, either individual or racial, or both.

 

… We needn’t suppose that an entity must have all of these attributes to be properly considered a person; (1) and (2) alone may well be sufficient for personhood, and quite probably (1)-(3) are sufficient. Neither do we need to insist that any one of these criteria is necessary for personhood, although once again (1) and (2) look like fairly good candidates for necessary conditions, as does (3), if “activity” is construed so as to include the activity of reasoning.

... any being which satisfies none of (1)-(5) is certainly not a person. (100-101, emphasis added)[2]

 

On Warren’s view, “all and only people have full moral rights.” (101) So if an organism has none of (1)-(5), it does not have full moral rights.

 

What’s more, “if (1)-(5) are indeed the primary criteria of personhood, then it is clear that genetic humanity [i.e., having human DNA] is neither necessary nor sufficient for establishing that an entity is a person.” (101)

·         It is not necessary: aliens and very sophisticated robots might count as people.

And, more to the point of the Schiavo case...

·         It is not sufficient: permanently incapacitated or defective genetic humans do not count as people.

 

If Warren is correct, then a genetic human being in PVS is not a person and does not have full moral rights.

 

Warren’s account of personhood is most in harmony with the cognitive criteria of brain-death. Someone who lacks all five of Warren’s criteria will be brain-dead on the cognitive criteria of brain-death.

 

***Pence suggests that consciousness is not all or nothing, but instead comes in degrees. If this is correct, might there be a minimum degree of consciousness that a being must have in order to count as a person?

 

DISCUSSION: Is Warren’s account of personhood a plausible one? If so, is what it implies about the Schiavo case correct?

 

 

[5.4.2.] The Argument from Mercy.

 

One argument used by Karen Ann Quinlan’s parents relied on the claim that their daughter sometimes seemed to be in pain, and that it would be good to allow her to die because that would end her suffering. This sort of reasoning is an Argument from Mercy.

 

According to a 1996 survey, 30% of neurologists believe that PVS patients experience pain.[3] So there is no professional consensus as to whether patients like Quinlan, Cruzan and Schiavo experience pain.

 

It is impossible to directly observe someone else’s conscious states. We can only infer that a human being or any other creature is conscious based on its outward behavior and, perhaps, by comparing its neuroanatomy with that of humans who can tell us whether or not they are in pain.

 

There is never an absolute guarantee, even in the case of a healthy, seemingly conscious human adult, that such an inference is valid. [This is connected to the epistemological problem called the problem of other minds.[4]]

 

So the argument from mercy will always have at least some element of doubt.

 

In one of his other textbooks, Pence suggests a dilemma, a version of the Argument from Mercy:[5]

 

1.      A patient in PVS is either (a) conscious, at least to some minimal degree of consciousness [in a so-called minimally conscious state (MCS)], or (b) completely unconscious.

2.      If (a), then the patient should be removed from life-support, since no one would want to stay alive as a mere “flicker of consciousness” for years.

3.      If (b), then the patient should be removed from life-support, since she will never be conscious again.

4.      So, either way, a PVS patient should be removed from life-support.

 

This argument is valid (if the premises were all true, the conclusion would have to be true).

 

Are the three premises true?

 

Of course, this still leaves open the possibility that a patient might be misdiagnosed as having PVS, as Terri Schiavo’s parents maintained was the case with her.

 

So as Pence himself acknowledges, all such arguments are fallible, since we cannot infallibly judge whether a seemingly comatose patient is completely, irreversibly unconscious.

 

 

 

Stopping point for Friday February 6. No new reading for next time. We will review for your first test, which is on Wednesday.