Fundamentals of Person-Centred Healthcare Practice. Группа авторов
This kind of argument gets played out in many ways in our daily lives and the fact that such emphasis is placed on preserving different species is not just an ecological argument but also a moral one where the rights of animals have been elevated in importance in recent years.
Even within the ‘human species’, a ‘person’ may mean different things, so, for example, debates about abortion are influenced by different ideas about whether or not an embryo is a person; is a foetus a person or when does a foetus become a person? This is a complex issue with different moral philosophical perspectives used to defend different beliefs and practices. We suggest the core issue is that of when a human being becomes a person – is it at the point of fertilisation or is it when the foetus is able to sustain life independent of the womb?
Physical and psychological attributes
For some philosophers (such as Frankfurt 1989), it is not enough to claim that human beings are persons on the basis of a collection of physical and psychological attributes because it is conceptually possible that members of another species could also lay claim to these. If attributes such as sight, taste, smell, sexuality, memory, desires, motives and so forth were to be used as a means of distinguishing persons from non‐persons, then we could easily provide a list of other species who would possess similar attributes. For example, the amazing developments in robotics and specifically humanoid robots and androids (i.e. robots or cyborgs made to look like humans on the outside) will find their way more and more into healthcare services in the future. Would it be possible to regard an android worker as a colleague and/or an electronic person? And would we ensure their rights are protected? While advancements are happening, societies and governments will have to find ways of managing or regulating the companies and products (or persons) they produce. In fact, the European Parliament is taking a proactive approach to exploring human‐like artificial intelligence, including considering giving rights and responsibilities to robots.
Further, if we argue that personhood is predicated merely on a set of physical and psychological attributes, then what happens to persons who may lose some of these attributes through disease and disability? For instance, a person with dementia may experience deterioration of memory and motivation and loss of physical attributes (e.g. mobility, hand–eye co‐ordination, etc.) and so could legitimately, on the basis of this argument, lose the status of person. Even such higher order attributes as ‘thought’ and decision making fail to distinguish persons from other creatures, as human beings are not alone in having desires and preferences. Members of other species share these attributes with human beings and some species could even be seen to base action on deliberation and even prior thought.
Therefore, distinguishing persons from non‐persons on the basis of a hierarchy of attributes is problematic. Some authors, such as Post (2006), argue that a dominant focus in Western cultures on some attributes being more important than others has led to a position whereby cognitive attributes of persons are given greatest importance. We see this played out in all kinds of ways in daily life, in that the ability to connect our thinking with our actions is essential for day‐to‐day functioning. Thus the loss of these attributes can have significant impact on human beings and their personhood as it can result in reduced ability to engage in daily activities of living, loss of employment, an inability to converse with others, a loss of connection with community, disconnection with friends and family, and increased loneliness and isolation.
So how should we think about ‘persons’ in ways that help us to not privilege cognition and rationality and in ways that avoid (human‐based) hierarchies of attributes? Most philosophers attempt to understand this through a focus on ‘personhood’ – and it is to this focus that we will turn in the Section 1.4, but first, here’s an activity to help you reflect on your reading so far.
Activity
From your perspective, what does it mean to be a person? Does your collage from the previous activity provide you with some insights into those aspects of being a person that you privilege most? Write an approximate 100‐word statement that begins with:
I am a person because …
If the activity seems too big, consider today and what it is about you today that makes you a person.
Consider how your statement reflects you as a person. Are you satisfied with your representation of ‘you’? Can you identify those parts of your description that are more dominant than others (maybe moral values shaped by your religious beliefs, for example, or beliefs about work and play shaped by your upbringing and childhood experiences)? All of these things are elements of your ‘personhood’.
Personhood
Connecting with an innate sense of ourselves as human beings with feelings, emotions, thoughts and desires is an essential component of being a person and de facto having personhood. Leibing (2008) argues that personhood is that inner feeling we have that guides us as a person. It is the sum total of all these feelings, desires, motivations and values – or what Leibing refers to as ‘that which really matters’ (Leibing 2008, p. 180). This idea of personhood equating with that which really matters to us potentially enables us to rise above discussions of physical attributes and cognition, for example. Instead, it enables a connection with our unique humanness as persons – those inner perspectives that we hold in our body and that influence our being in the world. Leibing uses the term ‘interiority’ to describe this:
The materialization of certain values in time – and the moral question of what matters to certain people.
(Leibing 2008, p. 180)
‘What matters to us’ is possibly the closest we can get to a neutral understanding of personhood and one that is connected with innate human characteristics. In reading this phrase (what matters to us), you might be reminded of the ‘what matters to me’ movement that is dominant in healthcare (refer to, for example, the ‘What Matters to Me’ day in Scotland: www.whatmatterstoyou.scot) which is an attempt by healthcare providers to understand and surface those inner perspectives that we all hold and may not easily articulate.
However, we need to be cautious in viewing this question (what matters to me/you) as the primary consideration, as Leibing argues that in diseases such as Alzheimer's, this interiority may become flattened through disease processes and the medicalisation of the associated symptoms. Accordingly, the response to the ‘what matters to you’ question may be limited, stunted, stilted or indeed may be voiced by an advocate (family member, friend, partner) and so is an interpretation of the person and who they are.
The reflective person
The work of Christian Smith is also important here (Smith 2003). Smith argues that what distinguishes us as human persons from other non‐human persons is that we live within a moral code or framework. This moral code is both inside us (our beliefs, values, desires, motives and feelings) and outside us (societal structures, cultures and processes). Every day, we operate through the lens of this moral code and so control of our actions is not just based on ‘interiority principles’, as Leibing argues. Like other philosophers such as Frankfurt (1989), Smith suggests that as human persons, we have the unique ability to reflect on our moral behaviour and recalibrate our actions if they misalign with the dominant moral code. We need to be aware, therefore, that our personhood is not just shaped by our internal beliefs, values, desires and feelings but also by our culture, which shapes, forms and reforms us on a continuous basis – thus personhood is not a static fixed concept but something that is continuously evolving and developing.
This is a very important point to reflect on in the context of healthcare practice. So much emphasis is placed on people working in healthcare having the ‘right’ moral attitude. Indeed, the standards