Personhood,
it’s a crucial concept in our everyday lives and in health care. Yet, to a significant extent in the area of
secular bioethics it has been under-theorised.
Into this gap steps and enormously important contribution, Personhood and Health Care, a collection
of thirty chapters by a variety of international contributors.

Edited
by David C Thomasma (Loyola University Chicago Medical Centre), David N
Weisstub (University of Montreal School of Medicine) and Christian Hervé
(Université Paris René Descartes, Paris).
This collection draws upon a variety of theoretical insights from a
variety of disciplines and contributors.
It even manages to move beyond being a collection of solely Western
conceptions of personhood. The book is
divided into four parts, namely: (1) Concepts of the Person (2) Theories of
Personhood in Medicine and Bioethics, (3) Person and Identity and (4)
Personhood and its Relations. Each
chapter in the collection is an important contribution in itself.

In
Chapter 1 Jean Delumeau explores “the development of the concept of
personhood”, providing an important historical exploration as an important
start to the collection. Based upon
this foundation Lenn E Goodman explores “persons” claiming that “Our powers as actors,
the magnitude of our projects as self-consciously, self-choosing subjects, set
the basic claims of persons on a moral plateau.” (p. 19) This raised for me one
of the issues taken up by some of the other writers in this collection: what
obtains when we do not have such consciousness.

David
Novak provides an important contribution with regard to “the human person as
the image of God” and a short contribution by Jean Bernard explores issues to
do with genetic personhood and the personhood of the embryo, an all too short
chapter. Tom L Beauchamp then goes on
to explore “the failure of theories of personhood”, an exploration which is
built upon by Edmund L. Erde in his aptly entitled chapter regarding “The Vain
and Pointless Quest for a Definition” with regard to personhood. Clearly influenced by Wittgenstein, he
explores a variety of “failures” in ways of defining persons. One of the best examples he draws upon is in
what the writers of the Declaration of
Independence actually meant and whether or not they truly encompassed all
of the aspects of personhood. As he
concludes: “Better than the originating question is: ‘What shall we value about
each sort of thing: persons, fetuses, the brain-dead-pregnant women, sexuality,
etc., and why?’ – not whether fetuses or the brain-dead, etc., are persons”. (p
89)

Tuija
Takala has an important chapter which explores “genetic knowledge and our
conception of ourselves as persons”, an unnecessarily short chapter for such an
important topic. On the other hand, a more traditional if utilitarian analysis is
provided by John Harris regarding “the concept of the person and the value of
life”, noting that personhood is “intimately connected with questions about
killing and letting die.” Harris argues
for a developmental perspective from fertilization of an egg with such a
biological entity becoming “…an actual person when she becomes capable of
valuing her own existence. And if,
eventually, she permanently loses this capacity prior to death, she will cease
to be a person. (p.110) Readers with an interest in disability and mental
illness will no doubt here reflect on the challenge of those who lose such
capacity, either temporarily or permanently. I find it difficult to accept that
such loss necessarily removes personhood.

In
Part 2, (“ Exploring Theories of Personhood in Medicine and Bioethics”) , Paul
Ricoeur explores “the just and medical ethics”. Hiubert Doucet also names an inpass with regard to the concept of
the person in bioethics, suggesting in a perceptive way that “… biomedicine’s
pressure to attain its objectives leads to a form of contradiction, excluding
some of the beings it expressly wishes to protect. “( p127) Ruud H. J. ter Neulen seeks to move beyond the
biological in his “towards the social concept of the person” and Simonne
Plourde explores concepts of personhood and dignity. An important perspective is provided by Jiwei Ci with regard to a
“Confucian relational concept of the person and its modern predicament”, a
non-western perspective which is complemented by Godfrey B Tangwa’s “the traditional
African perception of a person: some implications for bioethics”. The chapter by Ulrike Kostka explores “the
anthropological concept of modern medicine in the perspective of theological
ethics” exploring Biblical concepts in the way that moves beyond simplistic
stereotypes.

Part
3 (“Person and Identity”) provides insights that will be of crucial importance
to readers of Metapsychology. Judith Lee Kissell explores “the procedural
morphing of the person” in a chapter, whereby she points out:

“These
developments in biotechnology …. Thereby make possible the kind of empirical
dualism by which body parts take on the character of commodities or resources,
irreversibly linked to considerations of distributive justice. This transition is accomplished in this
brave new world, I contend by substituting procedures such as informed consent
for profound reflection on the human, on person and on subject”. (p.192)

Eric
Matthews explores “personal identity and mental health”. This provides some important insights. For example pointing to the way in which
paternalism cannot be justified by reference to irrationality, making reference
to Jehovah’s Witness beliefs about blood transfusion as an example of contested
notions of rationality. He bases his
analysis upon the importance of a “unified reasonably coherent identity that is
a pre-condition for moral agency…” (p.210)

This
analysis is complemented by Jean Guyotat’s chapter “the person, filiation,
possession” concerning dissassociative identity disorder (DID). As he notes “personality” is ambiguous and
this chapter utilises an exploration of psychopathology. David C Thomasma then explores multiple
personality disorder in a chapter which amongst other things is an important
contribution on the limitations of autonomy, suggesting that “…the diagnosis
and treatment of multiple personality disorder (MPD) has a rocky history and an
even rockier future.” (p.231) Thomasma’s
chapter explores the social context of not only this disease but disease in
general.

In
a chapter that draws upon his role as an ethics educator and consultant,
Jeffrey Spike advocates a course of action whereby there is a positive bias for
the narrative provided by patients in exploring the problematic concept of
“capacity”. This is complemented by
Michael Quante’s exploration of autonomy and personal identity and Helga
Kuhse’s explorations of the problems of advance directives, personhood and
personal identity.

In
Part IV (“Personhood and its Relations”), the issue of cloning is explored by
Matti Hayry and Tuija Takala, who offer a striking conclusion:

“If
scientists ever think that they can produce human beings out of simple
elements, then it is time to remind them that none of us is omnipotent or
omniscient, and that the human soul, whichever way we define it, cannot be
implanted in inanimate objects.” (p.296)

Michel
Silberfeld then explores “vulnerable persons” as do David N Weisstub and David
C Thomasma with regard to “human dignity, vulnerability, personhood”. The
naming of such vulnerability in such a collection is important, however I
couldn’t help reflect that the perspective of a consumer of mental health
services might also offer an important perspective in this area.

Constance
K Perry then reminds us of the individualized way in which we can regard
personhood and yet it has a much richer more communal sense as well. M. Gregg Bloche and Kevin P. Quinn explore
professionalism in terms of personhood and John Nessa explores the patient-doctor
relationship, while Guillermo Diaz Pintos explores “the medical interpretation
of pain and the concept of a person”.
The conclusion of this collection comes with Lazare Benaroyo’s
exploration of suffering in terms of narrative and the self. As he concludes: “…caring may be construed as the art of making again possible
through dialogue the existential unity of time by restoring the narrative
identity of an imperilled self.” (p.380)

Certainly,
this is an impressive collection of essays.
However, as I read them and found similarities and difference, I found
myself yearning for the next step. We
need not just formal papers, but evidence of the dialogue between these
perspectives as we seek to make concrete decisions about personhood in the
context of healthcare. Without that, we
face the inevitable reality that the dominant accounts of personhood will very
much rely on dominant power relations and discourses.

Accordingly,
this is a collection which will be of interest to undergraduate and
postgraduate students, ethicists, philosophers, and practitioners who wish to
go beyond their daily practice to explore some of the underlying concepts found
in healthcare, especially in terms of personhood and dignity.

 

© 2003 Christopher Newell

 

Christopher Newell, PhD is
Senior Lecturer in Medical Ethics, School of Medicine, University of Tasmania.

Categories: Ethics, Philosophical