9 Persons: natural, functional, or ethical kind?

American Journal of Economics and Sociology, The, Jan, 2007 by John P. Lizza

ABSTRACT. In this paper, I examine alternative views of personhood and how they affect our understanding of life and death. Building on David Wiggins's insight that our concept of person tries to hold in a single focus our nature as a biological being, a subject of consciousness, and a locus of moral values, I argue against views that try to reduce persons to one of these aspects at the expense of the others. Thought experiments that have been prominent in the literature on personal identity are criticized on grounds that they sunder persons from the moral and cultural context in which they appear and ignore an essential relational aspect of persons. I argue for a substantive view of persons that understands persons as "constituted by" but not identical to human organisms, and that treats persons as having essential relational properties. Persons are thus beings whose nature is not determined entirely by their biology or psychology but is, in part, a matter of individual, moral, and cultural construction. I argue that such a view provides the best theoretical grounding to answer the more practical, bioethical questions concerning the beginning and end of life.

I

Introduction

ADVANCES IN medical technology have posed significant challenges to how we fix the boundaries of the beginning and end of life. When does a person begin and cease to exist? Are embryos, artificially sustained whole-brain-dead bodies, individuals in permanent vegetative state (PermVS) (1), and anencephalics (2) living persons? In short, who should be counted among the living "we"?

Alternative positions on these issues have been assumed or implied by different views of the nature of persons. This has been evident in the debate over the definition of death and criteria for its determination. Simplifying the account somewhat, three alternative views of the person have been prominent in this discussion: (1) a "species" or natural kind concept that identifies the person with the human organism; (3) (2) a "qualitative" or "functionalist" view that identifies the person with certain abilities and qualities of awareness; (4) and (3) a "substantive" view that treats the person not as some qualitative or functional specification of some more basic kind of thing, such as a human organism, but as a primitive substance that has psychological and corporeal characteristics. (5)

Since the identification of the person with the biological organism leads to defining the beginning and end of life in strictly biological terms, this view has led some bioethicists to reject "brain death" as death. (6) Pointing to cases of postmortem pregnancy (7) and the extraordinary case of a whole-brain-dead body sustained for over 13 years, (8) these theorists argue that the human organism may continue to exist even if it has lost all brain functions. Persons may retain their organic integration, albeit through artificial life support, and thus continue to exist despite the loss of all brain functions. Accordingly, these theorists reject the whole-brain neurological criterion for determining death and accept only the traditional criterion of irreversible cessation of respiration and circulation. For example, Shewmon states, "as long as the human body is alive (from the biological perspective of somatic integrative unity) then the person is alive." (9)

Other bioethicists who identify the person with the human organism, however, accept "brain death" as death. For example, Alexander Capron writes that "the accepted criterion for being a person ... [is] live birth of the product of human conception." (10) In Capron's view, when we artificially sustain whole-brain-dead pregnant women, we are sustaining collections of human organs rather than the person, in other words, the human organism as a whole. If all brain functions are lost, including the integrative functions of the brainstem, then the person has died. Death is defined as the irreversible loss of organic integration. Capron and others hold that individuals in PermVS and anencephalics are living persons. Death has not occurred because these individuals retain brainstem functions and thus the human organism, that is, the person, has not lost its organic integration.

In contrast to those who accept a "species" concept of person, bioethicists who identify the person with a set of psychological functions define a person's life and death in terms of the beginning, continuation, and cessation of certain psychological functions. Thus, Green and Wikler (1980) argue in favor of a consciousness-related or "higher-brain" formulation of death that would consider individuals who have lost all brain function, as well as individuals in PermVS, as dead. Since individuals in PermVS are no longer psychologically continuous with their former selves, those former selves have ceased to exist, that is, they have died.

It is worth noting that some prominent critics of this higher-brain formulation of death, such as James Bernat, Charles Culver, and Bernard Gert, accept the functionalist or qualitative view of the person that Green and Wikler invoke, but reject the implication that individuals who have irreversibly lost consciousness and every other mental function have "died." Bernat, Culver, and Gert (1981) distinguish the person from the human organism and hold that individuals in PermVS are not persons. However, they object to characterizing individuals in PermVS as "dead" on grounds that this would be an incorrect use of the term "dead." They define "death" as "the permanent cessation of functioning of the organism as a whole" and claim that "death" is a strictly biological concept, applicable to human organisms but not to persons. Thus, they criticize the consciousness-related, neurological formulation of death as involving a metaphorical use of "death," "applying it to an organism which has ceased to be a person but has not died." (11) In their view, "death" cannot be applied literally to persons because death is a biological concept appropriate to biological organisms, not to roles, functions, abilities, or qualities of awareness. Just as a human organism may cease to be a banker or basketball player without dying, Bernat, Culver, and Gert hold that a human organism can cease to be a person without dying.