Tuesday, October 02, 2007

The Overlooked Question: Who is a Person?

Over two recent Sundays I led the Adult Forum in a local parish. As I've done before, I began with the "Georgetown Mantra," and then worked with them to explore what other, perhaps more Christian, more Episcopal values we might want to bring to the discussion.

One of the issues brought home to me again is the question of what we mean when we use the word "person." Where, somewhere between the encounter of egg and sperm and independent breathing and squalling, do we say, "This now is a person?" At what point, somewhere between "this now is a person" and some legally-defined age, do we say, "This person is now an independent person with full legal rights, responsibilities, and protections?" At the other end of life, how much function, both physical and cognitive, must a person lose to lose the dignity and integrity and protections of being a person. And in between are there events, including individual choices and actions, that can result in loss of personhood?

In health care, of course, this has impact in many areas, even if we don't necessarily speak explicitly of "personhood." After all, the principle underlying the entire "Georgetown Mantra" is "Respect for persons." We're certainly conscious of it in the issue of abortion. At the same time, it is important in other areas. For example, discussions of when to allow natural death (if one can consider it "natural" after we've started treatment in the first place) have to do with personhood. Many folks who complete health care treatment directives set as one of their standards of "a quality of life acceptable to me" the capacity to make decisions, and/or to communicate. Without those capacities, have they lost "personhood" in a meaningful sense? What about severe brain injury, or brain disease, or brain death? Certainly, those raise issues of personhood, legally as well as morally; and we know this best when we say to families trying to make hard decisions in the midst of grief, "The person you know and love will not come back, no matter what we do from this point."

We even are looking at issues of personhood in matters of informed consent. When a person's capacity to consent is limited (legally by age, or functionally by limited cognitive capacity), we still assess whether the person can give assent. So, we will discuss issues of consent with a 16-year-old that we would not discuss with an 8-year-old; even though both have the same (lack of) capacity to consent.

The troubles that tear at churches these days are also about personhood. We're more conscious of it in liturgical churches, when we look at specific rites and who might be persons appropriate to participate; but all churches wrestle with it at some point. (So, I'm sure, do non-Christians; but I can't speak to that.) Again, are there events or actions that cause the rest of us to feel someone has lost or rejected moral or legal personhood? Some folks are arguing bitterly whether sexual acts have that result; and if so, which acts. Certainly, all parties begin acknowledging personhood; but sooner or later someone gets around to, "yes, those folks are persons, but...." At that point, we're not simply discussing social norms; we're discussing qualifying personhood.

In all of our moral reflections, we need to keep this concern in mind. It's all too easy to pursue principle over persons, or at least over the certain persons in the specific events. We want to discuss moral principles and ethical processes as if we all agreed on "personhood." But next time you're in that place, wrestling with moral conundra and difficult decisions, it will be worth it to step back and think again: who are the persons involved in this? And, just how do I understand and value personhood - theirs, and our own?

5 comments:

The young fogey said...

This reminds me of an obscure fun fact I only recently learnt, Father. In the Roman Rite since the Middle Ages there has been a form for 'the baptism of monsters' (there's a topic for Halloween), because, like the question of when after conception human life begins, mediƦval people weren't sure if a severely deformed baby was really human. What if there's not much of a head so the brain is missing or not fully formed? So of course the baptism of monsters is really just a specialised form of conditional baptism: 'Name, if thou art human, I baptise thee...'

The argument used by some like Charles Curran that St Thomas Aquinas and others' notion of 'quickening' some weeks after conception opens a window for abortion doesn't hold up... especially now that we know more about biology than they did.

Former pioneering abortion doctor Bernard Nathanson was convinced by science that life begins at conception.

As you probably know or have guessed I stand with Rome regarding end-of-life care as on so much else: allowing somebody terminal to die, be he a premature baby (the Church of England was recently rubbished wrongly by the right-wing press as pushing euthanasia for teaching this), a horribly injured or sick person or an older person at his natural end, is of course allowable and even merciful (hooray for hospices) but no withholding of ordinary means (food or water). Of course I know about brain death... but is that the same as the soul 'checking out and leaving the building'? Because of that doubt again no starvation etc.

(My late rector was a hospital chaplain like you and could tell stories of people coming out of comas and recalling hearing what was said around them.)

This comes from a reverence for life that like so much else in the Catholic religion moderns think superstitious and stupidly literal but stands in the way of outright barbarism... it may stop somebody pulling the plug on you or me some day when we're inconvenient and a waste of resources as the Nazis thought of it.

Marshall said...

Well, John, that medieval term of "monster" continues to appear in medical dictionaries as an archaic clinical term for those infants born with significant abnormalities. On the other hand, the Latin root raises the question of just what "monsters" are supposed to show us (monstro, monstrare: to show or show forth).

Yes, the question of "quickening" is challenged in some sense by modern information on fetal development; but perhaps "viability" has become the contemporary equivalent. The size of a premature infant who might (operant word is might) survive is half what it was when I became a chaplain more than 25 years ago.

On the other hand, what is "natural?" Eating and drinking are natural and ordinary. Is it still "ordinary" when swallowing has stopped and nourishment passes through a tube through the abdominal wall directly into the stomach? The Roman church has taken a something of a teleological stance in saying it is the same. But it is a faith statement....

As for "brain death:" understood as that point where the brain itself is so damaged that no brain-regulated functions can continue (which, problematically, does include breathing but doesn't include heart beat) - that is pretty commonly understood, by clinical folk if not by the larger populace. But there remain the grey areas of coma, vegetative state, persistent vegetative state, and (a new category) minimally conscious state. All of those can be clinically distinguished. If we're not sure with a brain-dead person that the soul has "left the building," we are at least reasonably sure that the building will fail, even with intervention. Those other states are much less clear. At the same time, individuals have strong feelings of what they want for themselves and for those they love.

Thanks as always for your response.

Shel.F. said...

Marshall, it's Shelly from Bp. Packard's office, writing under my own steam so there's no confusion about whose views I'm representing (my own).

I would like to point out that the "personhood" argument in relationship to abortion (especially but not exclusively when it is men holding the conversation, as it is so far here on this blog) tends toward messy definitions in relationship to the personhood of the growing embryonic tissue with unique DNA.

However, I would like to point out the the personhood of the person who is nourishing that tissue with her body is always already completely established, and that personhood must be taken with utmost seriousness.

Shel.F. said...

I might also add that this post could be retitled, in light of my previous comment: "The Overlooked Person: Whose Life is in Question?"

Marshall said...

Shelly:

Good to hear from you.

Retitled? I think more recast, since you're working with a specific application, and I was thinking of the general category, with many messy issues involved. I appreciate that you can't post something like this at "Diocesan Chaplains" (link to your left); it's not your personal blog. However, you can respond at greater length here, or write enough and I'll post it here over your name.

Regarding the uncertain personhood of a fetus and established personhood of the mother: I certainly agree with you. That, I think, is why the General Convention has held again and again that abortion must ultimately be the choice of the mother, and that legislation is not an appropriate way to truly resolve issues around terminating a pregnancy.

However, I think it's a mistake to sell short the importance of wrestling with the messy issues and liminal decisions regarding the personhood of a blastocyst/fetus/baby. First, that's an important issue, however it is phrased, for every woman I've ever known who actually had to make a choice (however she chose). Second, changes in medical capacity dofigure into this, at least inasmuch as we can measure viability of premies, while we have no meaningful way to "measure" ensoulment (and that's even if we want to consider that a meaningful "event"). That's why General Convention as affirmed again and again that there's always a tragic element in abortion, even when it's the best (or least bad) choice. As my best beloved (who when younger was an intake volunteer for a women's clinic where abortions were done) has said, "Getting an abortion isn't like going out for an Egg McMuffin." That is, whatever the accusations might be, it is never a casual decision, never an easy or careless act.