Nucleus - January 2004 (pp10-15)

What is a Person?

John Wyatt explores a fundamental ethical concept

What does it mean to be a person? Is it possible to be a human being but not
a person? What duties do we owe to persons as opposed to non-persons? These
sound like the abstruse musings of philosophers light years away from the
practical issues of modern medicine. But in fact disagreements about personhood
lie at the heart of many current bioethical debates, including those involving
stem cell manipulation, prenatal screening, medical infanticide, the persistent
vegetative state, dementia and psychiatric illness.

Modern approaches

For centuries it was generally accepted that the terms 'person' and 'living
human being' were virtually equivalent. But over the last two decades, a number
of influential modern philosophers, including Peter Singer, Jonathan Glover and
John Harris, have challenged traditional understandings of personhood. As we
will see, this has led them to some startling conclusions.

For Peter Singer a person is a being who has a capacity for enjoyable
experiences, for interacting with others and for having preferences about
continued life. For John Harris a person is any being who is capable of valuing
their own life.

Once this kind of definition is accepted, there are a number of logical
implications. Firstly it is immediately obvious that in order to be regarded as
a person, you must have an advanced level of brain function. In fact you must
have a completely developed and normally functioning cerebral cortex. Secondly,
there must be a significant group of human beings who are non-persons. These
include fetuses, newborn babies and infants who lack self awareness, and a large
group of children and adults with congenital brain abnormalities, severe brain
injury, dementia and major psychiatric illnesses.

Thirdly, there are many non-human beings on the planet who meet the criteria
of persons. These include at least chimpanzees, gorillas, monkeys and dolphins,
but may also include dogs, pigs and many other mammals. In fact it has even been
argued that within the foreseeable future some supercomputers may meet the
criteria to be regarded as persons.

Speciesism and fragility

Those who meet the criteria of persons have moral rights and privileges. They
deserve to be protected from those who would injure or kill them. They should be
allowed to exercise their own choices or autonomy as much as possible. But the
same rights and privileges do not extend to non-persons. Peter Singer puts it
like this, 'only a person can want to go on living, or have plans for the
future, because only a person can understand the possibility of a future
existence for herself or himself. This means that to end the lives of people
against their will is different from ending the lives of beings who are not
people…killing a person against his or her will is a much more serious wrong
than killing a being who is not a person.'[1] In other words killing a
chimpanzee is a much greater moral evil than killing a newborn baby or an adult
with Alzheimer's disease.

When people respond with incredulity, Singer argues that to make moral
distinctions on the basis of species is to be guilty of a new crime,
'speciesism'. Instead we should make moral distinctions on the basis of
'ethically relevant characteristics', such as the ability to choose and value
your own life.

Of course there are major logical problems with this kind of definition of
personhood. In effect Singer has replaced one form of discrimination with
another. Instead of discriminating on the basis of species, he is now arguing
that we should discriminate on the grounds of cortical function. In fact if we
are into name-calling we could call him a 'corticalist'. But why should
corticalism be preferable to speciesism? Of course Singer may wish to argue that
cortical functioning is 'ethically relevant' whereas species membership is not.
But this is an arbitrary distinction that is hard to defend on entirely logical
grounds. Why should the functioning of a 5mm layer of neurones be the central
and only moral discriminating feature between beings? On purely logical grounds
species membership is a more coherent and fundamental basis for making ethical
distinctions between beings.

Personhood as defined above is a remarkably fragile and contingent property.
At the moment as you read this article you can be regarded as a person. But if,
when you walk out of your door, a brick falls on your head leading to cortical
damage, you are no longer a person. Of course if, following rehabilitation, your
cortical function recovers, then you will become a person again. Can something
so fundamental as personhood be so fragile? On Singer's definition it is not at
all clear if a human being who is anaesthetised, comatose, intoxicated,
delirious, psychotically confused or merely asleep remains a person. If a
burglar came into your room at night and killed you painlessly in your sleep,
would they have committed a crime? Singer and colleagues answer this challenge
by arguing that personhood is only lost if consciousness is permanently lost,
but why on logical grounds should this be so? Suppose I suffer severe brain
injury but have the prospect of gradual recovery to normal consciousness over
the next ten years. Am I a person in the intervening period? If someone kills me
in my unconscious state are they guilty of the serious crime of killing a person
or the less serious crime of killing a non-person?

A Christian perspective

At the heart of this secular philosophical perspective is the idea that you
earn the right to be called a person by what you can do, by demonstrating that
your brain is functioning adequately, by thinking and choosing. So how do we
respond as Christians? What does it mean to be a person in the light of the
Christian revelation? As we shall see, in the history of philosophy, the very
idea of a person comes directly out of a Christian understanding of what it
means to be a human being. It is necessary to look briefly at some rather
abstract theological history, but I hope it will become plain how it is relevant
to the modern debate.

God is personal

The original Greek word for person (prosopon) means literally 'the face', but
in ancient Greek it also referred to the mask that actors used to represent the
character they were playing in the theatre. In Greek and Roman thinking what
mattered about an individual was the face they showed to the world, the role
they played in society. We have retained this meaning when we refer to someone's
'persona'. It is the public face they show to the world. It is interesting that
this is how the word is used in the Greek New Testament. At several points God
is described as one who shows no favouritism. The literal Greek says that he is
not a respecter of persons, meaning that he is not influenced by our external
and social role.[2]

However in Hebrews 1:3 the Son is described as the exact representation of
God's person and a different word is used, hypostasis, which literally means
'what lies under'. The early church fathers, as they reflected on the nature of
the Godhead and the meaning of the Trinity, fastened on this word hypostasis to
describe the three persons of the Trinity. God's ultimate being (what 'lay
under' his activity), was in the form of persons - persons giving themselves to
one another in love. And as human beings are made in God's image, we too are
created as persons. We reflect God's nature in our personhood; we are created to
give ourselves to God and to others in love.

Relationship is vital

Just as the three persons of the Trinity are individually unique, yet give
themselves continually in love, so each human person is unique, yet made for
relationship with others. Personhood is not something we can have in isolation -
in Christian thinking it is a relational concept. Descartes came up with the
famous statement, 'I think, therefore I am'. It's a definition that led
ultimately to the modern concepts of Singer and Harris. By contrast we might
suggest an alternative Christian version, 'You love me, therefore I am'. My
being comes not from my rational abilities but from the fact that I am known and
loved - first of all by God himself, and secondly by other human beings. This is
why the experience of rejection and isolation can be so psychologically
devastating, and why children who have never experienced love and acceptance
fail to develop into normal healthy adults. But even if I am rejected by other
humans, I am still a person. Ultimately my personhood rests on the fact that God
called me into existence and that he continues to know and love me.[3]

The idea of a person as hypostasis, derived from the Christian theology of
the Trinity, gradually entered Western philosophy and remained of central
importance up to the present century. Humanism took on essentially the same
understanding of the human person, although its theological basis was
conveniently forgotten. It is only recently that the basic concept has been
derided and challenged by a number of philosophers, including Singer and
colleagues.

Doing or being?

For Peter Singer my personhood depends on what I can do, on the functioning
of my cerebral cortex. But in Christian thinking my personhood rests on who I
am, on the fact that God has called me into existence, and continues to know and
love me. Human beings do not need to earn the right to be treated as godlike
beings. Our dignity is intrinsic, in the stuff of our being, in the way God has
made us and the way he knows and loves us.

This Christian understanding of personhood is much more permanent, more
resilient, than the secular one. As we saw, to Peter Singer your personhood
might disappear at any moment if your cortex starts to malfunction. But in
Christian thinking, whatever happens to you in the future, whatever disease or
accident may befall your central nervous system, even if you are struck down by
dementia or enter a persistent vegetative state, you will still be you: a unique
and wonderful person known and loved by God. It is God's love that preserves our
identity throughout the whole of our lifetime - whatever tragic and unexpected
events may befall us - and on into eternity. And even when we were in our
mother's womb, God was loving us and calling us into existence. As the
theologian Gilbert Meilander put it, 'He was with us in the womb, as he will be
with us in the tomb'.[4]

Practical implications

So what are the practical implications for medical ethics of this rather
abstract theology? It's a huge topic and I can only point out a few headlines.
Firstly, in Christian thinking my moral value and significance does not depend
on the vagaries of my CNS function, but on my creation in God's image. Human
beings are godlike beings. We are lovingly designed by our Creator to reflect
his character and nature. Only human beings, in all the vast array of life on
planet Earth, have this privilege and responsibility. Hence we are to treat all
human beings, however tragically incapacitated, with wonder, reverence and
respect. We are called to protect all human beings from abuse, from manipulation
and from any who would deliberately end their life. We cannot rate some lives as
more worthwhile, more valuable than others. The malformed baby, the Alzheimer's
sufferer, the unwanted fetus, and the person with terminal motor neurone
disease; all have lives of unique significance and value, all are known and
loved by God. This does not mean that we have an absolute duty to provide every
possible treatment, or to continue life-supporting treatment in every case.
Sometimes it is right to withhold or withdraw medical treatment that is
burdensome and can bring no lasting benefit. But this is not because we estimate
one life as less valuable or less morally significant than another. Each human
being deserves our wonder, respect and compassionate care.

Secondly, whereas the law does not recognise personhood until the moment of
birth, Christian thinking points to the moral significance of the unborn fetus.
As illustrated so powerfully in Psalm 139, God is involved with us even in the
intrauterine environment. And although we cannot ultimately know in what sense
God has a relationship with an embryo (and thoughtful Christians continue to
differ on this issue),[5] it seems to me that we must treat even a microscopic
human embryo as a unique and precious being whom God is calling into existence.
And if this is right then we cannot destroy one human life to provide embryonic
stem cells for the benefit of another human life.

Thirdly, as far as we know, of all the species on the planet only Homo
sapiens is made in God's image and hence only human beings can be called
persons. Although we are called to treat not only chimpanzees and dolphins but
all sentient beings with care, as befits beings made by God, we cannot value
their lives as equal to those of humans. As Christians we must plead guilty to
the charge of speciesism, because our God is speciesist!

Finally, as we saw, there is no such thing as an isolated human person, and
therefore we cannot take ethical decisions as though human beings are isolated
entities. In Christian thinking we are all bound together in bonds of duty and
care. We are meant to be a burden to one another. In fact our lives are meant to
be ones of 'mutual burdensomeness'! We come into the world totally dependent on
the love and care of others, we go through a stage of life when we care for
others, and most of us will end our lives totally dependent on the love and care
of others. This is part of what it means to be a person. So even if a patient
with a terminal illness feels that their own life is worthless and requests the
right to be killed, we cannot agree. The intentional killing of one person
damages all of us, because we are all locked together in community. And by
contrast when we show compassion and love for the weakest and most pathetic
members of our society, we are expressing an essential element of our humanity.
This is the way we demonstrate God's image. This is the way he has made us to
be.

Conclusion

What does it mean to be a person? As I've tried to demonstrate it's not just
a question of academic philosophy. As Christian medics we are called to
demonstrate the reality of what we believe. It is by our behaviour, by our
compassionate caring, by our sensitivity and respect for the dignity of every
patient, the helpless, the confused, the malformed, the unborn and the disabled,
that we can really provide the answer.

References

Singer P. Rethinking Life and Death. Oxford: OUP, 1995:198

Rom 2:11; Eph 6:9; Col 3:25

Ps 139; Jer 1:5

Meilander G. Bioethics: A Primer for Christians. Carlisle: Paternoster
Press, 1997:30

See for example, Berry C. Beginnings: Christian Views of the Early Embryo.
London: CMF, 1993; Saunders
P. Deadly Questions on the Status of the Embryo. Nucleus 1998; July:28-34;
Berry
C,Saunders P. Head to Head - Prenatal Screening. Nucleus 1999; April:36,37

Further reading

Wyatt J. Matters of Life and Death. Leicester: IVP, 1998

McFarlane
G, Moore P. What is a Person? CMF Files no 10. London: CMF, 2000

Zizoulas J. Being as Communion. New York: St Vladimir's Seminary Press,
1991

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