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English: man coming out of coma.

English: man coming out of coma. (Photo credit: Wikipedia)

As I tell my students, the metaphysical question of personal identity has important moral implications. One scenario I present is that of a human in what seems to be a persistent vegetative state. I say “human” rather than “person”, because the human body in question might no longer be a person. To use a common view, if a person is her soul and the soul has abandoned the shell, then the person is gone.

If the human is still a person, then it seems reasonable to believe that she has a different moral status than a mass of flesh that was once a person (or once served as the body of a person). This is not to say that a non-person human would have no moral status at all—I do not want to be interpreted as holding that view. Rather, my view is that personhood is a relevant factor in the morality of how an entity is treated.

To use a concrete example, consider a human in what seems to be a vegetative state. While the body is kept alive, people do not talk to the body and no attempt is made to entertain the body, such as playing music or audiobooks. If there is no person present or if there is a person present but she has no sensory access at all, then this treatment would seem to be acceptable—after all it would make no difference whether people talked to the body or not.

There is also the moral question of whether such a body should be kept alive—after all, if the person is gone, there would not seem to be a compelling reason to keep an empty shell alive. To use an extreme example, it would seem wrong to keep a headless body alive just because it can be kept alive. If the body is no longer a person (or no longer hosts a person), then this would be analogous to keeping the headless body alive.

But, if despite appearances, there is still a person present who is aware of what is going on around her, then the matter is significantly different. In this case, the person has been effectively isolated—which is certainly not good for a person.

In regards to keeping the body alive, if there is a person present, then the situation would be morally different. After all, the moral status of a person is different from that of a mass of merely living flesh. The moral challenge, then, is deciding what to do.

One option is, obviously enough, to treat all seemingly vegetative (as opposed to brain dead) bodies as if the person was still present. That is, the body would be accorded the moral status of a person and treated as such.

This is a morally safe option—it would presumably be better that some non-persons get treated as persons rather than risk persons being treated as non-persons. That said, it would still seem both useful and important to know.

One reason to know is purely practical: if people know that a person is present, then they would presumably be more inclined to take the effort to treat the person as a person. So, for example, if the family and medical staff know that Bill is still Bill and not just an empty shell, they would tend to be more diligent in treating Bill as a person.

Another reason to know is both practical and moral: should scenarios arise in which hard choices have to be made, knowing whether a person is present or not would be rather critical. That said, given that one might not know for sure that the body is not a person anymore it could be correct to keep treating the alleged shell as a person even when it seems likely that he is not. This brings up the obvious practical problem: how to tell when a person is present.

Most of the time we judge there is a person present based on appearance, using the assumption that a human is a person. Of course, there might be non-human people and there might be biological humans that are not people (headless bodies, for example). A somewhat more sophisticated approach is to use the Descartes’s test: things that use true language are people. Descartes, being a smart person, did not limit language to speaking or writing—he included making signs of the sort used to communicate with the deaf. In a practical sense, getting an intelligent response to an inquiry can be seen as a sign that a person is present.

In the case of a body in an apparent vegetative state applying this test is quite a challenge. After all, this state is marked by an inability to show awareness. In some cases, the apparent vegetative state is exactly what it appears to be. In other cases, a person might be in what is called “locked-in-syndrome.” The person is conscious, but can be mistaken for being minimally conscious or in a vegetative state. Since the person cannot, typically, respond by giving an external sign some other means is necessary.

One breakthrough in this area is due to Adrian M. Owen. Overs implying things considerably, he found that if a person is asked to visualize certain activities (playing tennis, for example), doing so will trigger different areas of the brain. This activity can be detected using the appropriate machines. So, a person can ask a question such as “did you go to college at Michigan State?” and request that the person visualize playing tennis for “yes” or visualize walking around her house for “no.” This method provides a way of determining that the person is still present with a reasonable degree of confidence. Naturally, a failure to respond would not prove that a person is not present—the person could still remain, yet be unable (or unwilling) to hear or respond.

One moral issue this method can held address is that of terminating life support. “Pulling the plug” on what might be a person without consent is, to say the least, morally problematic. If a person is still present and can be reached by Owen’s method, then thus would allow the person to agree to or request that she be taken off life support. Naturally, there would be practical questions about the accuracy of the method, but this is distinct from the more abstract ethical issue.

It must be noted that the consent of the person would not automatically make termination morally acceptable—after all, there are moral objections to letting a person die in this manner even when the person is fully and clearly conscious. Once it is established that the method adequately shows consent (or lack of consent), the broader moral issue of the right to die would need to be addressed.


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  1. Doris Wrench Eisler

    If there is a soul, that is, a non-material counterpart to the body you cannot say the soul has departed the body because the body is in a coma. Many people have recovered fully after many years in a comatose state. Many people also say and seem able to prove they were fully aware of what was happening around them and understood what was said. We don’t understand enough to say much about these states but it is a moral matter that falls to some extent under the banner of practicality and there is a fairness issue as well: it is not possible to keep all comatose people on life support so how to choose, and would it be to some extent a matter of privilege and personal
    monetary advantage?

    There is also the very real problem of organ transplant and the over-eager reaping of organs before actual death: it seems quite possible that some donors (possibly unwilling to begin with)
    might be aware and in complete anguish in their last moments as they witness, by some special capacity, to see and understand what is happening to them.
    Starving comatose people for these reasons and others seems brutal and inhuman and can also be extended in time, a full week or more in some cases. Lethal injection of sedatives seems far more moral, and that would be in cases where several medical opinions hold out no hope, especially for aged people.
    I don’t like the introduction of “personhood” into the discussion at all: we’ve been there before
    in eugenics programs that have done us, as human beings, no credit.

  2. The soul is an ancient concept with no actual evidence to support it. There is less evidence to support the existence of souls than there is to support the continuation of what we consider person-hood in a brain-body in a vegetative state.

    As to person-hood, I was talking on Saturday to a person working in a local clinical system whereby they have now made considerable advances in brain control of computer language systems, such as that used by Hawking. In all the expected respects they can hold a conversation, though the output is delayed by several seconds. I take it from what was said that they would pass the Turing test to the Chinese room test.

    The morality of the issue is difficult, since for cases were there is no communication and little sign of inner life it isn’t at all clear whether the person really does exist no longer, whether they might come back to some degree if the brain managed to repair or ‘reboot’ – though that begs many questions about memory. I would expect some aspects of memory are intact as long as synaptic networks can be maintained, but can they be maintained to sufficiently operate with the same memories as the brain comes online again. The small scale technical aspects of human memory really are analogous to computer memories, if much more chaotic in organisation, but we still don’t know enough about how that small scale stuff relates to the consciousness that we all enjoy.

    As to headless bodies, they’re dead as people. We do not attribute person hood of an amputated arm or leg. Rather than thinking of the head removed from the body, think in terms of an amputated torso. The torso is meat, to be maintained for harvesting as any heart, lung, kidney might be. It might be more appropriate to think about the person-hood of the severed head, if only that could be kept alive. Anyone got a decent vat?

    Person-hood is troubling to us when it goes. That’s why death is traumatic when witnessed, and the more gruesome the more traumatic. Efficient hanging and some other forms of swift execution are bad enough, but we reserve greatest distaste for beheadings, by knives, swords, axes, guillotine – we wonder how long the head survives to contemplate its own death, and the more drawn out it is the worse we imagine it.

    Personally I have enough trouble dispatching a mouse after my cat has played with it to the point short of death. I’m not the least religious and don’t for one minute imagine there’s a mouse soul in there suffering, but I still find myself uttering “Sorry.” as I finish it off. An emotional human reaction I suppose, shared it seems by some other animals with reasonable brains that can make connections. We attribute ours the having a theory of mind and empathy, but it seems some animals have what superficially looks like something similar.

  3. think the term personhood is best dealt with in philosophical conjecture and even then I am not sure that there is a once and for all definition of this term. Whilst a person is apparently unable to communicate with the outside world it does not mean that the whole vast complexity of his or her system is similarly corrupt. It may be of interest to learn how common the apparent loss of mental states is. I’m sure it is not as common as say cancer or any other similar severe malfunction of the human organism. That being the case perhaps we can well afford and manage to keep these unfortunate people alive. On the other hand if complete loss of mental capacity becomes an epidemic or a pandemic them then we may well need to seriously consider terminating the life of such people. It would also be interesting to know how many of these people are actually on a life-support machine. And whether or not there is any chance of recovery.
    I think it is best to exclude the terms of soul and personhood in this discussion neither of them has as I have already said, a once and for all definition; what we are talking about here is a malfunctioning brain and what will we do about it? There are many other medical conditions which are incapacitating due to the malfunction of one or more organs and so far as I know if it is not the general practice in medicine to terminate the lives of such people.
    To generalise in this case is I think inappropriate. Each case should be treated on its own merits and regrettably I’m sure there will be some instances where the next of kin of the patient provided with all the medical details, can make a decision as to what is thought best to do. This will include the possibility of extinguishing the life of the patient. We have to remember that in some instances even if the patient does recover consciousness they may be, due to other injuries, subjected to a life of great misery and pain, mental and or physical, which is hardly worth living.

  4. Considering the moral aspects of this case I believe we should be aware that every difference makes a difference. No two states of affairs are identical. With this in mind I would say that a decision as to what action will be taken should be such that all those involved are preferably of one mind or that the majority are of the same mind. I suppose this is a utilitarian outcome. Someone has to make a decision and for him or her that is probably a great burden.

  5. Dennis Sceviour

    Mike wrote, “”After all, the moral status of a person is different from that of a mass of merely living flesh.”

    The scenario resembles a chamber of horrors. There is the potential of deliberately induced comatose patients warehoused for re-sale body parts. If lawyers are arguing the legality of such measures based on the Moral Status of a person then the inquiry is trite. Moral Status exists if a person can be wronged, and Moral Status could possibly be deemed an arbitrary political designation.

    If one assumes the autonomy of the person (and soul for that matter) then nature has given most of the signals for what the body must do upon death. Upon death, the body becomes an unwanted unfeeling thing like cut hair or fingernails. More important than Moral Status is the Moral Conscience of a person; that is, a person can distinguish right from wrong. This means that a comatose person is assumed to not have a Moral Conscience, or not able to choose right from wrong. Scientific experiments indicating cognitive memory patterns are not enough to establish Moral Conscience.

    As usual, the ethical principle of permission is important. The person must have given consent in advance to remain on life support.

  6. Re Dennis Sceviour July 8th

    “As usual, the ethical principle of permission is important. The person must have given consent in advance to remain on life support.”

    That is not possible if the person cannot communicate.

  7. Dennis Sceviour

    Don Bird,
    True. What would you suggest for borderline situations? If the person is a child then a guardian decides. If the person belongs to a religious group that prohibits life support, then it could be assumed consent for life support is not an available option. If the medical profession diagnoses a high probability of immediate recovery, then yes. If in doubt, then consent should govern. These are flexible professional decisions. The point is that a decision should not be made based on the moral status of a person.

  8. Don Bird,

    “It would also be interesting to know how many of these people are actually on a life-support machine. And whether or not there is any chance of recovery.”

    Electroencephalography, or EEG, will show electrical activity in the brain. If the brain is showing no activity, the person is generally considered to be dead. That’s generally, but instances such as Ariel Sharon, do occur. Sharon had a massive stroke in 2006, and was put on a life support machine, his brain showed no signs of electrical activity. Finally, February of this year, eight years later, they switch off the machine, and he became officially dead. Not to speak ill of the dead, but he may have been starting to smell. An immobile body will age and atrophy, even a life support machine will not keep someone indefinitely alive.

    EEG technology has come a long way, especially in the last 30 years. It’s something that has been know about since the 19th century, but with faster computer processing, more can be done with the signal. You can buy EEG games controller kits to use with the PlayStation or Xbox. People like Kevin Warwick are confident that it will be possible to electrically send information into the brain at some point in the future. If you have a little imagination and a taste for sci-fi, you can see where all of this is leading.

    Will it be possible in the near future to keep a brain in a container of liquid, while the person lives on in virtual reality, and continues to communicate with full bodied persons in the external world.

    Eternal life

    But what lays behind these Gates of Eden. Imagine dying as contented and decadent left-wing atheist, only to awake as right-wing Christian; with host of new and alien neuroses. Your thoughts pre-censored, your mental states managed – in this virtual world you’re free to do as you wish, just your wishes may not quite be your own, and instead engineered to an other’s tastes. And since you’re not quite dead, you can’t quite get out of work either; doubtlessly serving some Egyptian queen, who travels to the other world, with her “followers” and servants in toe. Sheryl Sandberg, for instance. Lest we should be bereft of “leadership”, I’m sure someone like Sheryl would insist on leading us; or insist on us following them; for are own benefit of course. In heaven, as it is on earth. Men wholly, totally free, to do anything they wish to do but die

  9. Re Dennis Sceviour July 8th

    “The point is that a decision should not be made based on the moral status of a person.“

    Regrettably, I’m not quite clear on what you mean by the above statement. What exactly is moral status, to whom does it apply, and who is to make the decision?

  10. Re JMRC July 8th

    Concerning your description of eternal life, when one wakes as a right-wing Christian are you implying that the person in question retains memories which were laid down before they died. Were that the case I imagine that life could be quite intolerable. How ever if that be not the case then presumably one will accept one’s lot as we mostly do, and live life accordingly. That is to say on the assumption that what they are living, is a normal life, and death would not be a consideration.
    We have no means of ascertaining with complete certainty that we are not brains in vats, how ever for the most part we assume that we are not, and that the life we are living is the norm for human beings. Would not such an assumption, also be made by the people whom you described as having eternal life, unless of course, they retain the memories of their prior existence?

  11. Dennis Sceviour

    Don Bird,
    “What exactly is moral status, to whom does it apply, and who is to make the decision?”

    Moral Status?

    Whom does it apply?
    The comatose person.

    Who is to make the decision?
    You tell me.

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