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Defining Personhood: towards the Ethics of Quality in Clinical Care
  1. Steven D Edwards
  1. Centre for Philosophy and Health Care, University of Wales Swansea

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    Sarah Bishop Merrill, Amsterdam-Atlanta, Rodopi, 1998, 222 pages, £24.50.

    The concept of a person is frequently invoked in medical ethics literature. Typically, it is appealed to in order to sustain a claimed difference in moral status between one (usually human) individual and another. Thus the concept is appealed to in the context of debates concerning the justification of abortion, the withdrawal of treatment from humans in persistent vegetative states, and the extent of our obligations to the severely cognitively impaired. Many contributions to these issues attempt to set out defining features of personhood, usually in the form of a list of necessary and sufficient conditions.

    In this book the author is critical of, and rejects, such attempts. Her aim is to identify a number of “distinctive features” of personhood which will not constitute a set of necessary and sufficient conditions of the concept. The strategy by which these distinctive features are to be identified is through a survey of the views of a number of groups of language users (physicians, nurses, patients, and philosophy students) within the author's own linguistic community (the USA). Readers are reminded in the book of the later Wittgenstein's dictum that “meaning is use” (page 116).

    Unusually for a philosophical work, the book includes a description of a considerable empirical research programme, surveying the views of “several hundred” subjects (page 70) on the features which they associate with personhood. Thus the task referred to in the book's title of defining personhood is conducted by an empirical survey rather than philosophical apriorism. As noted, aspects of the philosophy of language of the later Wittgenstein supply the philosophical justification for such an approach.

    Twenty-six distinctive features of personhood are put forward, ranging from being alive, and possessing rationality, to economic status and sense of humour. The author concludes from the empirical surveys that “no one feature, or single set of features, dominates the concept [of personhood]” (page 130), at least as this is understood by the groups surveyed. It is concluded, thus, that analyses of personhood in terms of necessary and sufficient conditions are at odds with ordinary usage. The survey is taken to suggest that the concept of personhood is, rather, “open-ended”; it is a fluid concept without fixed, determinate boundaries. This is not to say the concept is arbitrary, but rather that it is an “essentially contested concept” (page 143): differing groups have differing, if plausible, views about what is important to personhood.

    How do these findings help contribute to a resolution of the kinds of problems of health care ethics referred to above? The author's claim is that “the distinctive-features theory does not solve the problem of the fetus or the comatose individual, it explains what the problem consists in, namely, the absence of features usually thought important to those asserting and recognizing personhood in our culture” (page 157). So the approach described in this book helps to diagnose what is going on in moral debates in which the concept of a person is invoked. Opponents, for example, in the abortion debate, will have differing conceptions of personhood. If I understand Sarah Bishop Merrill correctly, her view is that one cannot simply assert one's own view of personhood over another in order to win an argument, and any position on personhood will be objectionable in some way—being either too inclusive or too exclusive. If protagonists consider the grounds for their differences less dogmatically there may be scope for a pragmatic agreement.

    In criticism of the author, one wonders whether this conclusion requires the complex empirical survey described in the book. And, more critically, it is cogent to wonder what follows from the fact that a group of language users in a specific linguistic community hold a range of features to be distinctive of persons. The moral realm, as the author recognises, is a normative one. It cannot be shorn completely from descriptions of how subjects do in practice think about personhood, but the further question of whether they are morally justified in thinking in such ways seems a legitimate one. Determining meaning by reference only to current usage, seems to invite acceptance of the status quo, and hence of existing moral prejudices, and thus to be objectionable (for example would “personhood” have included women, children and slaves in Ancient Greece)?

    In conclusion, this is a very wide ranging book. It includes interesting discussions of philosophical scholarship (notably the discussion of Locke's distinction between the self and the person), linguistic theory and medical ethics. But its Wittgensteinian-inspired methodology seems to this reviewer to call into question its conclusions.

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