FAMILY MEMBERS DISCUSS
THE LEVEL OF PERSONHOOD IN THE PATIENT
Even while the patient still has some capacity to
participate in medical decisions,
the family (perhaps some family members specifically designated as
proxies)
might find themselves discussing to what degree the patient
has lost some characteristics that make us all persons.
These universal marks of personhood include:
(1) consciousness, (2) memory, (3) language, & (4) autonomy.
(1) If the patient is permanently unconscious,
then memory, language, & autonomy are obviously also missing.
And if there is strong medical certainty
that the patient will never again return to consciousness, that individual's life as a
person is now over.
(2) Memory
is a mental capacity that sometimes gradually fades away.
The patient is still conscious every day,
but he or she cannot remember important things about himself or herself
that used to constitute being that specific person.
And the patient might not recognize family members.
When memory is almost
completely absent,
the family might say that the
person who used to be a member of the family
has been lost to them forever.
(3) Language
is also a capacity of personhood
that the family members might notice declining.
The patient might have difficulty finding the best word
to express himself or herself.
And eventually the patient might lose the capacity
to understand words that are spoken to him or her.
Alzheimer's disease might rob the patient of the ability to read and
write.
(4) Autonomy
could be the first mark of
personhood to disappear.
The patient who used to be able to direct his or her life
might now become dependent on others
to make decisions about what should be done and when.
In some ways, such loss of autonomy makes the patient like a child.
These four marks of personhood are discussed
completely
in a small book called: When Is a Person?
Pre-Persons and Former Persons.
This book contains about 200 questions
divided into the four marks of personhood outlined above.
This would be the most comprehensive way
to examine the personhood of the patient.
And a shorter presentation of these basic themes
appears on the Internet here: "When Is a
Person? Pre-Persons & Former Persons".
This cyber-sermon explains the four marks of personhood in about 4
pages.
HOW DISCUSSING THE PERSONHOOD OF THE PATIENT
DISCOURAGE IRRATIONAL SUICIDE
AND OTHER FORMS OF PREMATURE DEATH
When the patient is just beginning
to lose the capacities that make us persons,
there might be some danger of irrational suicide,
since the patient's mental capacities are declining.
If there were irrational urges toward self-killing
present in the patient's thinking before the onset of Alzheimer's,
these might become more dangerous
if the patient loses perspective on his or her life.
In such cases, the patient's 'reasons' for choosing
death become questionable.
And the decision-making power shifts to the proxies,
who presumably are operating with all of their mental powers.
Some objective actions such as better supervision
might be necessary to avoid the danger of an irrational suicide.
And if the patient definitely becomes suicidal,
then a 24-hour suicide-watch might be necessary.
When the patient can no longer be trusted to make
wise medical decisions,
the power to choose all future courses of action shifts to the proxies.
We would hope that the patient has appointed the best proxies
while the patient was still able to make medical decisions.
But if not, then family members will be asked somewhat less formally
to make all future decisions for the patient.
Since the proxies will have the best interest of the
patient in mind,
they will not approve or cooperate in any irrational suicides.
But they will have the power to make wise life-ending decisions.
If there is ever any doubt about the wisest course
of action,
here is another cyber-sermon
that articulates the differences between
irrational mercy-killing and wise merciful death: "Four
Differences between Mercy-Killing and Merciful Death".
The proxies will ask themselves
when would be the best time
for this patient to die.
There might be some further marks of decline
that would be significant factors
for choosing between keeping
the patient alive
and allowing nature to take
its course.
The proxies want to choose a last day for the patient
that is not too soon
and not too late.
And besides considering the decline from full personhood,
the proxies will use several other safeguards
to make sure that they are deciding the best time of death for this patient.
Created April 13,
2007; revised 8-28-2008; 9-11-2008; 10-23-2008