Respecting biographies all the way down: a conception of personhood best suitable for a person-centered healthcare of individuals with severe disorders of consciousness
DOI:
https://doi.org/10.5007/1677-2954.2020v19n1p105Abstract
Person-Centered Healthcare (PCH) is interested in persons, but for many philosophers (at least in traditional accounts) not all human beings should be considered (strictly) “persons.” Nevertheless, if PCH is interested in persons, and if persons are truly all that matters, then we need to rethink about these traditional accounts on the ontology of personhood. After all, in PCH, it is not solely individuals with mature rational selves that demand healthcare needs. Newborns, toddlers, children, the mentally handicapped, and the elderly with chronic or progressive conscious disorders, as well as people endowed with severe disorders of consciousness (SDC), are certainly also persons with rights to healthcare. So, in taking PCH seriously, it seems necessary that the concept of the person be extended in order to include those individuals with insipient or immature levels of consciousness as well as those who are severely and permanently mentally handicapped. After all, it seems plainly acceptable that in clinical practice those individuals also need appropriate care and should be cared for and respected in the same way we care and respect all non-mentally disabled individuals. In this chapter, we will depart from some well-known philosophical concepts of what it means to be a person and try to offer a broader and more inclusive meaning. In our ontology, persons are human beings with a socially recognized biography, which implies recognizing those individuals as bearers of not only necessities, but interests and claims. Sometimes, those interests and claims, besides necessities and wellbeing, are not expressed by them due to severe disabilities, as is the case of individuals with SDC. With a PCH approach in patients that suffer from SDC, it is not only care that matters, but also respect. Caregivers therefore should not only sympathetically care for the wellbeing of these people but also be concerned with respecting their interests and claims by interpreting them empathetically, in the light of their biographical story. Our conclusion is that, in order to be coherent, PCH must consider individuals with severe disorders of consciousness as persons, and we think that our revised concept of personhood fits with this requirement.
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