Personhood and Euthanasia

Bioethicists are working on the concept that all human beings should not be considered persons with 'rights' under the law. Opponents compare this to slavery and the Nazi euthanasia programme.

  • Studies agree that the attempt to de-humanise or de-personalise the other corrupts the de-humaniser.
  • Applying the "Rawls test": would the best-off accept the arrangements if they believed at any moment they might find themselves in the place of the worst-off?
  • Only the handicapped should have the right to advocate euthanasia for the handicapped.
  • Animals could be designated "'persons" and "non-persons" could be substituted for the higher primates in purely destructive experimental research.
  • The arguments used to define personhood come from philosophy, not grounded on scientific fact.
The debate over the legalisation of Euthanasia is moving toward a question of personhood: When is a person not a person (i.e. a non-person)? The process of de-humanisation or de-personalisation is a first necessary step before denying, or stripping, someone of their basic human rights - in this case the right-to-live.

Studies have been undertaken, around the globe, on the various historical attempts of the de-personalisation of certain racial and ethnic groups and classes of people (i.e. the cognitively and physically disabled).

These studies have looked at slavery (particularly in America), the Nazi T4 Programme and the Holocaust, oppressed indigineous peoples around the world, and eugenic abortions.

While these studies differ on various points, one thing they all agree on is that the attempt to de-humanise or de-personalise the other corrupts the de-humaniser.

Dr. Victor Frankl, an Auschwitz survivor, and victim of a multitude of Nazi torments called on those who become involved in the process of de-personalisation to refuse to co-operate, calling it: "the last of the human freedoms?to choose one's attitude in any given set of circumstances, to choose one's own way." 1

The philosopher John Bordley Rawls theorised that the ideal society should be constructed according to a straightforward principle that has come to be known as the "Rawls test": would the best-off accept the arrangements if they believed at any moment they might find themselves in the place of the worst-off?

This is quite important when considering the issue of personhood, as such decisions are generally made by healthy 'persons' who are not 'cognitively impaired' or otherwise handicapped.

Critics ask, "Why don't we take a page from the pro-abortionists who say that men have no right to oppose abortion because they can't get pregnant? We could say to these pro-eugenics and pro-euthanasia people "You have no right to advocate euthanasia for the handicapped unless you yourself are handicapped"."

Some bioethicists claim that any cognatively impaired human would qualify as a non-person, while others claim that the only living non-persons are Persistent Vegetative State 'PVS' individuals, anencephalics, and probably foetuses. Some even question the 'personhood' of healthy infants who are as yet unaware of 'existing over time.'

Defining a "person"
Peter Singer, tenured bioethics professor and Director of the Center for Human Values at Princeton University, defines a "person" as an animal (human or otherwise) who is actively exercising "rational attributes" (self-consciousness, knowing, choosing, loving, willing, autonomy, relating to the world around one, etc.) and/or who is actively exercising "sentience" (feeling pain or pleasure).

Quoting directly from a PBS interview with Singer:
"Well as I used the term 'person' -- a 'person' is a being who is capable of anticipating a future, having wants and desires for the future, which are cut off, thwarted, if that person is killed.

And I think that is generally a greater wrong than it is to kill a being who has no sense of existing over time. And that might be, for example, a chicken has no sense of existing over time. And that, I think, is one reason why it's normally worse to kill a human being than to kill a chicken.

But also, of course, newborn babies have no sense of their own existence over time. So, it's not equivalent. Killing a newborn baby -- whether able-bodied or not -- I think, is never equivalent to killing a being who wants to go on living."
The arguments for "personhood" ? i.e. "individuality", "rational attributes" or "sentience" ? are based, not on scientific fact but on philosophical grounds.

Defining a "person's" value and status
Bioethicist Joseph Fletcher drew up a comprehensive list of 'positive' and 'negative' human qualities that define exactly what a person is and is not.

For example, the following list of human patients may genetically be human beings but, according to certain criteria, they are not human "persons":
  • Alzheimer's and Parkinson's patients
  • the senile
  • persons with mental illness
  • the mentally retarded
  • drug addicts
  • alcoholics
  • the comatose
  • patients with multiple sclerosis
  • paraplegics
  • cripples
  • patients in persistent "vegetative" state
  • infants under one year of age, and many more...
If these adult human populations are only human beings but not human "persons" ? because they do not exercise "rational attributes" or "sentience" ? then they also will not have ethical, or legal rights and protections.

This is the position taken by Singer and other bioethics writers. Singer argues that the higher primates, e.g., dogs, pigs, apes, monkeys, are persons?but that some human beings, e.g., even normal human infants, and disabled human adults, are not persons.

Philosopher/bioethicist R.G. Frey has also published that many of the adult human beings on the above list are not "persons," and suggests that they be substituted for the higher primates who are "persons" in purely destructive experimental research. 2

Brain-related criteria
The pre-World War II doctors in Germany portrayed the disabled and mentally ill as subhuman and akin to animals in order to justify involuntary euthanasia. The backlash following the exposure of the Nazi concentration camps had eugenics advocate lying low for a couple of decades.

According to Dianne N. Irving, M.A., Ph.D., an Assistant Professor, History of Philosophy/Bioethics at De Sales School of Theology, commenting on her fellow bio-ethicists:
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"[Some] argue for some sort of brain-related criteria - either "rational attributes" (self-consciousness, autonomy, loving, willing, relating with the world around one, etc.) or "sentience" (the ability to feel pain or pleasure, or the integration of the nerve net or brain). But scientifically we know that neither full "rational attributes" nor full "sentience" are present until years after birth.

All of these theories are simply posited, and many scientists have argued that there is absolutely no scientific evidence which demonstrates the supposed correlation between "brain birth" and "brain death", pre-person and person, consciousness and self-consciousness. And if one defines a human person in terms of "rational attributes" only, or "sentience" only, one will eventually have to argue also for the moral permissibility of the infanticide of normal healthy human infants (as many writers do), since full rationality, or full brain integration or sentience are not present until well after birth." 3
Quality of care
Irving suggests that the quality of medical care for some of the above "less than perfect patients" could be affected if physicians, nurses and other health-care workers perceive patients as somehow "less than full human persons."
"This might include the small uncomplicated details, which require care and attention on a routine daily basis, as well as some of the more complicated medical treatment decisions.

Are these patients to be considered as "useless eaters", or inequitably fall prey to the allocation of scarce medical resources cuts? If incompetent, will their best interests really be the determining factor in surrogate decision making - or will it b the best interests of the surrogate - or of the hospital?
Irving points out that When conflicts arise concerning these patients, there is a danger that they will be seen "by some of those in the mediation process as "non-persons" whose "quality of life" does not demand that they be given equal respect and equal medical treatment."

This in turn may lead to poor quality health care both on a routine and acute basis, and abuse in medical research.

She goes on to cite examples where medical research and experimentation cases have already occurred.

Speaking of human beings in the "persistent vegetative state," Peter Singer argues as follows:
In most respects, these human beings do not differ importantly from disabled infants. They are not self-conscious, rational, or autonomous, and so considerations of a right to life or of respecting autonomy do not apply. If they have no experiences at all, and can never have any again, their lives have no intrinsic value. Their life's journey has come to an end. They are biologically alive, but not biographically.
Perhaps such philosophy is harmless, but the Nazi "euthanasia" program began with a philosophy in which, like Singer's concept of personhood, human attributes were denied to certain groups of people. Rudolph Hess defended the T4 programme at the Nuremburg Trials as such: "National Socialism is nothing more than applied biology."

Opponents say that legalised euthanasia, within a philosophical framework such as that of Singer, would pose a great danger to those who were considered "non-persons".

References:
  1. Victor Frankl, Man's Search for Meaning (New York: Washington Square, 1963)
  2. R.G. Frey, "The ethics of the search for benefits: Animal experimentation in medicine," in Raanan Gillon (ed.), Principles of Health Care Ethics (New York: John Wiley & Sons, 1994), pp.1067-1075.
  3. Irving Dianne N. Can Either Scientific Facts or "Personhood" be Mediated?