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The aim of this discussion paper is to explore factors and contexts that influence how nurses might conceptualise and assign personhood for people with altered consciousness, cognition and behaviours. While a biomedical framing is founded upon a dichotomy between the body and self, such that the body can be subjected to a medical and objectifying gaze, relational theories of self, multiculturalism and technological advances for life‐sustaining interventions present new dilemmas which necessitate discussion about what constitutes personhood. The concept of personhood is dynamic and evolving: where historical constructs of rationality, agency, autonomy and a conscious mind once formed the basis for personhood, these ideas have been challenged to encompass embodied, relational, social and cultural paradigms of selfhood. Themes in this discussion include: the right to personhood, mind–body dualism versus the embodied self; personhood as consciousness, rationality and narratives of self; social relational contexts of personhood and cultural contexts of personhood. Patricia Benner's and Christine Tanner's clinical judgement model is then applied to consider the implications for nursing care that seeks to reflexively incorporate personhood. Nurse clinicians are able to move between conceptions of personhood and act to support the body, as well as presumed autonomy and relational, social and cultural personhood. In doing so, they use analytical, intuitive and narrative reasoning which prioritises autonomous constructions of self. They also incorporate relational and social contexts of the person receiving care within the possibilities of technological advances and constraints of contextual resources. [ABSTRACT FROM AUTHOR]

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This paper considers relatively long‐term possibilities for the future relationship between humans and superintelligent robots (SRs). The great technological developments in fields such as artificial intelligence (AI), robotics and computer science have made it quite likely that we will see the advent of SRs towards the end of this century (or somewhat later). If SRs have a higher moral and legal status than typical adult human beings based on their greater psychological capacities, then they should also be entitled to human rights. However, even though SRs might be entitled to stronger moral and legal rights for this reason, it might nonetheless be necessary to limit their (otherwise justified) claims to avoid causing human beings to become extinct or endangered. The paper provides an argument in support of SRs' claims to human rights but also warns about the socio‐political, moral and legal implications of taking such a step. [ABSTRACT FROM AUTHOR]

This paper examines individual and societal duties to older adults in sub‐Saharan Africa who reside in skipped generation households, which are households in which a young and old generation live together with the middle generation absent. As they age, older adults in skipped generation households may lack the prospect of social and economic support from offspring, making their situation precarious. If ill health results in an older adult's inability to work, who will support them? If they need assistance with basic activities of daily living, who will provide it? This paper addresses these questions through the lens of African ethics. Section I appeals to the African ethic of ubuntu ('humanness') to identify normative conceptions of persons and moral character relevant to skipped generation ethics. Section II elaborates this focus by means of the virtues of gratitude and reciprocity, discussing their conditions, requirements, and limits and comparing surrogate parent‐child to parent‐child cases. Section III explores the application of an ubuntu ethic to society as a whole and defines societal duties toward older adults by appealing to African conceptions of dignity and justice. [ABSTRACT FROM AUTHOR]

Accompanying the ageing of contemporary ageing societies is an increase in age associated morbidity, with dementia having an important impact. Mental frailty in later life is a source of fear for many and a major policy concern to all those concerned with health and welfare services. This introduction to the special issue on 'Ageing, dementia and the social mind' situates the selected papers within the context of debates about dementia and its social relations. In particular it draws attention to the importance of the social imaginary of the fourth age and what this means for the issue of personhood, care, social representations of dementia and its social contextualisation. The papers illuminating these themes draw on a variety of disciplines and approaches; from the social sciences to the humanities and from the theoretical to the empirical in order to help orientate future researchers to the complexities of dementia and the social and cultural matrix in which it exists. This paper provides an introduction to the potential for a more extended sociology of dementia; one which could combine the insights from medical sociology with the concerns of social gerontology. [ABSTRACT FROM AUTHOR]

Being admitted to an acute mental health unit can lead to feelings of shame, and loss of personhood for some consumers. Promoting safety for consumers is a function of acute mental health units. This paper explores how consumers' personhood influences their perception and experience of safety in acute mental health units. Semi‐structured interviews were conducted with 15 participants who had previously been admitted to an acute mental health unit. Thematic analysis was used to analyse the data. Participants perceived safety as being intrinsically linked to their personhood. When participants' innate worth was affirmed in their interactions with staff, participants felt safe. Three subthemes were identified: 'Seen as an equal', 'Being respected', and 'Able to make choices'. These findings can be used to inform nursing practices that enhance consumers' sense of personhood and, in so doing, promote consumers' safety and recovery in acute mental health units. [ABSTRACT FROM AUTHOR]

In this paper, I critically examine Kitwood's account of personhood for people with dementia. His account has been influential in supporting appeals to personhood in both clinical and bioethical literature on dementia care. I demonstrate that Kitwood's account does not run into common objections against invoking personhood as a normative notion, namely, the objection of exclusionary implications and the objection of redundancy. I argue, however, that Kitwood's account suffers from two other major conceptual issues. These include (a) unreasonable social contingency, and thus, precariousness, of his notion of personhood for people with dementia; and (b) insufficient theoretical connection between his account of personhood and his proposed list of indicators of well-being for people with dementia. Despite these issues, I do not agree with the following view: that, in the context of dementia care, scholars should refrain from appealing to personhood considerations. Instead, I defend the view that while Kitwood fails to offer a compelling theoretical account of personhood of people with dementia, his empirically driven list of indicators of well-being and his notion of malignant social phycology seem to be sensitive to key ethical considerations relevant to dementia care. I propose that we pursue alternative ways of explaining what is morally (un) desirable about them without (explicit) appeal to personhood., (© 2021 John Wiley & Sons Ltd.)

National Disability Insurance Scheme (NDIS) funding rules determine who can access which supports. However, what is less frequently acknowledged, is that those rules produce an assumed model of personhood. Arguably, this becomes most evident when a case for funding reaches the Administrative Appeals Tribunal, where disputes are resolved between the administrators of the scheme (NDIA) and NDIS participants. In 2019, one such significant and controversial case asserted that 'WRMF', a woman living with multiple sclerosis, could use her NDIS funding to pay for the services of a sexual therapist. The basis for this ruling involved complex debates about citizenship and rights, which were embedded in contested notions of the person. In this paper, I use critical discourse analysis to examine these competing claims and the individualised framework in which WRMF's case was debated. The analysis reveals two key social justice issues: first, that there are limits to the citizenship available for people living with a disability (which assumes compulsory able‐bodiedness); second, that broader concepts of the person require explicit attention from the NDIS to embrace more expansive notions of citizenship for people living with a disability, including acknowledgement of sexual identities and needs. [ABSTRACT FROM AUTHOR]

Background: Multiple sclerosis (MS) is a chronic serious condition of uncertain course and outcome. There is relatively little literature on the experiences of people who live with a person with MS. They inhabit a locus of care that spans caring for (a relational act) and caring about (a moral stance, addressing fairness, compassion and justice) the person with MS. Methods: Using the theoretical lens of personhood, we undertook a scoping review and meta‐synthesis of the qualitative literature on the experiences of people who live with a person with MS, focusing on the nature of, and constraints upon, caring. Results: Of 330 articles, 49 were included in the review. We identified five themes. One of these—seeking information and support—reflects the political economy of care. Two are concerned with the moral domain of care: caring as labour and living with uncertainty. The final two themes—changing identities and adapting to life with a person with MS—point to the negotiation and reconstitution of personhood for both the person with MS and the people they live with. Conclusion: People with MS are embedded in relational social networks of partners, family and friends, which are fundamental in the support of their personhood; the people who live with them are 'co‐constituents of the patient's identity' assisting them to make sense of their world and self in times of disruption due to illness. Support services and health care professionals caring for people with MS are currently very much patient‐centred; young people in particular report that their roles are elided in the health system's interaction with a parent with MS. There is a need to look beyond the person with MS and recognize the relational network of people who surround them and broaden their focus to encompass this network. Patient and Public Involvement: Our research team includes four members with MS and two members with lived experience of living or working with people with MS. A third person (not a team member) who lives with a partner with MS provided feedback on the paper. [ABSTRACT FROM AUTHOR]

This paper explores philosophy in its relation to other disciplines and practices that also seek to understand the distinctive nature of human persons. It begins with a consideration of the nature of philosophy, arguing for a pluralistic conception reflecting different ends, and relating these to art, politics, religion, and science. It illustrates this via connections between the thought and work of Andy Warhol and Arthur Danto, Wagner and Nietzsche, and Roger Scruton and James MacMillan. It then shifts to a fifth methodological conception of philosophy as the discipline of disciplines, specifically in clarifying concepts and presuppositions, and relates this to marking the boundaries of personhood. Finally, it explores a particular example of philosophy in relation to another practice, art, this time giving priority to art itself. [ABSTRACT FROM AUTHOR]

In this paper I connect an anthropology of Christianity to an anthropology of the body and an anthropology of the nation. I try to achieve this by looking at changing notions of femininity in the Pentecostal context of Vanuatu. I do this on two different levels; on the one hand I show how the meaning of womanhood is changed in what I call the 'pentecostalised' neighborhoods of the capital Port Vila, and on the other I show how the household and the nation become contexts into which this new notion of femininity is played. Thus, in the first part of the paper I look at the ways in which Pentecostal Christianity change the meaning of gender, whereas in the second part of the paper I look at how this new form of gendered meaning has relevance for our understanding of wider social contexts. [ABSTRACT FROM AUTHOR]

This paper addresses the question of the relations between emotions and personhood, with a view to advancing a critical realist account of the role of emotions in social life. It is argued that the constitution of persons has to be approached from an ontological perspective, and that this raises questions about how sociology has addressed the meaning and role of emotions. Margaret Archer's critical realist perspective on them as commentaries on human concerns is broadly endorsed, but some significant correctives are proposed, especially with respect to the important distinction between primary and secondary emotions. To this end, it is argued that the affect spectrum theory advanced by Warren TenHouten can be fruitfully appended to a critical realist theory of emotions. [ABSTRACT FROM AUTHOR]

Humans are morally deficient in a variety of ways. Some of these deficiencies threaten the continued existence of our species. For example, we appear to be incapable of responding to climate change in ways that are likely to prevent the consequent suffering. Some people are morally better than others, but we could all be better. The price of not becoming morally better is that when those events that threaten us occur, we will suffer from them. If we can prevent this suffering from occurring, then we ought to do so. That we ought to make ourselves morally better in order to prevent very bad things from happening justifies, according to some, the development and administration of moral enhancement. I address in this paper the idea that moral enhancement could give rise to moral transhumans, or moral post-persons. Contrary to recent arguments that we shouldn't engender moral post-persons, I argue that we should. Roughly, the reasons for this conclusion are that we can expect moral post-persons to resemble the morally best of us, our moral exemplars. Since moral exemplars promote their interests by promoting the interests of others (or they promote others' interests at the expense of their own) we can expect moral post-persons to pursue our interests. Since we should also pursue our own interests, we should bring about moral post-persons., (© 2020 John Wiley & Sons Ltd.)

Abstract: Continence is a key moment of care that can tell us about the wider care of people living with dementia within acute hospital wards. The spotlight is currently on the quality of hospital care of older people across the UK, yet concerns persist about their poor treatment, neglect, abuse, and discrimination within this setting. Thus, within hospitals, the care of people living with dementia is both a welfare issue and a human rights issue. The challenge of continence care for people living with dementia can be seen as the ‘canary in the coal mine’ for the unravelling of dignity within the acute setting. This paper draws on an ethnographic study within five hospitals in England and Wales, selected to represent a range of hospital types, geographies and socio‐economic catchments. Observational fieldwork was carried out over 154 days in acute hospitals known to admit large numbers of people living with dementia. This paper starts to fill the gap between theory and data by providing an in‐depth ethnographic analysis examining the ways in which treatment as a person is negotiated, achieved or threatened. We examine how the twin assaults on agency of a diagnosis of dementia and of incontinence threaten personhood. The acute threats to this patient group may then act to magnify perils to treatment as a person. Our findings suggest that personal dignity and the social construction of moral personhood are both threatened and maintained in such a setting. We show how empirical ethnographic data can lend weight to, and add detail to, theoretical accounts of moral personhood and dignity. [ABSTRACT FROM AUTHOR]

Most opposition to abortion stands or falls on whether a fetus is the sort of being whose life it is seriously wrong to end. In her influential paper 'A defense of abortion,' Judith Jarvis Thomson effectively sidesteps this issue, assuming the fetus is a person with the right to life yet arguing this alone does not give it the right to use the mother's body. In a recent article, Perry Hendricks takes inspiration from Thomson and assumes the fetus is not a person, arguing that abortion is wrong because causing fetal impairment is wrong and abortion is worse than causing fetal impairment. Here I argue Hendricks' impairment argument fails. For Hendricks, risking fetal impairment is wrong because it risks harm to a future person, but if we assume the fetus is not a person, abortion doesn't harm anyone, it merely prevents them from existing. [ABSTRACT FROM AUTHOR]

Background Person-centred care ( PCC) is increasingly advocated as a new way of delivering health care, but there is little evidence that it is widely practised. The University of Gothenburg Centre for Person-Centred Care ( GPCC) was set up in 2010 to develop and implement person-centred care in clinical practice on the basis of three routines. These routines are based on eliciting the patient's narrative to initiate a partnership; working the partnership to achieve commonly agreed goals; and using documentation to safeguard the partnership and record the person's narrative and shared goals. Objective In this paper, we aimed to explore professionals' understanding of PCC routines as they implement the GPCC model in a range of different settings. Methods We conducted a qualitative study and interviewed 18 clinician-researchers from five health-care professions who were working in seven diverse GPCC projects. Results Interviewees' accounts of PCC emphasized the ways in which persons are seen as different from patients; the variable emphasis placed on the person's goals; and the role of the person's own resources in building partnerships. Conclusion This study illustrates what is needed for health-care professionals to implement PCC in everyday practice: the recognition of the person is as important as the specific practical routines. Interviewees described the need to change the clinical mindset and to develop the ways of integrating people's narratives with clinical practice. [ABSTRACT FROM AUTHOR]

This paper examines how middle-aged and older post-Soviet immigrants in eastern Berlin navigate the neoliberalized landscape of work-based integration in face of their long-term unemployment. I first show how these immigrants' own insistence on the centrality of paid work for their feeling integrated contributes to their experience of collective despondency and enrollment in exploitative quasi-markets, including workfare. Focusing on this insistence, I examine how it draws strength primarily from their continued subscription to the conceptions of self as deeply socially embedded, and of work as a practice of such an embedding, adopted through their Soviet-era socialization into the culture of dispersed personhood and obligation to work, rather than from their adoption of neoliberal concepts of citizenship in Germany. Contributing to geographies of post-socialist experience of neoliberalized regimes of citizenship and immigrant integration, this paper thus highlights how some of the aspects of post-socialist subjectivities dovetail unexpectedly with the neoliberal project. [ABSTRACT FROM AUTHOR]

The concept of dignity is pervasive in bioethics. However, some bioethicists have argued that it is useless on three grounds: that it is indeterminate; that it is reactionary; and that it is redundant. In response, a number of defences of dignity have recently emerged. All of these defences claim that when dignity is suitably clarified, it can be of great use in helping us tackle bioethical controversies. This paper rejects such defences of dignity. It outlines the four most plausible conceptions of dignity: dignity as virtuous behaviour; dignity as inherent moral worth; Kantian dignity; and dignity as species integrity. It argues that while each conception is coherent, each is also fundamentally flawed. As such, the paper argues for a bioethics without dignity: an ‘undignified bioethics.’ [ABSTRACT FROM AUTHOR]

The ecological and societal problems caused by product obsolescence and consumerism in modern economies constitute a "wicked human‐made problem" of significant magnitude. Current (old) ways of thinking cannot address these problems. Accordingly, in this paper, we critically explore the novel idea of integrated personhood and worldviews to theorize research on self‐repairers and their repair behaviours to extend product lifetimes. We conducted a structured and systematic review of published work (n = 183) to identify the conceptual content of the field to inform our theorization. Our findings highlight three key issues. First, constricted theorization undermines understanding of self‐repairers and their product lifetime extension (and spillover) behaviours. Second, the underlying conceptual complexity is typically underestimated. Third, the dominance of voluntarist and deterministic studies impedes new directions in research. From our review, an integrated worldview–personhood framework emerges that can deepen understanding of avant‐garde self‐repairers' engagement with product lifetimes. [ABSTRACT FROM AUTHOR]

Background: Collaboration with care partners is a political aim in recent white papers in Norway and internationally. Home care services regularly work closely with care partners, but there are many indications that the collaboration does not work satisfactorily. Aim: To explore home care staff and leaders' experiences of collaborating with care partners of older people with mental health problems through a personhood perspective. Methods: The study had a qualitative design and comprised eight health professionals in two focus groups and in‐depth interviews with three leaders in one home care district. The data were analysed using a thematic framework analysis building on previous research on personhood. criteria for reporting qualitative reporting guidelines were used to ensure comprehensive reporting. Results: Four themes were identified in the analysis: 'non‐negotiated relationships', 'contradictory agendas', 'weak paternalism' and 'moral compromise'. Conclusion: There seems to be a lack of facilitation of collaborative relationships through all levels of the home care organisation. The interactions between care partners and home care staff sometimes appear to produce low or negative levels of emotional energy, and situations where the personhood of neither of them is respected occurs. Paying attention to the four modes of being as a framework for understanding personhood creates the foundation for a person‐centred approach that enhances the potential of creating stronger partnership in care relationships. [ABSTRACT FROM AUTHOR]

Person-centred care is often cited as an aim of gerontological nursing and promotion of personhood is said to be the basis for person-centred care. As such, it forms a cornerstone value for many gerontological nurses, particularly those working in dementia care. Tom Kitwood’s ideas and definition of personhood are widely referred to in the literature and used in the dementia care field. More recently, there is a move to critique and partially reject Kitwood’s ideas on personhood. This paper has three aims: (i) to explore some central ideas around key theories of personhood (ii) to critique Kitwood’s work on personhood. (iii) To summarize current critiques of Kitwood’s ideas and provide a response that outlines why Kitwoods’ ideas are still relevant. It is suggested many critiques ignore Kitwoods’ ultimate purpose; that of moral concern for ‘others’. However, the main criticism put forward in this paper is that, rather than completely rejecting personhood theories, Kitwood locates his work on what it means to be a person within a traditional Cartesian personhood framework, albeit from a revised or pragmatic viewpoint. Finally, it is suggested that definitions of persons and personhood need to take account of the body and time (corporeality and temporality) and gerontological nursing may want to reassess how much allegiance is given to basing nursing frameworks on the concept of personhood. [ABSTRACT FROM AUTHOR]

In this paper, I address the important yet under-examined role of charismatic Protestant Christianity in the reconfiguring of personhood and social relations in the remote Yolngu settlement of Galiwin'ku. I focus in particular on the ways in which this form of Christianity, locally articulated, brings together indigenous concepts of personhood with those introduced by the market, the state, and evangelism to produce what I refer to as Christian individuality and Christian relatedness. These dialectical tendencies in postcolonial settlement life call attention to the ways Yolngu converts use their Christian practices both to continue kin-based moralities in the present and to engage (if selectively) modern individualism. This paper addresses post-colonial conditions where demands of state institutions and modern governance interact with changing ideas of personhood and sociality. It contributes to the growing anthropological literature on Pentecostal and charismatic Christianity. [ABSTRACT FROM AUTHOR]

In a paper published in Bioethics, Jason Eberl has argued that early embryos are not persons and should not be granted the status possessed by them. 1 Eberl bases this position upon the following claims: (1) The early embryo has a passive potentiality for development into a person. (2) The early embryo has not established both ‘unique genetic identity’ and ‘ongoing ontological identity’, which are necessary conditions for ensoulment. (3) The early embryo has a low probability of developing into a more developed embryo. This paper examines these claims. I argue against (1) that a plausible view is that the early embryo has an active potentiality to grow into a more developed embryo. Against (2), I argue that neither ‘unique genetic identity’ nor ‘ongoing ontological identity’ are necessary conditions for ensoulment, and that ‘ongoing ontological identity’ is established between early embryos and more developed embryos. Against (3), I argue that the fact that the early embryo has a low probability of developing into a more developed embryo, if true, does not warrant the conclusion that the early embryo is not a person. If Eberl is right that the human soul is that which organises the activities of a human being and that ensouled humans are persons, embryos are persons from conception. [ABSTRACT FROM AUTHOR]

In this paper, I critically examine Kitwood's account of personhood for people with dementia. His account has been influential in supporting appeals to personhood in both clinical and bioethical literature on dementia care. I demonstrate that Kitwood's account does not run into common objections against invoking personhood as a normative notion, namely, the objection of exclusionary implications and the objection of redundancy. I argue, however, that Kitwood's account suffers from two other major conceptual issues. These include (a) unreasonable social contingency, and thus, precariousness, of his notion of personhood for people with dementia; and (b) insufficient theoretical connection between his account of personhood and his proposed list of indicators of well‐being for people with dementia. Despite these issues, I do not agree with the following view: that, in the context of dementia care, scholars should refrain from appealing to personhood considerations. Instead, I defend the view that while Kitwood fails to offer a compelling theoretical account of personhood of people with dementia, his empirically driven list of indicators of well‐being and his notion of malignant social phycology seem to be sensitive to key ethical considerations relevant to dementia care. I propose that we pursue alternative ways of explaining what is morally (un) desirable about them without (explicit) appeal to personhood. [ABSTRACT FROM AUTHOR]

The debate concerning the moral permissibility of using human embryos in human embryonic stem cell (hESC) research has long centred on the question of the embryo's supposed right to life. However, in focussing only on this question, many opponents to hESC research have escaped rigorous scrutiny by making vague and unfounded appeals to the concept of moral respect in order to justify their opposition to certain hESC practices. In this paper, I offer a critical analysis of the concept of moral respect, and its use to support the intuitively appealing principle of proportionality in hESC research. I argue that if proponents of this principle are to justify its adoption by appealing to the concept of moral respect, they must explain two things concerning the nature of the moral respect owed to embryos. First, they must explain which particular aspect of the embryo is morally relevant, and why. Second, they must explain why some uses of embryos in research fail to acknowledge what is morally relevant about the embryo, and thereby involve a violation of the moral respect that they are due. I shall show that providing such explanations may be more difficult than it first appears., (© 2013 John Wiley & Sons Ltd.)

In the Trobriand Islands of Papua New Guinea, sexuality is valued as a positive expression of relational personhood, registering the efficacy of consensual and pleasurable practice in producing and maintaining social relations. The power of sexuality to demonstrate individual and collective capacity and potential holds particular salience for unmarried young people. This paper draws on my ethnographic research on culture and HIV in the Trobriands to address perduring questions about the locus of individual autonomy in Melanesian sociality, where relational personhood shapes identity and modes of exchange in the moral economy. I focus on the gendered agency of youth sexuality, including the use of kwaiwaga, or love magic, in exercising and controlling desire. The narrative identities of two young women provide the lens through which questions of agency are explored, revealing how the autonomous mind, nanola, is central to understanding the embodiment of social relations, how the power of love magic transfers agency from one individual to another, and how individual assertions and acts are ultimately expressions of situated relationality. [ABSTRACT FROM AUTHOR]

Patterns of sociality in Fijian evangelical Christianity differ from the mainline Fijian Methodist church in being notably less integrated with relations of vanua and chiefly hierarchy, leading scholars to speculate as to whether such traditions are more individualised. Analysing teachings, hymns, worship styles and spatial arrangements within a prominent Fijian Pentecostal ministry, I explore how sociality is produced through the interaction of spatial, conceptual, and embodied processes. Competing dynamics of hierarchy and equality, connections and boundaries, are mobilised within an overall framework that emphasises individual moral authority and personal relationship with God. Through this analysis, in conversation with previous studies, this paper argues for a critical examination of schemes of 'egalitarian individualism' and 'hierarchical holism', which, through the influence of Louis Dumont in particular, have been prominent in studies of Christianity and sociality in Oceania. [ABSTRACT FROM AUTHOR]

Progress is being made in transitioning from clinicians who are torn between caring for patients and populations, to clinicians who are partnering with patients to care for patients as people. However, the focus is still on what patients and others can do for patients, however defined. For clinicians whose interests must be similarly respected for their own sake and because they are integrally related to those of patients, what can and should patients do? Patients can be exempted from some normal social roles but are generally recognized to have moral obligations in health care. One of these obligations is caregiving to clinicians within the limits of each patient's capability. My paper moves this obligation beyond the ceremonial order of etiquette characterizing public statements on how patients should relate to others. It goes beyond a patient-centred ethic that is consumerist in nature, to a person-centred one that recognizes patients typically as moral agents who are dignified by recognizing the obligation to give as well as receive care as sincere benevolence. This obligation derives objective justification from divine command. It is also consistent, however, both with what people, if ignorant of their social role, would objectively produce for a hypothetical social contract, and with virtues constitutive of human nature and a relational and communitarian understanding of what it is to be a person. Including sentiment (intuition) and personal conscience, this relational identity makes caregiving intrinsically meaningful, yet caregiving also has an instrumental value to patients and clinicians. Its self-enforcement by patients will depend on their moral code and on society making caregiving achievable for them. A moral obligation for patient caregiving may then be specified to require patients to reflect on and invest in relationships in which they can feel and show care for others sincerely and respectfully. [ABSTRACT FROM AUTHOR]

We are living in a time when it is frequently assumed that the logic of capital has subsumed every single aspect of our lives, intervening in the organization of our intimate relations as well as the control of our time, including investments in the future (e.g. via debt). The theories that document the incursion of this logic (often through the terms of neoliberalism and/or governmentality) assume that this logic is internalized, works and organizes everything including our subjectivity. These theories performatively reproduce the very conditions they describe, shrinking the domain of values and making it subject to capital's logic. All values are reduced to value. Yet values and value are always dialogic, dependent and co-constituting. In this paper I chart the history by which value eclipses values and how this shrinks our sociological imagination. By outlining the historical processes that institutionalized different organizations of the population through political economy and the social contract, producing ideas of proper personhood premised on propriety, I detail how forms of raced, gendered and classed personhood was formed. The gaps between the proper and improper generate significant contradictions that offer both opportunities to and limits on capitals' lines of flight. It is the lacks, the residues, and the excess that cannot be captured by capital's mechanisms of valuation that will be explored in order to think beyond the logic of capital and show how values will always haunt value. [ABSTRACT FROM AUTHOR]

A challenge has recently been levelled against the legal and/or moral legitimacy of some advance directives. It has been argued that in certain cases an advance directive carries no weight in a decision on whether to withhold treatment, since the individual in the debilitating state is not the same person as the person who created the advance directive. In the first section of this paper, I examine two formulations of the argument against the moral legitimacy of the advance directives under review. The second section reviews, and criticizes, an objection to such arguments. In the penultimate section, possible models supporting the viability of the advance directives are considered. The final section makes good on an obligation incurred by the title of the paper.

One argument that is frequently invoked against the technological enhancement of human functioning is that it is morally suspect, or even wrong, to take an easy shortcut. Some things that usually take effort, endurance or struggle can come easily with the use of an enhancer. This paper analyses the various arguments that circle round the idea that enhancement of human functioning is problematic because of the 'easy shortcut' that it offers. It discusses the concern that quick fixes lead to corrosion of character and the idea that suffering, pain, hard work and effort are essential for real and worthy achievements, and argues that these views are largely mistaken. Next, the paper argues that the core worry about taking an easy shortcut is that it makes us lose sight of the complexities of our means and ends; in other words, the argument warns against reducing the richness of human activities. A vocabulary of 'practices', 'internal goods' and 'focal engagement' will be used to articulate this argument further. The conclusion is that the easy shortcut argument has no general validity as an argument against enhancement 'as such'. The paper urges us, however, to evaluate enhancement technologies not only in terms of their efficiency in reaching certain goals but also in terms of their contribution to intrinsically worthwhile human activities. It can point out some of the caveats, as well as the opportunities, of the use of enhancement technologies.

Many people have moral qualms about embryo research, feeling that embryos must deserve some kind of protection, if not so much as is afforded to persons. This paper will show that these qualms serve to camouflage motives that are really prudential, at the cost of also obscuring the real ethical issues at play in the debate concerning embryo research and therapeutic cloning. This in turn leads to fallacious use of the Actions/Omissions Distinction and ultimately neglects the duties that we have towards future persons.

Consideration of the potentiality of human embryos to develop characteristics of personhood, such as intellect and will, has figured prominently in arguments against abortion and the use of human embryos for research. In particular, such consideration was the basis for the call of the US President's Council on Bioethics for a moratorium on stem cell research on human embryos. In this paper, I critique the concept of potentiality invoked by the Council and offer an alternative account. In contrast to the Council's view that an embryo's potentiality is determined by definition and is not affected by external conditions that may prevent certain possibilities from ever being realized, I propose an empirically grounded account of potentiality that involves an assessment of the physical and decisional conditions that may restrict an embryo's possibilities. In my view, some human embryos lack the potentiality to become a person that other human embryos have. Assuming for the sake of argument that the potential to become a person gives a being special moral status, it follows that some human embryos lack this status. This argument is then used to support Gene Outka's suggestion that it is morally permissible to experiment on 'spare' frozen embryos that are destined to be destroyed.

The traditional approach to the abortion debate revolves around numerous issues, such as whether the foetus is a person, whether the foetus has rights, and more. Don Marquis suggests that this traditional approach leads to a standoff and that the abortion debate 'requires a different strategy.' Hence his 'future of value' strategy, which is summarized as follows: (1) A normal foetus has a future of value. (2) Depriving a normal foetus of a future of value imposes a misfortune on it. (3) Imposing a misfortune on a normal foetus is prima facie wrong. (4) Therefore, depriving a normal foetus of a future of value is prima facie wrong. (5) Killing a normal foetus deprives it of a future value. (6) Therefore, killing a normal foetus is prima facie wrong. In this paper, I argue that Marquis's strategy is not different since it involves the concept of person--a concept deeply rooted in the traditional approach. Specifically, I argue that futures are valuable insofar as they are not only dominated by goods of consciousness, but are experienced by psychologically continuous persons. Moreover, I argue that his strategy is not sound since premise (1) is false. Specifically, I argue that a normal foetus, at least during the first trimester, is not a person. Thus, during that stage of development it is not capable of experiencing its future as a psychologically continuous person and, hence, it does not have a future of value.

When one thinks about the ethics of abortion, one inevitably thinks about rights, since it is in terms of the concept of rights that much of the debate has been conducted. This is true of overtly feminist as well as non-feminist accounts. Indeed, some early feminist writers--Judith Jarvis Thomson and Mary Ann Warren, for example--employ a model of rights that is indistinguishable, or virtually indistinguishable, from that of their non-feminist counterparts. However, more recent feminist writers have developed a different understanding of 'a woman's right to choose.' In this paper, I will begin by outlining the non-feminist debate over the moral permissibility of abortion. I will suggest that this debate is irresolvable, since at its heart is an 'essentially contested concept', that of personhood. I will then consider the way in which some feminist writers have attempted to reconceive the terms of the abortion debate and suggest an expanded account of women's right to abortion, drawing on the work of Susan Sherwin. Finally, I will argue that there is a further element to a 'woman's right to choose' that expands on and provides a conceptual link between feminist and non-feminist understanding of abortion.

The most plausible pro-life argument claims that abortion is seriously wrong because it deprives the foetus of something valuable. This paper examines two recent versions of this argument. Don Marquis's version takes the valuable thing to be a 'future like ours', a future containing valuable experiences and activities. Jim Stone's version takes the valuable thing to be a future containing conscious goods, which it is the foetus's biological nature to make itself have. I give three grounds for rejecting these arguments. First, they lead to unacceptable inequalities in the wrongness of killing. Second, they lead to counterintuitive results in a range of imaginary cases. Third, they ignore the role of psychological connectedness in determining the magnitude or seriousness of deprivation-based harms: because the foetus is only weakly psychologically connected to its own future, it cannot be seriously harmed by being deprived of that future.

Bioethical debates such as those surrounding the manipulation of human embryos are often based on metaphysical assumptions that lack a foundation in the natural sciences. In this paper we support a gradualist position whereby the embryo progressively takes on the form and associated ethical significance of a human being. We support this position by introducing a concept of biological structure or form to show how the gradualist position has its metaphysical foundations in modern biology. The conceptual basis for form and structure are outlined and their compatibility with and basis in current empirical biology is demonstrated by some recent advances in our understanding of the processes of development from single cell to organism. We then briefly explore the ethical significance of accepting a form or structure based conception of biology for the status of the early embryo.

This paper is an exploration of the nature of personhood through the medium of the concept of piot in the Lihir islands, Papua New Guinea. Piot is an embodied experience in response to the movement of others in space. When people leave or arrive at a place and spend the night, others in the area feel unwell. Piot is thus one aspect of the relations between persons. I suggest that ideas of relational personhood are inadequate to fully comprehend piot, and, following LiPuma (1998) and Clay (1986) rather than Strathern (1988), argue that persons in Lihir are more than just relational beings who always act with others in mind. Piot is predicated on the dual themes of fixed sociality and mobility that are important in Lihir as elsewhere in Melanesia (cf Eves 1998; Patterson 2002). Through piot, persons comment on and sanction the movement of others, yet this mobility still occurs. [ABSTRACT FROM AUTHOR]

In this paper I address one site of technological development and cultural production, the permanent or persistent comatose condition and the institutions and practices that enable this life form to exist. As with other medical sites of ambiguity and change under recent scrutiny by anthropologists, the locations in which comatose bodies thrive are those in which the routinization of technology use in the clinic and a legitimating social and economic context come together to permit and create a further remapping of the notions of "life" and "person." I explore the new forms of knowledge, practice, and the body that are created at this site and how they are negotiated, and I discuss how the shifting understanding of "culture" and "nature" both have an impact on and are informed by American quandaries about approaching death. I argue that beings who are neither fully alive, biologically dead, nor "naturally" self-regulating, yet who are sustained by modern medical practice, destabilize the existing social order in ways that are different from other hybrid forms.

Aim. Drawing on research exploring nursing students’ experiences of working with older people, this paper aims to demonstrate how context and culture can impact on the realization of their ideals. Background. The principles underpinning individualized and person-centred approaches to care resonate with those focal to gerontologic nursing. Restrictive contexts of care and pervasive workplace cultures render nurses unable to deliver care in accord with these. Design and method. This interpretive study was informed by phenomenological–hermeneutic theory. A purposive sample ( n = 10) was recruited from a single educational institution. Data were generated in two phases using loosely structured interviews and supplementary activity. Themes explicating their experiences were identified via systematized detailed analysis and issues pertaining to nursing students’ orientation towards older people cut across these. Findings and discussion. Students perceived that older people were prone to depersonalization and marginalization, so sought to show respect by coming to know individuals, form human connections with them and personalize care accordingly. Giving respect, promoting personhood, asserting reciprocal identity and maintaining dignity were prominent features of this but were often frustrated by practices and cultures encountered in mainstream settings. Conclusions. Nursing students’ approaches to older people are contextual and reflect elements of person-centred ideology. Their attempts upholding their ideals are liable to be subverted by workplace norms. Preparatory education should address these, assist students to learn how to attend to personhood in restrictive environments and offer targeted placements in age-specific and non-acute services. Relevance to clinical practice. Demographic trends mean that working with older people has increased significance for nurses in most settings. Person-centredness is seen as beneficial for older people but contemporary service imperatives and enduring practices are inhibitory, preventing entrants to nursing from developing related skills. [ABSTRACT FROM AUTHOR]

Recent developments in aging research have added new urgency to the bioethical debate concerning life and death issues, the value of life, and the reasonable limits of medicine. This paper analyzes the basic structures of the liberal and conservative components of this debate, showing that there has hitherto been inadequate analysis on both sides concerning the nature and implications of the value of life, as well as, and as distinct from the value of life extension. Classic concepts of the intrinsic or extrinsic value of life are argued to be tangential or actually irrelevant to the value of life's continuance and so to the value of life extension. An analysis of personhood is proposed which focuses explicitly upon the value of life extension to persons. This analysis shows that persons may only intelligibly be understood as processes, for whom life extension is an inalienable and fundamental value. It is further proposed that, properly understood, such an analysis may significantly narrow the liberal/conservative divide in bioethics. [ABSTRACT FROM AUTHOR]

Advance directives permit competent adult patients to provide guidance regarding their care in the event that they lose the capacity to make medical decisions. One concern about the use of advance directives is the possibility that, in certain cases in which a patient undergoes massive psychological change, the individual who exists after such change is literally a (numerically) distinct individual from the person who completed the directive. If this is true, there is good reason to question the authority of the directive -- which is supposed to apply to the individual who completed it, not to someone else. This is 'the someone else problem'. After briefly introducing advance directives as a basis for medical decision-making, this paper elaborates 'the someone else problem' in the context of severe dementia. The paper then reconstructs the reasoning that leads to this putative problem and exposes the important underlying assumption that we are essentially persons. An alternative view of what we are, one that regards personhood as inessential, is then considered, before several arguments are advanced in favor of that alternative view. The paper next explores implications for advance directives: 'The someone else problem' is effectively dissolved, while it is noted that a related problem (one beyond the paper's scope) may persist. A few implications beyond advance directives are also identified.

While pain is common among seniors, it is not adequately treated or managed. In particular, pain in seniors with dementia is often undertreated and undermanaged. Although the undertreatment of pain among persons with cognitive impairments represents a serious ethical concern for pain clinicians, most writers in the area explain the undertreatment of pain by focusing on issues related to liability, fears of addiction to opioids, and erroneous beliefs that pain is a normal part of the ageing process. We argue that the philosophical notion of personhood must also be given careful attention when considering the problem of pain undermanagement. In this paper, we consider the undertreatment of pain among seniors with dementia, while focusing on the ontology of relationships and on existential philosophy. Moreover, we outline a series of recommendations to help minimize the probability of pain undertreatment in this population and to encourage considerations relating to personhood when treating people with dementia. [ABSTRACT FROM AUTHOR]

In examining affective motivations and meanings associated with kin‐based tattooing, this article proposes a practice of 's/kinship': the tangible inscription of relational personhood on the body. While research on the practice of Western tattooing has long been drawn into discourses of deviance and individual identity, little attention has been paid to the tattooing of social relations. Drawing on surveys and interview data, this article highlights the significance of kinship and other forms of relationality in tattooing, bringing attention to how these are manifested through the skin as expressions of social proximity, permanence, and porosity. In doing so an analytic approach to s/kinship is developed to foreground the practice of tattooing as an expression of relational personhood, one that highlights the permeability of personhood as a salient ontological feature in the social life of tattoos and the tattooed. [ABSTRACT FROM AUTHOR]

The dominant conception of brain death as the death of the whole brain constitutes an unstable compromise between the view that a person ceases to exist when she irreversibly loses the capacity for consciousness and the view that a human organism dies only when it ceases to function in an integrated way. I argue that no single criterion of death captures the importance we attribute both to the loss of the capacity for consciousness and to the loss of functioning of the organism as a whole. This is because the person or self is one thing and the human organism is another. We require a separate account of death for each. Only if we systematically distinguish between persons and human organisms will we be able to provide plausible accounts both of the conditions of our ceasing to exist and of when it is that we begin to exist. This paper, in short, argues for a form of mind-body dualism and draws out some of its implications for various practical moral problems.

It has been argued that there can be no person-regarding reasons for practising genetic therapy, since it affects identity and causes to exist an individual who would not otherwise have existed. And there can be no such reasons for causing somebody to exist because existing cannot be better for an individual than never existing. In the present paper, both of these claims are denied. It is contended, first, that in practically all significant cases genetic therapy will not affect the identity of beings of our kind. This is so irrespective of whether, essentially, we are beings with minds or beings of a certain biological species, the human one. Second, it is contended that, even if genetic therapy were to affect our identity, there could be person-regarding reasons for conducting it, for existence can be better than non-existence for the individual.

In this paper I want to try to clarify the nature of the two different problems indicated in the title: there is a lively debate on whether or not genetic selection is a morally licit practice, and there are strong disagreements on whether or not the embryo is a person. I think that most of such controversies depend on confusions and/or unclearness about specific problems involved in each issue, I have no precise normative proposal on the morality of genetic selection, but I hope that my analysis will be helpful in avoiding some current confusions.

Some conditions detrimental to human well-being, such as sickle-cell anaemia, cystic fibrosis, muscular dystrophy, Lesch-Nyhan disease and various immunodeficiencies, are genetically determined. One potential means of preventing the development of such conditions is the manipulation of genetic material in the conceptus of an organism which would otherwise develop such conditions. Genetic manipulations could take the form either of excising and substituting genetic material, excising but not substituting genetic material, adding but not excising genetic material or reorganizing existing genetic material. To succeed, manipulation would have to change genetic structure so as to change its informational content. It might be thought, however, that all or some such manipulations would involve causing particular individuals to cease to exist and involve bringing into existence new, distinct individuals. Gene therapy could not, therefore, be a procedure which improved the circumstances of the particular individual to whom it is applied. It might be suggested that once the metaphysics of identity and the facts of gene therapy are understood, certain interesting conclusions concerning the ethics of gene therapy emerge. Some such conclusions have been discussed in this journal by Noam J. Zohar and Jeffrey P. Kahn. More, however, needs to be said about them since neither Zohar nor Kahn draws the correct conclusions. While both have pertinent things to say, neither has given a completely clear account of the metaphysics of gene therapy and so neither has completely traced out the implication of the metaphysics for the ethics of gene therapy. This paper attempts to remedy these defects.

In his paper on the effects of Prenatal Genetic Intervention (PGI) on personal identity, Noam Zohar comes to a conclusion about genetic makeup and the uses of gene therapy quite different from the one I reach in another piece in this issue. Zohar's argument rests on the contention that personal identity changes with alteration of the genome, following what I have identified as the "constitutive" view. To see that this is the pillar supporting the weight of his argument, consider the following. Questions of identity aside, how can it be that altering the genome of children suffering from Lesch-Nyhan syndrome or Tay-Sachs disease so that they now produce the enzyme that they formerly lacked does not benefit them? Clearly, if their identities were not changed, such individuals would in fact realize great benefit from PGI, since the devastating bad effects of the genetic flaw would be avoided. Such a change would certainly make the altered individuals better off, that is, it would benefit them. On this, Zohar and I do not disagree. Persistence of identity through such genetic change is the sticking point.

Mapping the human genome is an immense project with numerous objectives. Indeed, it is likely that some of its most important ramifications and applications remain as yet unglimpsed. All we can presently attempt is to focus on some of the more obvious possibilities and prepare for the problems already looming on our horizon. One such possibility is that of Prenatal Genetic Intervention (PGI), which might be said to be a therapeutic intervention on behalf of the embryonic child. In this paper, I argue that "genetic therapy" is likely to be a misnomer, and that if PGI becomes possible, we should generally resist its inclusion under the special moral duty of providing health care. "Therapy" necessarily means helping a person, while PGI -- though effecting improvements from an impersonal perspective -- will frequently not consist in directly helping any person. This is due not to the embryo not being a person, but rather to the basic philosophical problem of personal identity persisting through significant alterations -- especially the alteration of genotype. The decisive moral question then hinges on the definition of "significant" alteration. I shall examine the feasibility of drawing analogies from criteria for personal identity proposed in discussions of how persons maintain their identity across time and through physical and psychological change. Certain metaphysical aspects of human identity and individuality will be also touched upon, partly in terms derived from classical Judaism. In conclusion I argue that, regarding embryos in particular, persistence of genotype must generally be deemed a necessary condition for maintaining personal identity. Therefore, many proposals for PGI should be excluded from the notion of therapeutic intervention and thus denied the special moral status of requests for therapy.