Minimal intelligence
Self-awareness
Self-control
A sense of time
A sense of futurity
A sense of the past
The capability to relate to others
Concern for others
Communication
Control of existence
Curiosity
Change and changeability
Balance of rationality and feeling
Idiosyncrasy
Neo-cortical function
The Potential Person
It is sometimes argued that although an embryo may not be a person, it is a potential person. Therefore, it should be given rights and the status of a person (although it is not a moral agent in the sense of being capable of making moral choices or being morally responsible). However the objection is often raised that the problem with claiming that an embryo is a potential person – and then giving it the status of a person with the fundamental right to life – is that there may be something premature in making such a claim. We would not normally give full status and responsibility of a qualified nurse to a student nurse, although we might say that a student nurse is a potential nurse. Joel Feinberg (1984 pp. 147–148) puts it very well with the following analogy: “In 1930, when he was six years old, Jimmy Carter didn’t know it, but he was a potential president of the United States. That gave him no claim then, not even a very weak claim, to give commands to the U.S. Army and Navy.” Therefore, it may not be enough to be a potential person to have the status and rights of a person, the individual needs to be an actual person.
Burgess (2010 p. 141) points to three types of potentiality. Firstly, there is ‘passive receptivity’.
If it is accepted that an embryo has an active potential to become a person, then this potentiality is not something extrinsic but rather intrinsic to it. This would mean that stating that an embryo is a potential person is not the same as claiming that it is a potential nurse because the nursing is something that is extrinsic to the individual and does not define his/her very nature; the same could be said of any potential president.
A further step can be taken by arguing that an embryo is a person with potential. As Joyce (1988 p. 199) contends, “… every living individual being with the natural potential, as a whole, for knowing, willing, desiring, and relating to others in a self-reflective way is a person. But the human zygote is a living individual (or more than one such individual) with the natural potential, as a whole, to act in these ways. Therefore the human zygote is an actual person with great potential.”
Applying the Concept of Person to Nursing Practice (Including Case Study)
Although the concept of person may, for some, be very useful in debates about beginning and end of life issues, it might pose some difficulties for other nursing situations. Let us now consider a case below using the concept of person.
The Case of John
John O’Brien is an 81 year old man. After suffering a major stroke, he was admitted as an inpatient and has remained in hospital ever since. He has two sons and a daughter but they have not agreed on what will happen to him in the long-term. John is now suffering from severe cognitive decline, memory loss, and is very confused. He often talks about his wife as if she was still alive although she passed away two years previously. Sometimes he wants to go to work at a factory which he retired from many years ago. Every day, there is more and more evidence of his cognitive deterioration. He can’t seem to remember which day of the week it is. One day, he was found staring at his own reflection in a mirror – it seemed that he didn’t recognise the man looking back at him. Some days, John doesn’t seem to recognise his own daughter, other days he does. The daughter says he is no longer the same. John is usually put to bed at about 9pm but does not want to go, he would rather go for a walk. When he attempts to get out of bed, he is gently put back in. Because he is trying to get out of bed the decision was taken to put him into a bed with bed rails. Now that John is getting more and more confused, his carers do not want him to go alone for walks even during the day. This has led to situations where John is in a chair for long periods of a time. A tray is kept in front of him and prevents him from getting out. For no apparent reason, one day John started to lash out at the nursing staff both verbally and physically. Now staff have resorted to using sedation which has had the side effect of more confusion, agitation, drowsiness and drooling.
Analysing the Case of John
The above scenario paints a broad picture of what can happen to those whose cognitive abilities and general competencies gradually deteriorate. Before looking at the case from the perspective of the concept of person, consider the following questions: What is wrong with John wanting to go for a walk at night, or wanting to get out of his bed or his chair? Is the reaction of the staff to John’s behaviour perfectly reasonable or are they employing unreasonable institutional routines to deal with people whose cognitive capacities have deteriorated? Are the actions of the staff impinging on John’s autonomy? However, is John autonomous anymore? Or more fundamentally is John a person anymore? As we have seen there is no really uniformed view of what makes an entity a person. However, if we accept the broad common denominators of self-consciousness, rationality and moral agency as the defining features of a person, this leads to an important question as to whether John is either beginning to lose his personhood or whether John is in fact no longer a person.
We saw that the philosopher Locke emphasised self-consciousness, thinking and reflection as defining features of a person. John’s sense of himself and his ability to think is gradually deteriorating. Would we still consider John to be a fully thinking intelligent being? Does John continue to show reason and reflection? Can John really make rational decisions that are based on comprehension and understanding? Perhaps John can make some rational decisions (e.g. whether to go out for a walk), but have his cognitive abilities been compromised to such an extent that we would be still happy to claim that he is a rational, thinking being?
Is John the same person that he was 10 years ago? His daughter does not seem to think so. Does John still consider himself as a self? His own sense of his life’s narrative in terms of a past, present and future is certainly compromised. Following Singer’s work, can we consider John to be a being with awareness of his own existence over time, and having the capacity to have wants and plans for the future? Although John might seem to indicate a preference to go for a walk at night, it is difficult to ascertain if this is his actual wish. John does not seem to have the capacity any longer to have wants and plans for the future. On this issue, Singer (1994 p. 197) contends that, “only a person can want to go on living, or have plans for the future, because only a person can even understand the possibility of a future existence for herself and himself.” It is difficult to envisage John having any future plans and it is unclear whether he can consider the possibility of a future existence for himself.
We saw that Kant emphasised an agency that is rational, autonomous and has the ability to act on moral principles. Can John discern moral principles and act on them in the Kantian sense? Can John take moral decisions and perform actions that display intentionality and consent? Would we hold John morally responsible for lashing out at the nursing staff? Probably not. On the other hand, while the lashing out can be explained as a product of John’s cognitive impairment, it may not be. Even if John is evidencing cognitive impairment here, to the degree that he cannot be held responsible of this lashing out, it may not mean he is therefore generally incapable of moral thought, action, or decision making.
Overall, is John’s level of self-consciousness, capacity for rationality and moral agency enough for him to be considered a person? Or is John a lesser person now because of his condition? Although John may (soon) no longer be a person in the strict sense of the word, to use Engelhardt’s term, some may want to include him in the social sense of person. In this case, it may be claimed that John has no moral duties but he has moral rights. Some may want to claim that John has welfare rights. He will still have a right to be cared for, he needs to be looked after in terms of subsistence, nutrition and hygiene.
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