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Death & Dying

Review of "Suffering, Death, and Identity"

By Fisher, Robert, N., Daniel T. Primozic, Peter A. Day and Joel A. Thompson (Eds.)
Rodopi, 2002
Review by Stan van Hooft, Ph.D. on Apr 7th 2003
Suffering, Death, and Identity

This book results from a recent international conference on Persons and, like many such collections, suffers from a lack of thematic unity. Nevertheless, the mostly short contributions are of a high quality and several will be of considerable interest to philosophers working in the field of bioethics. Being a volume in a series called ‘Personalist Studies’, one might have hoped for a definition of ‘personalism’ in order to provide a context for the various discussions. Without such a definition, the reader is left to surmise from the content of the essays that personalism is at home in a Christian theological tradition and in a broadly constructivist and historicist theoretical framework. It would appear that persons are understood in terms of a personal identity that is formed within the narrative of a life and within the constructive context of interpersonal and community relationships and within the benevolent regard of God. However, this latter regard is not theorised by way of the postulation of a soul in the manner the natural law tradition. Rather, God is understood as the ‘Absolute Other’ in relation with which one’s personhood is realised. Essentialism in relation to persons is rejected and, by implication in a fascinating essay by Chris Belshaw, any essentialist definition of death. Moreover, one essay challenges the strategy of many philosophers to define personhood by way of a set of criteria that focus on the possibility of self-consciousness and autonomy.

In his introduction to the collection, Robert Fisher sees suffering as an inevitable contributor to our personal identity and, in a later essay, he asks how we may ‘redeem’ suffering: that is, see it is part of a narrative that gives it a place in our lives. The problem with any theodicy is that it objectifies suffering and considers it from a detached viewpoint. Rather, we should become involved in the suffering of those we love. Continuing this theme, Mike Awalt argues that disaster, which disrupts the order of a life, requires us to write about it so as to inscribe the self within a narrative. David Pailin, in a more theological essay, argues for the worth of severely disabled humans, while Charles Conti’s stylistically complex essay uses Lacan to argue that one’s sense of self is formed during the ‘mirror stage’ of infant development. Patricia Sayre and Linnea Vacca use the stories of Luigi Pirandello to argue that the kind of distancing in relation to life and others that narrative control can give has its dangers: that of impersonalising others and manipulating them. Eric O. Springsted contributes an essay on how St Augustine’s notion of the will defines our moral identity and is relevant to the problem of evil.

In what is probably the least satisfactory essay in the collection, Tony Dancer argues that pastoral care has lost its way by adopting the anthropology of the enlightenment and thus using psychoanalysis and a variety of humanistic forms of therapy. What it should do is recover the distinctly Christian conception of humanity and seek to inculcate that. Unfortunately, instead of sufficient detail to give substance to this claim we are given mere theological rhetoric. More sensitive to the role of religion in a secular society is Margaret Morris’s argument that the Christian church has not come to grips adequately with the AIDS epidemic because it has not overcome the psychodynamic forces within it which lead to fear and rejection of such diseases and their victims.

At this point the book turns to a set of bioethical issues. The category of personhood is central to Matthew Bonzo’s essay in which he criticises philosophers such as Dan Brock for having argued that there is less of an obligation to help people with severe dementia because they are not fully persons. Like people in a permanent vegetative state, they have no sense of their identity though, unlike the former, they do have the power to act to a limited degree. Bonzo critiques this making of decisions in medical ethics on the basis of a classification of personhood that excludes some from the privileges of that classification. He argues that we all have obligations to others in that we are enmeshed with them. The difficulty is that we often have to make decisions in the context of limited resources. Who should be helped when one of the needy ones has severe dementia? Bonzo argues that there is no decision procedure or theory which would overcome the need to make the tragic decisions that have to be made. The obligations we have to others, whatever their abilities or sense of identity, have to be negotiated in an ‘open discussion’ rather than in the closed terms of essentialism and bioethical theory. However, it seems to me that this is unsatisfactory if no rules are given for how this open discussion should take place. Is it just a matter of the various families fighting over the available resources, motivated by their obligations to their loved ones? Or must they be able to stand back, adopt an impartial stance and discuss the issue in the light of the requirements of justice? And if the latter, won’t there be a need for objective criteria of the kind that Brock as enunciated?

A further attack on mainstream bioethical positions comes from Gavin J. Fairbairn who argues against those theories of persons that posit a range of criteria for personhood (such as self-consciousness, autonomy, etc) by calling them arbitrary. Given that he admits that such views are developed on the basis of seeing what features are present in paradigm cases, what is his basis for calling this mode of argument arbitrary? Seeing as I plan to counter his argument I had better quote it in full. Fairbairn says ‘No reason exists at all to say that displaying one or more of the set of characteristics that we value in human persons is what makes a person, a person. This would be like saying that because we value green apples for their greenness, crunchiness, and bitter sweetness, what makes them green apples is their greenness, bitter sweetness, and crunchiness.’ And he goes on to say that this is absurd because ‘anything else which shared one or more of these characteristics would by such a line of reasoning be a green apple.’ (131) But this mistakes the practical form of the bioethical position. Mainstream bioethicists offer arguments in practical ethics rather than arguments just about how things should be classified. It is not simply that persons are classified as such on the basis of a set of criteria. Leaving aside the adequacy of such criteria, it is important to see that the form of such arguments is driven by the need to understand what we should give value to and what we should do in relation to such things. That we classify persons as persons because they fulfil the relevant set of criteria has immediate practical applications. We already have the moral norm that persons are to be valued. The question is that of deciding which entities that norm applies to. This question is answered by saying that it applies to all and only those entities that fulfil those criteria. And a consequence of this argument is not only the familiar one that if a human organism could not fulfil those criteria then it need not be given the respect due to persons, but also that if non-human entities were found that did fulfil these criteria (for example if great apes were found to display them) then we would have to accord them the same kind of respect we give to human persons. It follows from this that, unlike ‘green apples’, ‘person’ is not a purely classificatory concept. It is an ethical concept. It is not applied just on the basis of classificatory criteria. It is applied as part of an ethical decision to treat that to which it is applied in accordance with a relevant moral norm. If the concept of ‘green apples’ were a moral concept in this way then it would not be absurd to say that because a given entity was green, crunchy, and bitter sweet it was a green apple. Saying that would not simply mean that this entity belonged to a certain category, but rather that we should treat this entity with the same respect as that which we give to green apples.

The essay by Chris Belshaw which I mentioned above reviews the circumstances under which a definition of death is said to be important for making ethical decisions, like removing organs for transplantation, but argues that once we have given a description of the situation (‘the patient is still breathing, but has no possibility of consciousness’ for example) we have all the facts we need to make a moral decision. There is no further fact called ‘X is dead’ that will settle the moral issue. Offering definitions and describing necessary and sufficient conditions for death is useless. There will be clear and obvious cases, of course, but borderline cases such a people in a permanent vegetative state are not solved by having a definition of death. Moral decisions have to be taken on the basis of what is evident before us rather than in terms of an essentialist definition of death.

For his part, John Lizza does not heed Belshaw’s advice and after a very thorough review and critique of the relevant literature says: “Death can be defined as a change in kind of living entity marked by the loss of some essential property. The criteria for the death of a person or human being will therefore be determined by the loss of whatever properties are deemed essential to the nature of persons or human beings.” (164) He goes on to argue that what are deemed to be the essential properties of persons is culture relative, but, in the west, the consensus is that ‘some cognitive function is an essential condition for being a person’ (165). Accordingly, the loss of such functions – which arises from the death of the cortex – is the death of the person.

Anne Eyre provides a change of pace in an essay which describes death rituals and beliefs amongst ethnic Chinese in contemporary Malasia and Andrew Dawson draws the volume to a close with an essay on what it is to be a person which draws on the literature of Liberation Theology.

While not every essay in this volume will be of interest to everyone, especially to those who are not theologically inclined, there are many insights to be gained from perusing the book. In particular, bioethicists should note the essays by Belshaw and Lizza.

 

© 2003 Stan van Hooft

 

Link: Publisher's web page for book

 

Stan van Hooft teaches philosophy at Deakin University in Australia. His 1995 book: Caring: An Essay in the Philosophy of Ethics has just been remaindered by the University Press of Colorado. He is currently working on a book to be entitled, Life, Death and Subjectivity.

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