Personhood and care in disorders of consciousness. An ontological, patient-centred perspective

Abstract

People in unresponsive wakefulness syndrome/vegetative state or minimally conscious state are characterized by the alteration – or the complete loss – of self-awareness and consciousness of the external environment. According to the functionalist and brain-centred approach, this kind of clinical situations also implies the loss of the moral status of person. This paper critically discusses this perspective and proposes an alternative paradigm of personhood concerning the disorders of consciousness (DOC). After a preliminary analysis, I will compare the function-based approach with the pragmatic perspective, arguing that the latter seems to deal better with the evaluation of the status of personhood in patients with disorders of consciousness, and specifically criticising the functionalist view from both the theoretical and ethical levels. Nevertheless, I will claim that the pragmatic view only works as a provisional approach, falling back into the functionalist perspective once the uncertainty of the clinical diagnosis is resolved or decreased. I will thus propose an ontological personalist approach that avoids the radical separation of the concepts of person and human being, considering personhood as an intrinsic condition of human existence, instead of an emerging property from certain contingent faculties or decisions made by a community of moral subjects. In this sense, the patient with DOC is understood as a human being with some damaged features (rationality, consciousness, self, etc.) but still a person worthy of care and attention precisely because of her/his human nature in a fragile and non-autonomous condition. Moreover, I will argue that such an ontological personalism could guide healthcare professionals towards a proactive attitude for the wellbeing of these patients.