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Peter H. Schwartz
To cite this article: Peter H. Schwartz (2024) Defining and Defending Personhood:
Lessons from the Disease Debate, The American Journal of Bioethics, 24:1, 41-43, DOI:
10.1080/15265161.2023.2278581
Blumenthal-Barby (2024) presents strong arguments proper definition for decades (Boorse 2011). In this
that bioethicists should stop using the concept discussion, “disease” is generally taken as synonymous
“personhood.” She points out that “person,” meaning with “pathology,” or any deviation from health, so a
an entity with full moral rights, is defined in vague broken bone counts as “disease.” The concept is hard
and problematic ways. Definitions have counterintui- to define: Diseases are not just bodily conditions that
tive and at times offensive implications and sound people don’t like: I may not like my ugly nose or my
unacceptable to non-philosophers. In addition, she short stature, but those are not diseases. Societal opin-
says, determining whether an entity is a person does ion or medical practice does not settle the issue, since
not settle how to treat it. attitudes about desirability and acceptability infect
Philosophers have presented similar arguments judgments about which conditions are diseases.
against “disease:” the concept is vague and poorly Philosophers have presented many sets of necessary
defined, and determining whether a condition is and sufficient conditions for “disease,” utilizing facts
pathological does not settle whether healthcare pro- about harm, biological function, and other factors, but
viders should treat it (Boorse 2016; Hesslow 1993). In each definition faces at least some serious counterex-
response, I and others have offered more precise defi- amples (Boorse 2011). Participants emphasize the
nitions of disease and have argued for continuing to problems with their opponents’ views and downplay
use the concept for specific purposes (Daniels 2008; the problems with their own, and the battle goes on.
Schwartz 2014, 2016). This stalemate reflects the fact that the philosophers
My response relies on framing the philosophical are offering strict criteria for a concept that, as used
project not as a search for the meaning of the term by scientists and the lay public currently, fits the
(the traditional project of “conceptual analysis”) but Wittgensteinian picture of family resemblance, or the
instead as a pragmatic attempt to define a concept cognitive science model of prototype and similarity
that can do certain sorts of work while avoiding (Ramsey 1992): there are “central cases” (think of
important problems. This approach, recommended by pneumonia or advanced cancer) and then various
Quine (1960) and others, can frame the discussion of dimensions of similarity (abnormality, suffering,
personhood as well. Using this framework, I respond potential mortality). This disconnect means that any
to some of Blumenthal-Barby’s concerns and describe set of necessary and sufficient conditions will fail to
appropriate uses of the concept. As Bill Clinton said perfectly match the extension of the previously poorly
in a different context: “Mend it, don’t end it.” (He defined term. This problem faces conceptual analyses
was talking about affirmative action, a topic for a dif- throughout analytic philosophy, for concepts ranging
ferent time.) from “knowledge” to “fairness.”
Quine (1960) recommends that philosophers
should drop the claim that their proposed definition
DEFINING AND USING A CONCEPT OF DISEASE
captures the meaning of the term being analyzed.
The concept of disease is central to the philosophy of When philosophers offer a definition, he recommends,
medicine, and analytic philosophers have debated the they should see themselves as proposing a new
CONTACT Peter H. Schwartz phschwar@iu.edu Indiana University Center for Bioethics, Indianapolis, IN, USA.
ß 2024 Taylor & Francis Group, LLC
42 OPEN PEER COMMENTARIES
concept to replace the old one. The project begins, he such actions can be ethically taken on permanently
says, when a concept that plays some important role comatose humans even though they are considered
is “somehow troublesome”: “ … it is vague in ways living persons (Singer 1995), but that approach raises
that bother us,” he writes, “or it puts kinks in a theory its own problems.
or encourages one or another confusion” (Quine Proposed definitions for “personhood,” then, should
1960, 260). In response, theorists propose a new def- be evaluated by whether they can play this role and
inition for the term that allows it to play a key role avoid problems. The definitions that Blumenthal-Barby
while avoiding the problems. describes—e.g. Warren’s, Fletcher’s, and Tooley’s—
Looking at the disease debate in this way, as a each have significant vagueness and misclassify cases.
“philosophical explication” as I’ll call it, begins by iden- Seeing the definitions as proposed philosophical expli-
tifying the key role, which in this case is to identify con- cations helps explain the problem: any well-defined
ditions that should receive priority in public health and concept that could replace inchoate notions of
healthcare. Hesslow (1993) questions whether “disease” “personhood” will have some counter-intuitive conse-
should play this role. The reason why heart attacks are quences. Vagueness may be inevitable, given the reli-
a focus of public health and healthcare, he argues, has ance on concepts such as communication or self-
nothing to do with their disease status: What matters is awareness, and still be useful: a definition may focus
that this condition kills and hurts people, and preven- attention on specific characteristics of entities without
tion and treatment can greatly improve people’s lives. offering a simple calculus for determining personhood.
No one knows whether and when they will have a heart Blumenthal-Barby highlights problems posed by
attack, so pooling risk through health insurance makes entities such as “human-brain organoids, artificial
sense. Describing the history of pain control during intelligence, uploaded minds, [and] human animal
birth and of contraception, Boorse (2016) argues that chimeras … ” (7). For instance, a definition may coun-
medicine has never limited itself to treating diseases. terintuitively classify such entities as persons, but
Thus, according to Hesslow and Boorse, directing these implications may not disqualify a definition.
medicine based on which conditions are “diseases” is Even if it is difficult to accept at first, perhaps
misguided: other factors are more important. The simi- uploaded minds or some form of AI in the future
larity to Blumenthal-Barby’s concerns about the use of should be recognized as persons. Considering whether
personhood in bioethics should be clear. to reject a proposed definition due to a counterintui-
In the disease debate, I and others have responded tive implication, vs. changing our views, can be part
that although it is ethically acceptable for doctors to of a healthy discussion, a pursuit of a sort of Rawlsian
treat many healthy conditions, for all sorts of good reflective equilibrium.
reasons, the core activities of medicine and public An important concern about the proposed defini-
health are still oriented around disease—preventing, tions is that they fail to classify cognitively impaired
treating, and ameliorating its effects—meaning that human beings as persons. A requirement of a high
the concept of “disease” is essential (Schwartz 2014, level of cognitive ability is unacceptable due to its
2016). Daniels (2008) has provided a broader justice- implication that many individuals with reduced cogni-
based account of why public health and medicine tion are not persons. But even definitions requiring
should focus on disease, rather than other undesirable lower levels of cognitive ability may rule some
conditions. humans non-persons, and this is deeply problematic.
A possible response: Cognitively impaired humans
may be classified as persons by alternative criteria,
DEFINING AND USING A CONCEPT OF based on factors such as familial relationship and spe-
PERSONHOOD cies membership. That may still be problematic since
Using the framework of philosophical explication their personhood rests on a different basis than
helps clarify and address some of Blumenthal-Barby’s others, but it may be an unavoidable and potentially
concerns. The key role of “personhood” is presumably acceptable consequence of clarifying the concept.
answering questions about ethical and unethical Blumenthal-Barby argues that drawing a line
behavior, including which human beings can be ethic- between persons and non-persons can blind us to the
ally killed by removing their organs for transplant (i.e. many dimensions and infinite degrees of mental life
those who satisfy whole-brain-death criteria) or be and moral status that non-persons may have, includ-
allowed to die by withholding standard health care ing characteristics that have been described recently
(e.g. anencephalic infants). Singer has argued that by DeGrazia, Shepherd, and others (Blumenthal-Barby
THE AMERICAN JOURNAL OF BIOETHICS 43
Ethics is frequently concerned with how to resolve understanding how (1) competing claims between a
clashes between competing claims from claimants of woman and her fetus, and (2) competing claims
different kinds. The idea of moral status is crucial to between human beings and nonhuman animals, can
CONTACT Hon-Lam Li honlamli@hotmail.com Department of Medical Humanities, School of Humanities, Southeast University, Jiangning District,
Nanjing, Jiangsu, 211189, China.
ß 2023 Taylor & Francis Group, LLC