Theoretical Medicine and Bioethics

, Volume 34, Issue 6, pp 479–498 | Cite as

Saving a life but losing the patient

Article

Abstract

Gregor Samsa awakes to find himself transformed into a gigantic bug. The creature’s inchoate flailing leads Gregor’s sister to conclude that Gregor is no more, having been replaced by a brute beast lacking any vestige of human understanding. Sadly, real cases of brain injury and disease can lead to psychological metamorphoses so profound that we cannot easily think that the survivor is the person we knew. I argue that there can be cases in which statements like, “It’s just not Gregor anymore,” are not merely figures of speech. With this in mind, I consider three possible results of saving a biological life: (1) ordinary cases where saving the life will save the person, with strong duties to save the life; (2) cases where the intervention needed to save the life will replace the person, with strong duties not to save the life; (3) cases in which it is indeterminate whether the person will be saved or replaced. How should we think about indeterminate cases? Impersonal ethical considerations miss the point, while standard person-affecting considerations are inapplicable. I suggest turning attention away from survival towards a richer focus on what I call “personal concern.” I show how considerations of personal concern, unlike those of self-interest, need not be tied to survival and how this allows personal concern to provide a basis for ethically substantive discussion of cases where saving a life might result in losing the patient.

Keywords

Identity Survival Replacement Indeterminacy Life-saving Brain injury Persons Personal concern Metamorphosis 

Notes

Acknowledgments

My thanks to Galen Giaccone, Jessica Best, Melissa Koenig, Brittany Boyle, David Fuhrman, and to two anonymous reviewers of this journal for their careful reading and insightful commentary on versions of this paper. For rich discussion of presentations of the ideas in this paper, I am indebted to Philosophy Department students and faculty of the University of South Carolina, to participants in the American Society for Bioethics and Humanities Philosophy Interest Group, and to my colleagues at the University of Delaware Center for Science Ethics and Public Policy’s Research Group. This research was supported by the Center for Science Ethics and Public Policy and the National Science Foundation EPSCoR program, grant EPS-0814251.

References

  1. 1.
    Kafka, Franz. 1996. The metamorphosis. Trans. Stanley Corngold. New York, NY: W. W. Norton & Company.Google Scholar
  2. 2.
    Muenchberger, Heidi, Elizabeth Kendall, and Ronita Neal. 2008. Identity transition following traumatic brain injury: a dynamic process of contraction, expansion and tentative balance. Brain Injury 22(12): 979–992.CrossRefGoogle Scholar
  3. 3.
    Greene, Mark. 2008. The indeterminacy of loss. Ethics 118(4): 633–658.CrossRefGoogle Scholar
  4. 4.
    Payne, Ian. 2001. Another Händel borrowing from Telemann? Capital gains. The Musical Times 142(1874): 33–42.CrossRefGoogle Scholar
  5. 5.
    Tooley, Michael. 1972. Abortion and infanticide. Philosophy and Public Affairs 2(1): 37–65.Google Scholar
  6. 6.
    Fleminger, S. 2008. Long-term psychiatric disorders after traumatic brain injury. European Journal of Anaesthesiology 25(42 suppl.): 123–130.CrossRefGoogle Scholar
  7. 7.
    Northoff, Georg. 1996. Do brain tissue transplants alter personal identity? Inadequacies of some “standard” arguments. Journal of Medical Ethics 22(3): 174–180.CrossRefGoogle Scholar
  8. 8.
    Mathews, D.J.H., J. Sugarman, H. Bok, et al. 2008. Cell-based interventions for neurologic conditions—ethical challenges for early human trials. Neurology 71(4): 288–293.CrossRefGoogle Scholar
  9. 9.
    Hayes, Jeanne, Craig Boylstein, and Mary K. Zimmerman. 2009. Living and loving with dementia: negotiating spousal and caregiver identity through narrative. Journal of Aging Studies 23(1): 48–59.CrossRefGoogle Scholar
  10. 10.
    Hinton, W.Ladson, and Sue Levkoff. 1999. Constructing Alzheimer’s: narratives of lost identities, confusion and loneliness in old age. Culture, Medicine and Psychiatry 23(4): 453–475.CrossRefGoogle Scholar
  11. 11.
    Orona, Celia J. 1990. Temporality and identity loss due to Alzheimer’s disease. Social Science and Medicine 30(11): 1247–1256.CrossRefGoogle Scholar
  12. 12.
    Parfit, Derek. 1984. Reasons and persons. Oxford, UK: Clarendon Press.Google Scholar
  13. 13.
    Parfit, Derek. 1971. Personal identity. Philosophical Review 80: 3–27.CrossRefGoogle Scholar
  14. 14.
    McMahan, Jeff. 2003. The ethics of killing: problems at the margins of life. New York, NY: Oxford University Press.Google Scholar
  15. 15.
    Bourget, David, and David Chalmers. 2009. The PhilPapers surveys: preliminary survey results. http://philpapers.org/surveys/results.pl?affil=Target+faculty&areas0=0&areas_max=1&grain=medium. Accessed April 29, 2013.
  16. 16.
    Parfit, Derek. 2009. My philosophical views: PhilPapers surveys public responses. http://philpapers.org/profile/10297/myview.html. Accessed October 20, 2013.
  17. 17.
    Perry, John. 1976. The importance of being identical. In The identities of persons, ed. Amélie Oksenberg Rorty, 67–90. Berkeley, CA: University of California Press.Google Scholar
  18. 18.
    Whiting, Jennifer. 1986. Friends and future selves. Philosophical Review 95(4): 547–580.CrossRefGoogle Scholar
  19. 19.
    Loftus, E.F., and J.E. Pickrell. 1995. The formation of false memories. Psychiatric Annals 25(12): 720–725.Google Scholar
  20. 20.
    Frontczak-Baniewicz, M., S.J. Chrapusta, and D. Sulejczak. 2011. Long-term consequences of surgical brain injury—characteristics of the neurovascular unit and formation and demise of the glial scar in a rat model. Folia Neuropathologica 49(3): 204–218.Google Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2013

Authors and Affiliations

  1. 1.Department of PhilosophyUniversity of DelawareNewarkUSA

Personalised recommendations