Saving a life but losing the patient
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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 The creature’s inchoate flailing leads Gregor’s sister to conclude that Gregor is no more, having been replaced by a brute beast lacking any vestige of human understanding.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.
KeywordsIdentity Survival Replacement Indeterminacy Life-saving Brain injury Persons Personal concern Metamorphosis
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.
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