Department of Psychiatry, University of Oxford, Oxford, UK
Wellcome Centre for Ethics and Humanities, Oxford, UK.
J Med Ethics. 2023 Oct;49(10):699-706. doi: 10.1136/medethics-2021-107381. Epub 2021 Sep 11.
A prominent view on personal identity over time, Jeff McMahan's 'Embodied Mind Account' (2002) holds that we cease to exist only once our brains can no longer sustain the basic capacity to uphold consciousness. One of the many implications of this view on identity persistence is that we continue to exist throughout even the most severe cases of dementia, until our consciousness irreversibly shuts down. In this paper, I argue that, while the most convincing of prominent accounts of personal identity over time, McMahan's account faces serious challenges in explanatory power of dementias and related neurodegenerative conditions. Particularly, this becomes visible in the face of emerging methods for neural tissue regeneration, and the possibility of 're-emerging patients'. I argue that medical professionals' neglecting qualitative aspects of identity risks resulting in grave misunderstandings in decision-making processes, and ethically objectionable outcomes in future practices. Finally, I propose revisions which could potentially salvage the great benefits that Embodied Mind Theory still can bring to the field of dementia care in terms of understanding life, death, and identity across the lifespan.
一种关于时间中个人身份的突出观点,杰弗里·麦克马汉的“具身心灵账户”(2002 年)认为,只有当我们的大脑无法再维持维持意识的基本能力时,我们才会停止存在。这种关于身份持久性的观点有许多含义,其中之一是,即使在最严重的痴呆症病例中,我们也会继续存在,直到我们的意识不可逆转地关闭。在本文中,我认为,尽管麦克马汉的观点是最令人信服的关于时间中个人身份的观点之一,但它在解释痴呆症和相关神经退行性疾病方面的能力面临着严重的挑战。特别是,在新兴的神经组织再生方法和“重新出现的患者”的可能性面前,这一点变得尤为明显。我认为,医疗专业人员忽视身份的定性方面,可能会导致决策过程中严重误解,并在未来的实践中产生道德上不可接受的结果。最后,我提出了一些可能的修订意见,这些意见可能会挽救具身心灵理论在理解整个生命周期中的生命、死亡和身份方面为痴呆症护理领域带来的巨大好处。