Is Koko a person?

I am a person. I am human. Am I both?

No one would have raised this question when times were simple, when medicine involved a doctor, a stethoscope, a thermometer, or perhaps even an x-ray machine. But we live in a complex world. Medical technology takes four-color photographs of the developing fetus. It tells us that we all began our lives as single-celled organisms the size of a pencil dot. And each dot is a human being. That is, each of us, just after conception, was human, and each of us at that beginning stage was a living being.

But can we apply to that dot the term person? If “person” is defined as the equivalent of “human,” then, of course, the answer is easy. But if by “person” we mean an individual who possesses self-consciousness, for example, then the newly conceived life does not qualify to be called a person.

New questions

The dilemma of human/person definition raises difficult questions. Given the elemental nature of a conceptus, is the use of a morning-after pill ethical? Is an IUD morally permissible, since it strips the days-old blastocyst from the uterine wall? Is RU-486 a blessing or a great evil, since it is most often used to thwart pregnancies after five or six weeks of gestation?

Consider an elderly patient with a terminal illness who lapses into a semi-comatose state. Whether this condition is viewed by society, the patient, and the family as a significant aspect of living or as a meaningless part of dying depends a great deal on where the patient is seen along the human-to-person continuum. And increasingly, patients who lie dying in medical centers are incompetent, and others must make the crucial decisions. Today, fully three-quarters of deaths occur because of a conscious decision made by caregivers that the therapies being used to sustain the patient should be discontinued. Whether the patient’s life is viewed as merely human existence or as meaningful personal living is crucial to the decision.

Modern knowledge compels us to explore the enigmatic moral status of human—and yes, animal—lives. I argue that the possession of self-consciousness is a necessary and sufficient condition to be a person of full moral status. I see the term person as denoting an individual who possesses self-consciousness and is thus entitled to maximal moral standing. There are certain individuals, e.g., normal newborns, who should be and are considered persons because they show significant development toward realizing their potential for self-consciousness.

The dilemma of marginal human life

My concern is not the ethical status of readers of this article—a maximal status that we do and should take as a given. Rather, my interest is in grappling with the moral standing of “marginal” human life. Here I have in mind the Karen Ann Quinlans, the Baby Michelles, the Nancy Cruzans—and even the Kokos—of society.

Colliding moral galaxies

The all-physical-humans-are-sacred and the only-persons-are-maximally-valuable groups are colliding moral galaxies. The benefit of the “physicalist” approach is tradition and clarity. Civilized society has long seen human life as possessing a categorically privileged moral status. The benefit of the “personalist” view is that its rational view of valuable beings fits more easily with the complexity of modern knowledge and life. Neither approach can be “proved.” Thoughtful individuals will not easily label either position as either “right” or “wrong.” Each position is held for deep-seated social, philosophical, or indeed, religious reasons. Ronald Dworkin is correct, in his recent book, Life’s Dominion: An Argument About Abortion, Euthanasia, and Individual Freedom,1 to contend that abortion and such issues as we are discussing here are “essentially religious.” I have deepest respect for those in the physicalist camp, but for my own philosophical and religious reasons, I argue for the adequacy of the personalist approach.

I contend that human and person are not equivalent terms. For example, I do not see either of the following as qualifying as a person: a human conceptus or a human who is irretrievably beyond consciousness—such as a patient in a truly permanent coma. Neither of these possesses self-consciousness, so neither qualifies for the moral status of personhood. And just as not all humans are persons, all persons are not human. For examples I point to the aforementioned Koko as at least a quasi-person, and to angels and God Himself as surely persons. The Bible speaks of angels and God as intelligently self-conscious in ways similar to us—individuals who are indisputably persons, that is, entities with full moral status.

The distinction between “human” and “person” is important and will become even more significant as medical technology gallops ahead and resources shrink. A conceptus slowly evolves into a person, so how one defines human/person issues goes far in determining the permissibility of interrupting a pregnancy. As medicine allows patients with less and less quality of life to be sustained longer and longer, the issue of human existence versus meaningful personal life increases in importance.

Moral status and brain function

A person’s unique moral claim to life depends primarily on his or her higher mental capacities. The individual being who will never possess—or is forever beyond possession of—neo-cortical functioning does not have a special moral claim to life. Thus, for example, an anencephalic infant or a permanently comatose patient lacks the special claim to existence that you or I possess.

Even more difficult than issues surrounding upper-brain-absent patients is the question of aggressive treatment for the severely handicapped newborn or the nursing home resident with advanced senility. There is no simple answer to the dilemma presented by these patients; however, a failure to decide on such borderline cases itself constitutes a decision because the technology to sustain life is readily available in advanced nations and will be used unless predetermined limits are set. Decisions on marginal human life are made every day in the modern medical center, and their number and difficulty will only increase. Hence, we must grapple with the question of what it is about an individual’s life that gives him or her or “it” a distinctive moral right to existence.

Thus the big question is, How do we decide who has a special moral claim to life and scarce medical resources? This question is made more urgent because of modern medicine’s powers. My argument is that the more nearly an individual human or animal approximates a life of self-consciousness (such as you or I), the greater the claim of that individual to maximal moral status.

My rationale for viewing life as I do is not merely my own personal opinion, but emerges from my particular religious tradition. Philosophical and religious traditions have long determined fundamental views about life, and today they continue to inform us on big existential issues.

More needs to be said about the two fundamentally different traditions that are at odds on the question of personhood.

Physicalism and personalism

Physicalism. In physicalism, the essence of a person is found in his or her biological make-up. All humans are persons, ipso facto. Accordingly, Baby P (see sidebar) is surely a person, and so is Baby K, only she is severely handicapped. The physicalist tries to save every human life possible: the 400 gram newborn with the remotest chance of survival and the Alzheimers patient who might be kept alive an extra year.

Although William E. May, the Roman Catholic theologian, distinguishes “moral beings” from “beings of moral worth,” both categories are in the physicalist camp. He argues that moral beings are those creatures who are “capable of performing acts of understanding, of choice, and of love.” These humans are moral beings because they are “minded” entities. However, not all humans are “minded” moral beings (i.e. anencephalic newborns). But regardless, all humans are “beings of moral worth” because all share “something rooted in their being human beings to begin with.” This “something is the principle immanent in human beings, a constituent and defining element...that makes them to be what they and who they are...; it is a principle of immateriality or of transcendence from the limitations of materially individuated existence.”2

Personalism. Contrasted with physicalism, personalism sees the essence of a person as being located in one’s mental capacities and ability to use these in satisfying ways. Whether one is a human is not important. If a computer were self-conscious, it would possess moral worth—as do angels and extraterrestrials. But Baby K is not a person, and has no chance of ever becoming one. Baby P is not a person at birth, and her parents had the right to request her death.

Michael Tooley has long contended for the morality of infanticide—up to three months for newborns like Baby P. Says Tooley: “Anything that has, and has exercised, all of the following capacities is a person, and that anything that has never had any of them is not a person: the capacity for self-consciousness; the capacity to think; the capacity for rational thought; the capacity to arrive at decisions by deliberation; the capacity to envisage a future for oneself; the capacity to remember a past involving oneself; the capacity for being a subject of non-momentary interests; the capacity to use language.”3

The late Cardinal Joseph Bernardin, insightfully summed up the contrasting philosophies: Physicalism (he called it “personalist humanism”) finds human dignity in “being human,” whereas personalism (he called it “pragmatic humanism”) finds human dignity in doing “human things.”4

Proximate personhood

As a Seventh-day Adventist, I am uncomfortable with either pure personalism or physicalism. Born and reared in my church tradition, I have been taught that one’s dignity is found in being created in God’s image. I have long appreciated Ellen White’s simple definition of what it means to be created in God’s image, a definition that is emblazoned in the minds of hundreds of thousands of Adventist students worldwide from their study of her book Education: “Every human being, created in the image of God, is endowed with a power akin to that of the Creator—individuality, power to think and to do.”5

The higher powers of the mind and the power to act in a distinctively personal manner are all-important. This view of the human person is in stark contrast to the belief in an immortal soul that begins at conception. Understandably, in cultures where the concept of an immortal soul dominates, an ethos of physicalism prevails.

Personalism is an appealing philosophy, especially today when medicine can sustain the physical body at such great lengths—e.g., Baby K! But a big problem with personalism—as well as with physicalism—is that of rigidity.

Both philosophies are analogous to light switches. To these philosophies, the life being considered is either black or white; it is either without moral status or it has full moral status. But given our modern knowledge, human life is much more like a rheostat: it begins with a flicker, swells to fullness, then dims to nothing in death. The proximate personhood is rheostat-like. It is a common-sense position. It takes its intellectual content from personhood thinking, but listens to the intuitions of physicalism.

Proximate personhood suggests that the greater the proximity or nearness of the individual to that of undisputed personhood—such as you or I have—the greater the individual’s moral status.

There are three pivotal criteria for making decisions in the proximate personhood approach:

  1. the potentiality for gaining or regaining personal being;
  2. the development toward becoming a personal being or development beyond such being; and
  3. the bonding of an individual and significant others or society at large.

These criteria are, respectively, intellectual, physical, and social.

What difference does it make whether you are in one camp or the other? Depending on your view of persons, you will possess different answers on several contemporary dilemmas:

How we define personhood does make a difference on a score of contemporary decisions. And depending on culture, religious background, and personal convictions, one is likely to be a thorough-going physicalist or personalist—or profess a hybrid position such as that of proximate personhood.

The dilemma of personhood

What do we mean by the word person? Consider the following two cases:

Baby K: Baby K (Stephanie Keene) was born in October 1992, at the Fairfax Hospital in Falls Church, Virginia. While a fetus, Baby K was diagnosed as anencephalic, but her mother continued her pregnancy despite recommendations from her pediatrician and a neonatologist. At birth the baby had difficulty breathing, and a ventilator was begun. Within a few days, physicians began urging the mother to give permission for them to cease the ventilation, but she declined. A hospital ethics committee recommendation was also refused. Within six weeks, Baby K was no longer ventilator-dependent, and the mother agreed to have the baby transferred to a nursing facility, with the stipulation that her baby could return if respiratory support became necessary. Baby K was returned to the hospital at least three times because of breathing difficulties.

Fairfax Hospital went to court claiming that it must not be forced to render “inappropriate” care. The mother’s position was that “all human life has value, including her anencephalic daughter’s life.” The mother “has a firm Christian faith...[and] believes that God will work a miracle.”1 The trial judge ruled in July 1993 that the mother had the legal right to acquire lifesaving treatment for her infant. Under the Emergency Treatment Act, enacted by Congress to prevent “patient dumping,” treatment must be provided until the patient is medically stabilized. The hospital conceded that respiratory distress was an emergency condition, but it argued that such treatment was “futile” and “inhumane.” The judge disagreed, stating that both the Rehabilitation Act and the Americans With Disabilities Act also prohibited discrimination against Baby K based on her anencephaly. On February 10, 1994, the U.S. Court of Appeals, in a two-to-one ruling, affirmed the earlier judgment of the trial court. The majority opinion held that the language of the Emergency Treatment Act was unambiguous and had been interpreted correctly. The court sympathized with the hospital’s interest in appropriate treatment, but said that the U.S. Congress was the appropriate branch of government to “redress the policy concerns.”2

Baby P: The story of Baby John Pearson is the British equivalent of America’s original “Baby Doe” case. Born in 1980, Baby Pearson was an apparently uncomplicated Down’s syndrome infant whose parents decided that they did not want their newborn to live. (A post-mortem examination revealed a damaged heart and lungs, but these defects were not known during the newborn’s life.) The attending pediatrician, Dr. Leonard Arthur, complied with the parents’ wishes and prescribed nursing care only and large dosages of adult pain medication. Dr. Arthur faced murder charges in this highly publicized case, but after supportive testimony from leading physicians was finally acquitted. A BBC poll showed that the public by a margin of 86 to 7 favored a “not guilty” verdict if a physician is charged with murder because, with parental consent, “he sees to it that a severely handicapped baby dies.”3

Raanan Gillon, writing in the British Medical Journal, justified Dr. Arthur’s use of euthanasia on the pivotal basis of personhood: “I believe that the issue turns on the question of personhood and that it is because the newly born infant is not a person that it is justifiable in cases of severe handicap to ‘allow it to die’ in the way Dr. Arthur allowed baby Pearson to die.”4

It is too easy to dismiss these cases as polar extremes. On the one hand, there is an overly religious mother, and on the other, a self-absorbed yuppie couple. In these cases, if you were the decision maker, would you have let Baby K die, as the physicians repeatedly recommended? Why? Would you have requested adult analgesics for Baby P? Why?

  • In the Matter of Baby K, 832 F Supp. 1022 (E.D. Va. 1993).
  • In the Matter of Baby K, 16 F 3rd 590 (4th Cir. 1994). See George J. Annas, “Asking the Courts to Set the Standard of Emergency Care: The Case of Baby K,” New England Journal of Medicine 330 (May 26, 1994): 1542-1545.
  • See a full account of this case in Helga Kuhse and Peter Singer, Should the Baby Live? The Problem of Handicapped Infants (Oxford: Oxford University Press, 1985), pp 1-11.
  • Raanan Gillon, “Conclusion: The Arthur Case Revisited,” British Medical Journal, 292 (1986), pp 543-45.
  • James Walters (Ph.D.,Claremont Graduate School) teaches ethics at Loma Linda University. He is also the executive editor of Adventist Today. This essay is adapted from the author’s seventh book, What Is a Person? An Ethical Exploration (Chicago: University of Illinois Press, 1997). His address: Loma Linda University; Loma Linda, California, 92350; U.S.A.

    Notes and references

    1. New York: Knopf, 1993
    2. William E May, “What Makes a Human Being to Be a Being of Moral Worth?” The Thomist 40 (July 1976), pp. 416-38.
    3. Michael Tooley, Abortion and Infanticide (Oxford: Clarendon Press, 1983), p 349.
    4. Joseph Bernardin, “Medical Humanism: Pragmatic or Personalist?” Health Progress, (April 1985), pp 46-49.
    5. Ellen G. White, Education (Mountain View, Calif.: Pacific Press Publ. Assn., 1952), p. 17.