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Am I Still Me? Personal Identity in Neuroethical Debates

Medicine Studies

Abstract

Neurosurgery is a topic that evokes many hopes and fears at the same time. One of these fears is concerned with the worry about losing one's identity. Taking this concern seriously, the article deals with the question: Can the concept of ‘personal identity’ be used successfully in normative considerations concerning neurosurgery? This question will be answered in three steps. First, a short introduction to the philosophical debate about personal identity is given. Second, a new theory of personal identity is presented. This theory has two components. On the one hand, it explains the phenomenon of human existence through time. On the other hand, it demonstrates the normative concept of personal identity. The final step proves the explanatory power of the theory on the basis of a practical example, namely deep brain stimulation. It will be shown that personal identity alters quite easily, whereas human persistence is rather stable. The distinction between both concepts finally serves to develop a terminology that is able to structure normative debates very effectively.

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Notes

  1. Nowadays, the discipline ‘bioethics’ is a very large domain. It developed out of medical ethics, but broadened its focus fundamentally. In general, it deals with the diverse possibilities of technically manipulating ourselves and our environment. It includes reflections on a responsible usage of biological resources, genetic engineering, the handling of laboratory animals and the impacts of biotechnological inventions on the human being. The relatively young research area ‘neuroethics’ belongs to the last-mentioned area. The discussion in neuroethics focuses on normative impacts of research results and technical developments generated by the neurosciences. The present article is grounded in this discussion.

  2. Besides diachronic identity, one can investigate a second notion of the unity of persons. One can also ask what determines the unity of a person at a given point in time. A criterion of ‘synchronic identity’ specifies in what way different parts of an object have to be related to each other to belong to the same object. Another part of the question deals with the criterion of separating objects. For an introduction to these distinctions, see, e.g., Tegtmeier (2007).

  3. This theory has been developed by the author in her PhD thesis (Brand 2010). A very short version was presented at the 21st German Philosophical Congress (Brand 2008).

  4. It is not possible within this framework to narrate the development of the debate in detail. The very short overview presented here serves to provide the reader with basic knowledge of the problems involved. For further reading, several introductions can be recommended, e.g., Noonan (2003), Martin and Barresi (2006) or Quante (1999).

  5. This applies to all psychological criteria. The standard solution to this problem is the so-called ‘q-memory’ (Shoemaker 1963; Parfit 1987; Noonan 2003). Q-memories match normal memories in all their features except one: Q-memories do not imply that the events they contain information about have to be experienced by the owner of the q-memories. A normal memory instead presupposes that the experience it entails has been made by the same person that remembers this experience right now. There has been a long discussion about the validity of q-memories that has not come to an end. For our argument here, it is enough to mention that the concept is a very artificial one that only serves to solve a logical problem and does not really help us to define personal identity.

  6. Northoff adopts Thomas Metzinger’s (2004) self-model theory, and so he is confronted with all the problems this approach entails. For example, it cannot be clarified how the different mechanisms and features of the self model work themselves and how they together generate the self model. Furthermore, it remains unclear how all those mechanisms relate to each other.

  7. The debate about persistence theories is a very complex one. Therefore, it is not possible here to go into the details. A very good introduction can be found in Hawley (2001). The connection among personal identity, persistence theories and the so-called ‘sortals’ is very clearly presented by Rapp (1995). An early version of a personal identity theory that works with a perdurance-persistence theory can be found in Lewis (1983).

  8. The author is aware of the fact that this explanation of the term ‘person’ can be criticized. A cognitive definition of the term implies that it has a gradual character. Depending on the set of personal features an individual possesses, it can be more or less a person. This also means that not all humans are persons, and not all persons are humans. This is why it seems reasonable to link the term ‘person’ to the term ‘human being,’ so that humans are persons because of them being human. On the other hand, it seems to go much too far to ascribe all rights and duties to an embryo. We just do not treat embryos as full-fledged persons, and it is hard to see why we should. A very readable short introduction to the topic can be found in Birnbacher (2006). A more comprehensive overview is given by Kather (2007). The role of the concept in bioethical debates is analyzed by Wagner-Westerhausen (2008).

  9. A problem case that is still very much under discussion is the phenomenon of ‘dissociative identity disorder’ (DID), formerly known as ‘multiple personality disorder.’ It has not yet been decided whether this is a real pathology or a mere thought experiment. Therefore, I will not focus on DID. What I want to show is that my criterion can be used successfully in real problem cases like, for example, amnesia and DBS. For further reading on personal identity and DID, I recommend Gunnarsson (2009).

  10. This conclusion surely bears some problems. The question arises whether empirical research in general will be able to delineate the thresholds. Logically, all delineations have to be arbitrary (Lewis 1983: 70). Furthermore, the notion of causality itself is still under discussion (Esfeld 2007). What we can do is to mark clear cases of persistence and clear cases where persistence is broken. Taking these instances as reference points, we can narrow down the thresholds to those circumstances where we do not know what to say about persistence. In such cases, we have to investigate the first-person perspective and the third-person perspective to decide how to judge persistence. As this is a descriptive process, we have to take empirical research into account.

  11. In this sense, the endeavor to fulfill duties does not belong to the personal properties.

  12. Insofar as 'being able to fulfill duties' is not only important for a society in general, but also for the individual human being, the demand to enhance this capacity could be understood as part of the biomedical principle of beneficence. Of course, it may be difficult in certain circumstances to trade beneficence off against, e.g., autonomy. As this insight addresses a general problem of the four principles approach (see Beauchamp and Childress 2001), it cannot be discussed within the scope of this article.

  13. One might get the impression that this argument is liable to a naturalistic fallacy. Being able to fulfill duties is a descriptive notion, whereas demanding an intervention is a normative notion. The fallacy is avoided by revealing a further normative assumption that goes along with the argument: Persons have to be able to fulfill as many duties as possible. This premise included, the argument is valid. For a very clear analysis of naturalistic fallacies in bioethical debates, see Engels (2008).

  14. Surely, a successful intervention also and mainly increases the quality of life of the patients. However, in my terminology, this would only have an effect on the personal status if a certain level of quality of life were one of the requirements of the ability to fulfill duties.

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Acknowledgments

The preparation of this article would not have been possible without the support of the International Centre for Ethics in the Sciences and Humanities (IZEW), the Research Training Group ‘Bioethics’ (DFG GRK 889/1) and finally the German Research Foundation (DFG). Furthermore, I would like to thank Tobias Meilinger and Johanna Steffen for their help with the English language.

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Correspondence to Cordula Brand.

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Brand, C. Am I Still Me? Personal Identity in Neuroethical Debates. Medicine Studies 1, 393–406 (2009). https://doi.org/10.1007/s12376-009-0034-4

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