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Threats to Neurosurgical Patients Posed by the Personal Identity Debate

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An Erratum to this article was published on 30 March 2017

Abstract

Decisions about brain surgery pose existential challenges because they are often decisions about life or death, and sometimes about possible personality changes. Therefore they require rigorous neuroethical consideration. However, we doubt whether metaphysical interpretations of ambiguous statements of patients are useful for deriving ethical and legal conclusions. Particularly, we question the application of psychological theories of personal identity on neuroethical issues for several reasons. First, even the putative “standard view” on personal identity is contentious. Second, diverse accounts of personal identity have been introduced into the neuroethical debate, which are incompatible. Third, the criteria for “diagnosing” the supposed changes in “identity” are ambiguous and indeterminate. Fourth, the metaphysical theories of personal identity imply highly questionable ethical and legal revisions, namely the denial of advance directives, particularly of Ulysses contracts, and, for patients with brain cancer, even therapeutic nihilism.

We discuss three examples in which ideas from the personal identity debate in metaphysics are straightforwardly applied to discuss ethical issues of neurosurgery. We discuss revisions of the current medico-legal practice that have been proposed on grounds of psychological theories of personal identity. We argue that the established status quo in law and clinical practice is beneficial to the patients concerned. Furthermore, it is metaphysically neutral, which is an important principle of liberal, democratic, pluralistic societies.

We recommend a pragmatic approach: (1) empirical research on personality changes arising from brain disorders or interventions, (2) comprehensive information about risks of personality changes, and (3) advance directives, particularly Ulysses contracts.

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Notes

  1. This distinction is borrowed from Peter F. Strawson: “Descriptive metaphysics is content to describe the actual structure of our thought about the world, revisionary metaphysics is concerned to produce a better structure” ([32], p. 9).

  2. For example, an Animalist can say that what patients really mean with “loss of personal identity” is that patients noticed a change, which they consider relevant for the application conditions of the term ‘person’ as a phase sortal, whereas they obviously refer to themselves as the same continued substance (see [33]). Neo-Parfitians can insist that persons just are substances and that patients therefore report to have ceased to exist as the selfsame substance.

  3. In other words, we cannot settle perennial metaphysical controversies just by interpreting patient’s reports. This would reduce metaphysics, which is about concepts, to naïve empirical investigation taking appearances as facts. Perhaps any of the proposed psychological accounts of personal identity can be defended by sound arguments, but neuroethicists who rely on patients’ reports to make metaphysical claims (not to just to illustrate them) must first do so. For example, they could provide compelling reason by demonstrating, if possible, that Animalism is logically inconsistent.

  4. The notion of person lingers in the literature between a normative reading of persons referring to persons as subjects of moral status and a descriptive reading referring to the identity conditions of personhood. In what follows, we will use ‘person’ in the normative sense, since we discuss only literature where personal identity (i.e. the identity conditions of persons as subjects of moral status) are discussed to draw neuroethical conclusions. So for example, according to Witt [29] (see below), a post-operative patient presenting severe personality changes may have some moral status after surgery, but – so the idea of this view – the patient has not the continued selfsame moral status as being the same person than before neurosurgery. The proposed reason is that neurosurgery has changed the patient’s personality in a fundamental way.

  5. With “forensic personhood” Schechtman refers to a neo-Lockean concept of person in the normative sense as being a subject with the moral status of a person. With “forensic identity” she seems to refer to the identity conditions that determine whether we hold a person morally accountable as one continued selfsame subject or not.

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Authors and Affiliations

  1. Department for Psychiatry and Psychotherapy, CCM, Charité – Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany

    Sabine Müller, Merlin Bittlinger & Henrik Walter

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  1. Sabine Müller
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  2. Merlin Bittlinger
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Correspondence to Sabine Müller.

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An erratum to this article is available at http://dx.doi.org/10.1007/s12152-017-9329-4.

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Müller, S., Bittlinger, M. & Walter, H. Threats to Neurosurgical Patients Posed by the Personal Identity Debate. Neuroethics 10, 299–310 (2017). https://doi.org/10.1007/s12152-017-9304-0

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