Theorizing personhood: for better or for worse

Abstract

Person-centered medicine is emerging as one of the most formidable critiques of evidence-based medicine. One of its claims to priority over patient-centered care, humane medicine, narrative-based medicine and values-based medicine is its attention to the philosophy of personhood. While it defines personhood in widely accepted terms, using adjectives employed by Cassell, such as 'embodied, purposeful, thinking, feeling, emotional, reflective, relational', it offers no examination of the numerous debates and disagreements about personhood. In particular, it has not so far explored the tension that exists between the neo-Lockean account of persistent psychological attributes, such as intention, cognition and rationality and the `animalistic' account that ascribes personhood to human existence, to the human body and brain. Nor has it examined the significance of personhood as an emergent property of human beings imbedded in cultures and societies. Medical ontology is basically realist and its epistemology empiricist. Person-centered medicine faces the task of translating a contested, emergent concept into something realistic and empirically examinable, if it is to persist and have pedagogical purchase. Schectman's 'person-life view' may provide a starting point for conceptualisation and teaching and respect is a relationship that underpins an understanding of personhood, but other guidelines will be needed. Some relevant suggestions are made in this article. Keywords: Discourse, evidence-based medicine, humanism, narrative-based medicine, patient-centered care, person-centered medicine, personhood, person-life view, respect, science, values-based medicine