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The changing face of personhood at the end of life: The ring theory of personhood

Published online by Cambridge University Press:  03 July 2014

Lalit Kumar Radha Krishna  and
Suat Yee Kwek
Lalit Kumar Radha Krishna*
Affiliation:
National University of Singapore, Yong Loo Lin School of Medicine, Singapore
Suat Yee Kwek
Affiliation:
National University of Singapore, Yong Loo Lin School of Medicine, Singapore
*
Address correspondence and reprint requests to: Lalit Kumar Radha Krishna, Department of Palliative Medicine, National Cancer Center Singapore, 11 Hospital Drive, Singapore 169610. E-mail: lalit.krishna@nccs.com.sg
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Abstract

Objective:

The manner in which personhood or “what makes you who you are” is conceived is key to the provision of patient-centered care and maintenance of the dignity and quality of life of terminally ill patients. However, there is little agreement on how this pivotal concept ought to be defined. Some have argued in favor of an innate concept of personhood, while others see an individual as a reflection of their familial identity or their conscious function, and all share a common position that personhood is unchanging, and hinges upon the central theme of their respective concepts. The present paper aims to explore a more clinically influenced perspective of personhood.

Method:

We report the case of a 42-year-old Malay Singaporean who had been a caregiver for her husband throughout his cancer and then became a cancer patient herself after his passing. This case explores her changing and multifaceted conceptions of personhood throughout her life and illness, and discussions about end-of-life care.

Results:

The patient reports a concept of personhood that encompasses the innate, individual, relational, and societal aspects, which are interlinked and vary in terms of depth and conviction according to the various times in her life and illness.

Significance of results:

Our findings support the ring theory of personhood, which provides a clinically supported model of the conception of personhood that is context dependent and encompasses the four abovementioned aspects.

Keywords

PersonhoodPalliative careRing theory of personhoodEnd of life
Type
Case Report
Information
Palliative & Supportive Care , Volume 13 , Issue 4 , August 2015 , pp. 1123 - 1129
Copyright
Copyright © Cambridge University Press 2014 

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References

REFERENCES

Buron, B. (2008). Levels of personhood: A model for dementia care. Geriatric Nursing, 29(5), 324–32.Google Scholar
Cheng, K.Y., Ming, T. & Lai, A. (2012). Can familialism be justified? Bioethics, 26(8), 431–439.Google Scholar
Chochinov, H.M. (2002). Dignity. Conserving care: A new model for palliative care. The Journal of the American Medical Association, 287(17), 2253–2260.Google Scholar
Devine, P.E. (1987). The species principle and the potential principle. In Bioethics: Reading and cases. Brody, B.A. & Englehardt, H.T. (eds.), pp. 136–41. Englewood Cliffs, NJ: Prentice Hall.Google Scholar
Douritch, D., Wros, P. & Izumi, S. (2001). Relief of suffering and regard for personhood: Nurses' ethical concerns in Japan and the USA. Nursing Ethics, 8, 449–458.Google Scholar
Ellis-Hill, C. (2011). Identity and sense of self: The significance of personhood in rehabilitation. Journal of the Australasian Rehabilitation Nurses' Association, 14(1), 6–12.Google Scholar
Fan, Ruiping (2007). Which care? Whose responsibility? And why family? A Confucian account of long-term care of the elderly. Journal of Medicine and Philosophy, 32(5), 495–517.Google Scholar
Farah, M.J. & Heberlein, A.S. (2007). Personhood and neuroscience: Naturalizing or nihilating? American Journal of Bioethics, 7(1), 37–48.Google Scholar
Fins, J.J., Illes, J., Bernat, J.L., et al. (2008). Consciousness, imaging, ethics, and the injured brain. American Journal of Bioethics, 8(9), 3–12.Google Scholar
Fletcher, J. (1979). “Humanness,” humanhood: Essays in biomedical ethics, pp. 12–16. Buffalo: Prometheus Books.Google Scholar
Gallagher, A. (2007). The respectful nurse. Nursing Ethics, 14, 360–371.Google Scholar
Gastmans, C., Mahieu, L., Vanlaere, L., et al. (2011). Author response. Nursing Ethics, 18, 264–265.Google Scholar
Goh, C.R. (2008). Challenges of cultural diversity. In Supportive care in heart failure. Beattie, J. & Goodlin, S. (eds.), pp. 451–461. New York: Oxford University Press.Google Scholar
Ho, M.Z.J., Krishna, L. & Yee, A.C.P. (2010). Chinese familial tradition and Western influences: A case study in Singapore on decision making at the end of life. Journal of Pain and Symptom Management, 40(6), 932–936.Google Scholar
Hui, E. (2008). Parental refusal of life saving treatments for adolescents: Chinese familism in medical decision making revisited. Bioethics, 27(5), 286–295.Google Scholar
Huijer, M. & van Leeuwen, E. (2000). Personal values and cancer treatment refusal. Journal of Medical Ethics, 26(5), 358–362.Google Scholar
Kitwood, T. (1997). Dementia reconsidered: The person comes first. Buckingham: Open University Press.Google Scholar
Krishna, L.K.R. (2013). Accounting for personhood in palliative sedation: The ring theory of personhood. Medical Humanities. Epub ahead of print September 26. doi: 10.1136/medhum-2013-010368.Google Scholar
Krishna, L.K.R., Alsuwaigh, R. & Sim, S.W. (2013). Ring theory of personhood. The American Journal of Hospice & and Palliative Care. Epub ahead of print August 13. doi: 10.1177/1049909113500136.CrossRefGoogle Scholar
LiPuma, S.H. (2013). Continuous sedation until death as physician-assisted suicide/euthanasia: A conceptual analysis. Journal of Medicine and Philosophy, 38(2), 190–204.Google Scholar
Mitchell, M. (2012). An analysis of common arguments against advance directives. Nursing Ethics, 19, 245–251.CrossRefGoogle ScholarPubMed
Nelson, G. (2000). Maintaining the integrity of personhood in palliative care. Scottish Journal of Healthcare Chaplaincy, 3(2), 34–39.Google Scholar
Paley, J. (2011). Commentary: Care tactics—arguments, absences and assumptions in relational ethics. Nursing Ethics, 18, 243–254.Google Scholar
Parfit, D. (1971). Personal identity. The Philosophical Review, 80(1), 3–27.Google Scholar
Radha Krishna, L.K. (2013). Personhood within the context of sedation at the end of life in Singapore. BMJ Case Reports. Epub ahead of print June 7. doi: 10.1136/bcr-2013-009264.Google Scholar
Rich, B.A. (1997). Postmodern personhood: A matter of consciousness. Bioethics, 11(3&4), 206–216.CrossRefGoogle ScholarPubMed
Saunders, C. (1984). The philosophy of terminal care. In The management of terminal malignant disease. Saunders, C. & Sykes, N. (eds.), pp. 232–242. Baltimore: CRC Press.Google Scholar
Selling, J. (1999). Is a personalist ethic necessarily anthropocentric? Ethical Perspective, 6, 60–66.CrossRefGoogle Scholar
Tsai, D.F. (1999). Ancient Chinese medical ethics and the four principles of biomedical ethics. Journal of Medical Ethics, 25, 315–321.Google Scholar
Tsai, D.F. (2001). How should doctors approach patients? A Confucian reflection on personhood. Journal of Medical Ethics, 27(1), 44–50.Google Scholar
Tsai, D.F. (2002). The two-dimensional concept of Confucian personhood in biomedical practice. In Advances in Chinese medical ethics: Chinese and international perspectives. Doering, O. & Chen, R. (eds.), pp. 195–211. Hamburg: Institute of Asian Affairs.Google Scholar
Twycross, R. (2003). Quality of life in general topics: Introducing palliative care, 4th ed. Oxon, England: Radcliffe Medical Press.Google Scholar
Vanlaere, L. & Gastmans, C. (2011). A personalist approach to care ethics. Nursing Ethics, 18, 161–173.CrossRefGoogle ScholarPubMed
Zhang, X. (2012). Reflection on family consent: Based on a pregnant death in a Beijing hospital. Developing World Ethics, 12(3), 164–168.Google Scholar