Taking Persons Seriously (with Mihretu Guta)

The most fundamental question that our polarized culture faces is this — Who should be included in the human community? And on what basis? Should embryos, fetuses, the severely demented or the persons in a vegetative state? What does our view of a person suggest about how we care for people at the end of life? Taking Persons Seriously connects philosophy and bioethics—it’s a bit more technical discussion so hang in there with us and the dots will connect and the light will come on as we go along. It’s a book that Scott and Dr. Mihretu Guta edited together. Dr. Guta will be with us on this episode. 

Dr. Mihretu Guta is adjunct professor of philosophy in the Philosophy and Apologetics programs at Talbot.  He is the author of several high level philosophical books and numerous journal articles. 

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Transcript

Scott: Who should be included in the human community? And on what basis? Should embryos, fetuses, the severely demented, or persons in a vegetative state, should they count as human persons? What does our view of a person suggest about how we care for people at the end of life? We'll discuss these questions and more with our guest, Dr. Mihretu Guta. He and I have edited a new book entitled Taking Persons Seriously, Where Philosophy and Bioethics Intersect. I'm your host, Scott Rae. 

Sean: And I'm your co-host, Sean McDowell. 

Scott: This is Think Biblically from Talbot School of Theology at Biola University. Mihretu, welcome. Really glad to have you with us. Mihretu was a student in our philosophy program years ago. He's gone on to distinguish himself with a number of very, very influential publications, and I'm delighted to have been involved in this project with him. So, Mihretu, welcome. Great to have you with us. And tell us a little bit about how this project, this book project, got started. 

Mihretu: Thank you so much, Scott and Sean, for having me for the second time. So, it's a delight to be here. The genesis of this book actually will take us back to my graduate student years. And I was in Scott Rae's class and J.P.'s class, and I was able to make some kind of weird observations. The more I learned about bioethics, and the more I learned about metaphysics, there was kind of a hole in the bioethical discussions. Metaphysical assumptions were not really clear. There wasn't a clear link between metaphysics and bioethical issues. So, I made a suggestion to Dr. Scott Rae. 

Scott: He still refers to me somewhat respectfully. 

Mihretu: [laughs]

Sean: Was that a hint at me, just for the record? [laughs]

Mihretu: I made a suggestion to him because I took a number of classes with him, and I was really, really impressed by the courses that I took with him. “One day, would you mind teaming up with me to write and also edit a book?” I just made that remark seriously, and then he took it seriously. So, it lingered for a number of years. I went on to my postdoctoral studies and postdoctoral studies. And a number of years after, a number of years, I came back to Biola, and I reminded him of the promise he made a number of years ago. And he was absolutely ready, and we ended up editing this book, and we are writing a book from scratch. That's the sequel to this book. 

Scott: That was another promise that I made to him that he reminded me of. 

Sean: Oh, okay.

Mihretu: Dr. Scott Rae is not off the hook yet. So, he is going to be challenged in a number of different ways. 

Sean: Okay. So, let's get to the heart of this book, connecting bioethics with metaphysics. Why is it important to do that? And, maybe, why haven't we done that well so far? 

Mihretu: I think one of the things that you can easily observe if you are a philosopher or a metaphysician like me is, metaphysical assumptions are already embedded within bioethics. They are there, but people pretend as if those assumptions are not there. So, they actually try to undermine the relevance of metaphysics for bioethics. So, the link is not clearly drawn because many people believe that metaphysics is not relevant to deal with bioethical discussions. 

Sean: Okay. So, metaphysics are questions of what is real, and being, and existence, and then bioethics…give us a quick definition of what we mean by bioethics. 

Mihretu: Yeah. Metaphysics is the study of the structure of reality in general. Reality includes you and me, rocks, lizards, plants, everything that exists. 

Sean: Okay. 

Mihretu: So, metaphysics is a kind of an umbrella term that really, kind of, tries to categorize things in different compartments and then tries to show the relationship between those things that really do belong to different categories. And bioethics, I will defer that to the right person to give us that definition. 

Scott: Yeah. Bioethics simply has to do with the ethical issues in medicine and the life sciences. So, that's it. And most of the ethical issues are at the beginning of life and at the end of life. Let me give you an example of how these connect. Most of the issues in bioethics make assumptions about what a human person is. So, abortion, for example, makes assumptions about what kind of a thing is a fetus or an embryo. Reproductive technologies does the same thing about embryos. Euthanasia and assisted suicide makes assumptions about what kind of a thing is an elderly or seriously ill human being. Are they human beings at all? On what basis can we say that this is an entity or a thing that has value and dignity and intrinsic worth? So, the metaphysical assumption…philosophical assumptions are embedded within almost all of the main questions that bioethics deals with. 

Sean: Okay. So, they're there. We're just not doing it consistently, we're not doing it well, we're not doing it thoughtfully, is a part of the concern. 

Mihretu: The concern is actually more serious than that. Some people really do think metaphysics is not relevant. So, we don't have to approach bioethical issues through the lens of metaphysics. By metaphysics, I mean, metaphysics actually comes in different shapes and sizes. So, if you start with Aristotle, you're realist. You take things extremely seriously because you believe in mind-independent reality. Reality is not contingent on how you think reality should be like. It is just what it is, regardless of what you think about it. 

Scott: Basically, it's the idea that what we perceive about the world is actually the way things are. 

Sean: Sure. 

Mihretu: That assumption has been rejected in subsequent generations. For example, if you take Immanuel Kant, who was a German philosopher of the 18th century, he says, "Look, you can't have access to reality in and of itself. So, what you need to do is, you have to project your own conceptual scheme on reality. Reality is not something you have direct access to, but you have this conceptual scheme that you have to deploy in order to conjure up, basically, in your mind what you think reality is. So, your understanding of reality is not the way reality actually is, because you don't have access to it.” So, Kant actually doesn't follow Aristotle in that sense. So, we do have other metaphysicians who actually think that metaphysics is an illusion. So, it's just nothing more than language. 

Scott: That's another story for another day. So, I think when it comes to bioethics though, the questions about life, the questions that we wrestle with around the dinner table and around coffee conversations, about what do we do with embryos that are left over from infertility treatments, or what do we do with an unwanted pregnancy, or how do I take care of my loved one at the end of life? We're all making assumptions about what kind of a thing the human person actually is. And for most of the bioethics that Mihretu is describing, they're assuming a view of a human person without...they're just assuming that that's the only option out there. And that’s what's called a physicalist view of a human person. We are nothing more than a collection of our parts and properties. We're nothing more than the physical stuff that composes our body. There's no such thing as a soul, no such thing as a mind that operates independently of the brain. So, things like that. That's the assumption that's made. And we found, even in Christian circles, we sort of bracket out those conversations, because I think for Christians who wanna get a seat at the table in the secular bioethics discussion, you just can't...that's just not something you can contest. And I think sometimes the skepticism about these philosophical assumptions is because, for the most part, people are all over the map on this, and people ignore the metaphysical part because they despair of people ever agreeing on it. And so, what that does is it makes the bioethical issues procedural, which means that all that bioethics has to offer is a procedure for coming to the right decisions. But there's no principles, there's no virtues that underlie those. There's no view of a person that underlies those. And so, the idea that a person has dignity is sort of an empty concept for a lot of bioethics today. 

Sean: Hence, not taking persons seriously by that reductionistic, naturalistic understanding of what it means to be human. If we include metaphysical ideas, we take persons seriously and hence make more ethical, wise, good moral decisions on all the bioethical issues at play. 

Scott: Couldn't have said it better myself. 

Sean: Fair enough. So, let's go to this question. What does it mean that a person is a substance? 

Mihretu: Good. A substance means…the word came from a Latin term, it's a coined term, “sub-” means something under, substance, “stance.” Something is “standing under.” So, it's sort of like a foundation of a house or a building. But in a technical term, in a technical sense, substance has got a very, very sophisticated meaning. For example, for Aristotle, it's a bearer of properties. So, there's a distinction between a substance and the properties that the substance bears. If you take an apple, an apple is an object. You can talk about an apple being red. Redness is a property. You can talk about the size of an apple. The size is a property of an apple. The shape of the apple. It’s a property of an apple. But the apple itself is an object. You can't reduce an apple to size, to redness, or to sphere—

Sean: Or taste, or whatever. 

Mihretu: Exactly. So, basically, it's a property bearer that persists over time through different kinds of changes. 

Scott: And that's really the important part, is that if we're nothing more than a collection of our parts and properties, then as soon as my parts change, I become a different entity. So, take for example, somebody who is…or, take what I've just gone through in the last few months. I gave up a kidney. So, I am missing now a significant part that I had prior. And so, you could make an argument, if you take that literally, you could actually make an argument that I'm a different person than I was four months ago. 

Sean: Or 95% of what you were, or something like that. [laughs]

Scott: Something like that. And the reason this matters is because our whole notion of moral responsibility and criminal justice is premised on the idea that human persons are substances—that we endure, our identity endures through time and change, through something immaterial, not material. So, it's our soul that gives us our identity through time and change. Because somebody who believes that we're nothing more than parts and properties could say, for example, if they committed a crime 20 years ago—they could have been on the lam all that time—and if they're brought to justice, say, "Well, wait, I'm a different person than the person who committed the crime 20 years ago. And you can't try me for that crime because I'm a different person." And thankfully, most courts will still laugh that out of court. And the reason for that is because they take a substance view of a person very seriously. And that's the reason we have the views of moral responsibility and criminal justice that we do today. 

Sean: And that really is a common sense view that we hold. You're just underlining what's there. Now, this matters to questions like abortion, not just criminal justice outside of the world. 

Scott: That's correct. 

Sean: Because is this a purely physical system that's getting more and more complex? And then we deem it has personhood at some stage of development or capacity? Or is it a person because of the kind of thing and substance that it is from the beginning? 

Mihretu: Okay. I think there are so many complications here. First of all, many people no longer believe that there's a continuity between a human being and a person. What they call a person is entirely dependent on a set of properties, cognitive properties that persons are supposed to have. Let's say, ability to solve problems, to have an ability to have a self-concept, and ability to think, and being rational, and so on. So if you take all of these cognitive properties, then they believe that someone is a person. If those properties are not there through dementia or some sort of disability and so on, they would believe that—

Scott: Or if they just hadn't emerged yet. 

Mihretu: Exactly. So it's entirely contingent on the emergence of this cognitive capacity. So when we talk about persons, the common sense view is exactly the way you put it, Sean. Yes, the common sense view would be, yes, it's substance, just like Scott says. But in academics, I think that that view is not going to hold any water. So many people think that there's a distinction between a human being and a person. So a person is entirely dependent on having some sort of cognitive capacity. 

Scott: So the fetus and embryos could be human beings, but not yet persons.

Mihretu: Potentially. Yeah. 

Scott: Or people at the end of life could have been…are still human beings and have been persons, but no longer are. 

Sean: So you can have human non-persons, technically, would be the idea. 

Mihretu: Yes, correct. 

Sean: And rights come from persons, not from being human. 

Scott: And I think what's important for our listeners to know is that the question of who constitutes person is not a scientific question. That's a philosophical one. And scientists, when they take off their lab coats and become amateur philosophers and make that determination about who counts as a person, they've lost the cloak of scientific authority for that. And we have to treat that for what it is. 

Mihretu: Philosophers are also guilty of that because if you take philosophers like Michael Tully, Peter Singer, Daniel Dennett, and others, they say it's entirely contingent on someone having this set of capacities. Philosophers are even problematic guys who really set the tone for the debate to actually to move forward. So yes, but it's entirely arbitrary. So, who can be in a position actually to decide that these are the criteria to deem someone to be a person and not a person? Is it the culture? Is it the U.S. Constitution? Who can be in a position? I mean, it's the funniest stuff. By the way, there are so many incredibly funny concepts and conclusions you might end up drawing from this. If you take fuzzy logic, just briefly, I'm not going to go into detail. Fuzzy logic is the exact opposite of classical logic. In classical logic, if something is true, it is true or false. Fuzzy logic gives you, like, between zero and one, something can be true 0.5 times, 0.3 times, 0.7 times, and so on. So if you accept that personhood is dependent on having certain cognitive qualities, let's say 10 of them, what if you meet, Sean, six of them? What if you, Scott, meet nine of them? What if I meet two of those? So Scott is more a person than you, I am less person than you. So here it is. Degree in all of us has been drawn. 

Scott: You would be way less of a person than me. 

Mihretu: Way less. Yes, way less. 

Sean: Or more since he has both kidneys. I mean, depends on how we look at it. [laughs] 

Mihretu: So what does that mean? I mean, if you think about this, it's so incoherent. I mean, you can actually come up with a fraction in math, literally to assign someone…someone is three fourths a person, one fifth of a person, and so on. What does that mean? 

Sean: It just reminds me—and this is a separate issue—of things we've done even in the history of our country, assigning certain people because of characteristics. They have a right to vote, three fifths of a person, et cetera. So if you take this down its logical step, we're going to deny certain full human beings, that are persons, rights. And a lot of people don't want to take it that far, but they don't realize that once they take metaphysics out of the question of bioethics, it's going to lead to that result. 

Scott: And then being a person is not something that's all or nothing. It's a more or less. It's a matter of degree. And this is why, for our listeners, who connect the image of God with some of these capacities that Mihretu was talking about, that's, I think, it’s a bit of a troubling trend because what follows from that is that the image of God is something that can be possessed in a matter of degree, which in the Scripture is nothing of the sort. I mean, you are either in the image of God or you're not, and it's not something that you can lose. So I think this makes a big difference for how, theologically, we understand something like what it means to be made in the image of God, because that's a status, not a set of functions. 

Sean: Okay, so let's apply this, because here's where it comes out. It's like, if a person's in a permanent vegetative state, something's clearly lost if it's actually permanent. They're human, but some people would say, "Yeah, that's not a person. I can't talk to them. I can't relate with them. They're not who they were.” Do they count as persons? If so, how can that be?

Sean: Now, this is, I think, the most challenging of all of those. This is more challenging, I think, than fetuses and embryos, because fetuses and embryos don't have those capacities. They don't have a self-consciousness yet, but they will. They have all the capacities within them to mature into those over time. So, they are at the developmentally expected place given what's going to happen later on as they mature. With the elderly, somebody in a vegetative state, that's not the case. And we actually say, because somebody in a vegetative state has lost all higher brain function, what that means is that only their brainstem is working. And so only the things that are involuntary, like breathing and respiration, heartbeat, digestion, all those are the only things that are working. Now, what we don't know is there might be more there than we think. And one of the chapters in our book suggests that there might actually be some degree of consciousness in somebody who's in a vegetative state. But, for the most part, we would say they're just not there. Now, I think you can make an argument that those still ought to be considered full persons, because your designation as a person doesn't depend on your ability to function in any specific way. If it did, then people who were in reversible comas, who were under general anesthesia, would not be persons during that time that they were under those things. And that's clearly not true. And so for somebody in a vegetative state, they have lost the ability to perform a lot of those functions, maybe permanently. But since we don't tie being a person to the ability to perform those functions, then that's not determinative of whether somebody in a vegetative state is a person or not. What we would say is, they are still a person who has lost the ability to function in some very specific and important ways, but those were never the criteria for saying that they're a person in the first place. 

Sean: Okay. So the follow-up question, where that gets tricky and we go beyond this is, okay, the person in a permanent vegetative state is a person, but do we treat persons who cannot recover back to their consciousness and life…how do we handle and deal with those ethical challenges?

Scott: Different set of questions. 

Sean: Exactly. That's the point. 

Scott: And I'll get to that in just a second. 

Sean: Okay.

Scott: But here's for the person who wants to deny that that person in a vegetative state is still a person, I would say, well, then why don't we just take them out and bury them? If they're no longer a person in any meaningful sense, let's not spend any more money keeping them, let's just go bury them. Or why can't we take their organs, whether they consent to it or not? In fact, whether they consent to having their feeding tube pulled out or not is really irrelevant, since they're no longer a person with any rights to be recognized. But we don't think that way. We still acknowledge that there's something about their dignity that needs to be respected. Now, what should be done with those? I think that the treatments necessary to keep them alive can be refused. If the patient has actually indicated that they don't want to be sustained in that vegetative state, or if they've communicated in a living will or to their family member who's making decisions for them, if they've communicated to them that that's their wish not to be sustained in that condition, then I think those treatments can be removed. And even if it includes food and water that's medically provided, because there's no more obligation to provide that than there is to medically provide air to breathe, both of those are just as basic to human life. Yet, we would say if somebody's on a ventilator, there's no problem removing that if it's their wish. 

Mihretu: This is a brilliant analysis. 

Scott: Thank you very much. 

[laughter]

Scott: It’s about time you showed me some respect.

Mihretu: No, no, no, I always show respect. Sean, he doesn't really believe what I say.

Sean: I know, I know.

Mihretu: I think here, we need to bring into this discussion a sort of model I introduced in my chapter where I talk about the multi-track dispositional model. So, people who are in a vegetative state are still manifesting dispositions, even if they are not able to normally function in the way they used to function. So the manifestation of dispositions is not a one-way street. It's a two-way street. If I used to, for example, be rationally engaged with so many people, let's say through some sort of disability, and I no longer find myself in a position to be able to carry on that kind of activity. Still I'm a person, but I'm now manifesting a different kind of disposition, the disposition of not being able to do the things that I used to do, which means that my personhood is literally still there, intact. So I am not able to engage in activities that I used to engage in. So, another conundrum—for comatose patients, some are able to come back to, let's say, to regain their consciousness. They were able to tell the stories of what their relatives were saying, frustrated with them, and so on.

Sean: That’s crazy.

Mihretu: So the only thing that kept them being unable to respond was just, they couldn't order their bodies. There was no sync between the person and the person's body for some mysterious reasons. But when they regain their consciousness, they tell you that they were following everything that people were saying. What this means is, like, we need to be cautious. Just one of the writers in our book actually cautions us that there's a lot we don't know. So we are really kind of basing our conclusions on what we observe, but we're not really assessing things from the person's first-person perspective. So if a person is aware of what's going on and is, at the same time, not being able to respond to external stimuli, you can't say much with any degree of confidence about that person's experience. So we need to leave this door open. There's very mysterious stuff about this issue. 

Sean: Okay, so this is really helpful. Essentially what you're arguing is that the first question with bioethical issues, and in particular at the end of life is, is this individual still a person? We have to keep that in track. Then it helps us establish questions of, okay, how do we treat this person who's in a permanent vegetative state? Or maybe we think it's permanent, and it's not, and they're more aware, but this isn't just a physical body that's sitting there. It's a person. And so how we talk about them, how we help them, has to be established first to get our care for this person right. 

Scott: And I think, for example, we often have people say, what do I do? My elderly father or grandfather is in this horribly compromised state, who doesn't know the Lord. And what do I do? And I think there's a lot of merit to the suggestion that I often give people: I say, you know what I would do? Go to their bedside, go hold their hand, give them the gospel as straight as you know how, because there may be more going on in there than we realize. And even if they can't respond to you, there's still an opportunity to present the gospel to them and take advantage of that. And that's not inconsistent with somebody saying, I don't wanna be sustained in this vegetative state indefinitely. And I think we can stop treatments without necessarily causing the death of the patient. And what we can't do is directly cause the death of the patient by euthanasia or by assisted suicide. But stopping a treatment is allowing the disease or condition to take its natural course absent from any more medical interventions. And so, that's just a different thing morally. And the Supreme Court recognizes that's different legally, too, than assisted suicide or euthanasia. 

Sean: And you'd say that's a way of respecting the inherent dignity within the person by allowing a disease we cannot stop…to give them some sense of autonomy of saying, I just wanna be able to die because of this, without being full of diseases and machines. So you're not killing the person, you're allowing this to run its course by showing dignity to the individual. Is that a fair way of putting it? 

Scott: Yes. 

Mihretu: That's an excellent point. But at the same time, Scott was emphasizing, like, we shouldn't lose sight of the fact that the personhood question is already taken care of. These are persons. They're as much persons as anyone else is. So there's no confusion over that. So if a person is not willing to continue with that treatment, I think it's ethical to stop that. So there's no confusion here. The problem is, for so many philosophers, well, no, that's not even fully human, it’s a human vegetable. So we're not even dealing with a person, we're not even dealing with a full human being. It's less than a human being. Those are confusions that should be really rejected. 

Scott: And the thing is, both at the beginning and at the end of life, philosophers who hold that view don't have the stomach to follow it to its logical conclusions. Because they don't have the stomach to say, well, if these capacities are necessary to designate a person at the beginning of life, and fetuses and newborns up to a certain age still aren't demonstrating those capacities, then infanticide ought to be legal, at least for the first 30 to 60 days of life, if not more so. And at the end of life, if that's the case, then we no longer have a person, and consent to euthanasia is irrelevant. We ought to be able to euthanize anyone who's taking up resources unnecessarily in that view. 

Sean: That's really the power of a biblical worldview here, is that if individuals are persons, and we know they are because of the kind of thing that they are, the most important question is, how do we treat persons right in this vulnerable state? And I can't imagine being this individual who hears people saying things, like, they're costing us money or time, or maybe say mean stuff like, I hope they just die anyways. I mean, who knows what people say when they're unguarded? And you hear that, and can't do anything about it and come out of it. How painful such a thing would be. And your point is, there's a mystery there, that we really don't know how much people are cognizant, and are aware of this, and how much damage we could be doing. So taking persons seriously helps us with our care and respect of people in this vulnerable state. 

Scott: Yeah, maybe they're actually listening and taking names at the same time. 

[laughter]

Sean: There you go. Now, last question. What can people expect when they pick up this book? Because I endorsed it, I recommend it, but I want people to know this is not a light two to three hour airplane or Sunday afternoon read. These are academics, and it's probably, what, 400 pages? It's readable, but it's a book you’ve got to commit to to understand these issues. So, Mihretu, to maybe wrap this up by just saying what somebody could expect if they pick up Taking Persons Seriously. 

Mihretu: I think people can expect to really have a very good understanding of the metaphysical foundations that these chapters actually give for us to think clearly and in a healthy way about some important issues in bioethics. Let's say transhumanism. How should we think about transhumanism? How should we think about gene editing, for example, CRISPR technology? And how should we think about the dualism versus physicalism debate, and whether persons are degreed or there's a kind of a Boolean sort of algebra. Persons are, you are a person or not, black or white? Something like that. So there are so many things people can get from this book in palliative care, for example. 

Scott: That's sort of specific, as you were mentioning, about how we care for people at the end of life, given what we've established already about persons. 

Mihretu: Yeah. So this is an excellent book, and we respectfully deal with opposing views. We don't denigrate. We don't undermine. We don't come up with a cheap argument. We present in a fair way pros and cons and so on. So I think people can really enjoy this book, and it's a great place to start. 

Sean: And you do posthumanism and transhumanism because that's where questions of persons go. 

Mihretu: Yeah. 

Sean: Our definition of what it means to be a person, if it's functional, then all of a sudden robots and artificial intelligence can become persons. And this is where some debate is going. You guys deal with it in this book. Great book. Love it. For those who want to go deeper and have a biblical understanding of what it means to be a person, and how it applies to some of the most pressing bioethical issues of our day, check out Taking Persons Seriously. Mihretu, thank you for coming back. We'll certainly have you on again. 

Mihretu: Oh, thank you so very much. I will treat you guys to coffee or anything you want. Maybe a latte. 

Sean: Oh, before I close, we will take him up on that for the record next time. 

Scott: Like, right after we're done with this recording. 

Sean: Let’s go.

[laughter]

Mihretu: Even today. 

Sean: Hey friends, this has been an episode of the podcast Think Biblically, Conversations on Faith and Culture. The Think Biblically podcast is brought to you by Talbot School of Theology at Biola University, offering programs in Southern California and now online, including our Masters in Christian Apologetics that both Mihretu and I teach in, which is also fully distanced. We love your comments and your questions. Please send them to thinkbiblically@biola.edu. Scott, we finally got a thousand reviews. 

Scott: Oh, terrific.

Sean: I was sending out tweets, getting people to just wrap it up. We got a thousand reviews. Every single one helps. So if you enjoyed today's conversation with this podcast, please just take a couple moments to give us a rating on your podcast app and consider sharing it with a friend. We appreciate you listening, and we will see you Friday for our weekly Cultural Update. And remember, in the meantime, to think biblically about everything.