JounuiloJAilvanccilNursinfi, 1987.12,245 249

Concept ofthe person: introduction to the health professionals^curriculum

Christine Henry SRN HV cert BEd MEd(Phil) PhD Senior Lecturer in Psychology/Heallh.

Department of Health Studies, Sheffield City Polytechnic and A. C. Tuxill BA(Hons) Principal

Lecturer in Ethics, Department of Public Administration, Sheffield City Polytechnic, 36 Collegiate

Crescent, Sheffield S10 2BP

Accepted for publication 6 June 1986

HENRY C. 8L TUXILL A.C. {]9^1) Journal of Advanced Nursing 12. 245 249Concept ofthe person: an introduction to the health professionals' curriculumThis paper deals with the concept of the person and its necessity in health care and healthcurrieula. Specitically it looks at aspects of both the biological and social sciences. Further,there is some suggestion that for caring professionals in particular the concept of the personrequires more analysis than purely a 'common sense' everyday meaning and use. and that thereis some requirement for sorting out and understanding the difTerence and the interconnectionsofthe two terms 'human" and 'person'. This first proposal will be followed by a further paper thatdiscusses in more detail the distinction between the two terms and the moral issues that derivefrom the centrality of use of the concept of the person by the health professions.

INTRODLCTION

In common sense everyday language the terms•person' and 'human' are used interchangeably(Henry 1986). Nevertheless, it is essential toremark that there is a distinction between thetwo terms 'human' and 'person". The term'person' generally encompasses more evaluativeand prescripti\e aspects than the term 'human*and therefore is central in its meaning and usewhen attributing respect and value to each indi-vidual, and. in turn, avoids depersonalization.This paper attempts to support the proposal thatthe concept of the person therefore requiresfurther clarification by the caring professionsand ought to be a part of the curriculum(perhaps integrated through the social sciencesand ethical perspective).

First, it seems necessary to discuss aspects ofthe curriculum usually seen as important for thecaring professions. It is only within the last10-15 years that a balance has been soughtbetween the biological sciences and the social

sciences, particularly for ihc health professions.In ihe educalion and social work fields therehas been a longer traditional acceptance relatinglo the social sciences in particular. Generally,the areas of knowledge that the caring pro-fessions have used have broadened and therehas been some attempt to encourage specificepistemological application in order to enhancecare. Parallel to this development is the view thatthe individual person is the central characterfor concern (one may refer to the nursing pro-cess, child-centred education and client-centredemphasis in the respective fields).

BIOLOGICAL SCIENCES

It is essential to discuss biological sciences inrelation to the health professions only becauseof the central and important aspect of its use.Whilst there is certainly evidence of rejecting thetraditional medical model by some health pro-fessionals, problems still occur with its extreme

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appIiciUion. It can he scon thai llicrc is an uneasyami uiKoiiiforlablc relationship witliin the curri-culum IxMwccn the biological ami social scienceswhich retlects the major Ciinlroversy surn^uiul-mg the question, \\liat constitutes science andareas of knowledge that aecrue more statusepistenioIogicallyV Further, there is the moreobvious problem of viewing the individual onlyas an organic organism. Both ofthese aspects areimportant for philosophical debate in that thetormer in\ol\es meaning and use oT the term'science" and uhal would properly constitute ascientific domain, and the latter involves ethicalissues for actions and decisions taken in relationto care.

Hidden dangers

II the central constructs of explanation inrelation to the indi\idual who is ill take on arigorously biological perspective (which fitsnicely with the medical model) then there is,on one le\el. a hidden danger of cognitivelyintcrnali/ing such a \ ie\\ and treating the personas an object or as a particular biological dysfunc-tion, for example *the appendectomy in bed 14*or *the coma in bay 12'.

Underpinning the biological science is amateriahstic reductionistic and causal modelwhich fits into a posttivistic picture; the term•p>erson' does not seem rele\ant to technical orscientific descriptions, whereas more specificallythe term 'human* can be seen as purely descrip-tive relerring to species membership. From aphilosophical stance both Abelson (1977) andHarris (19H5) remark that the concept of theperson is species neutral. In other words it is nota natural concept referring to membership of abiological species but is a purely normative term(Abelson 1977). Further, the meaning and inten-tion of the term 'person* allows for the logicalpossibility of a non-human person existing(Teichman 1972). This can be problematic if theargument in philosophical terms allows for thepossibility of a non-human person.

At this stage it seems appropriate to reintro-duce the necessity for a distinction to be madebetween the terms 'person' and 'human* andto state that a common sense viewpoint is notsufficient for the caring professions in respectof actions taken and decisions made. The major

concern ofthe aspects discussed so far is that anyone profession which uses a biological frame ofreference, particularly in relation to care, mustreview a ccMicept of the person more closely Oneis not advocating that biologists should laketime out from their specialism and educate them-selves on the concept ofthe person, but perhapstaking a philosophical look at their subjectmay encourage more awareness. However, onewould advocate that the medical professionmight do this even if caring is seen as peripheralto their discipline. Further, it is essential that thehealth professional concerns her/himself morewith thinking about the concept of the personsimply because not only do they use and applythe biological sciences but also they may be seenas the patient's advocate. It is therefore necess-ary that they have the knowledge to check andeven monitor the medic's care. Looking at theconcept of the person as an integrated part ofthehealth professional's curriculum may also serveto strengthen the links between the biologicaland social sciences.

SOCIAL SCIENCES

On one level the social sciences may be morepredisposed to using the term 'person* in aunified and meaningful way. This is partly dueto the fact that the term 'person' has a socialelement in relation to status and social features.One obvious reminder of this is the attempt inNazi Germany to strip a whole race of peopleof their personhood by denying them socialidentity, rights, freedom of choice and socialinteraction. Present day sociological studiesemphasize the danger of denying individualperson features within the various institutions.e.g. hospitals, schools and prisons.

What is important for the caring professions isthe individual person and so theories explored inthe social science domain which highlight theperson appear more relevant. This is not tosay that other theories in a more positivistictradition are not relevant to understandingaspects of persons, such as learning. However,the concern is with persons, not rats, eats inpuzzle boxes or deprived monkeys. (It is necess-ary to remind ourselves of the ethical issueswhich surround the use of animals, particularlyfor trivial psychological experimentation.)

Concept of ihe person 247

Further, this lias implications Ibr person statusgiven to non-humans, especially if they arestrikiniih like us, indeed some animals are nearto making It into the person class (Sprague1^78).

With some qualification it can be suggestedthat the social sciences have developed into twobroadly disparate areas of study, namely, thepositixistic and humanistic approaches. Thiscrude di\ ision sutVices in order lo lease out someofthe problems that arise. Generally speaking,in line with the positivistic approach are theoriesof behaviourism, psychobiological approaches,psychomelrics and experimenlal psychologywhich includes arliticial intelligence. In theseareas there is little room for a unified concepto{' the person, and the same can be said oi' thebiological sciences. In order to emphasize thispoint an example can be given. Watson (citedin Gabriel 1980) changed psychology from thestudy of consciousness to the study of behaviour.Inlerestingly. the development in the humanisticand phenomenological perspectives begin tobring the development full circle, returningto the study of consciousness (Henry 1986).Behaviour can be observed and seen to be moreobjective. Extreme behaviourism sees the indi-\idual purely as a stimulus response model andthe intervening organism is ignored becauseiniernal representations cannol be observed.The person is seen as a reactor to stimuli andconsciousness runs parallel to the S R bonds.There is a danger of taking it as an extremelyuseful form of psychological management whichagain fits nicely with a medical mode! in that theindividual is an object to manipulate. There has.therefore, been a move away in psychology notonly to turn back and consider aspects of humanconsciousness, but also to avoid the mechanisticdehumanizing viewpoint put forward by causalmodels of behaviour.

The humanistic movement sees the individualas more active, responsible and free. Theapproach deals more with human featuresof intentionally, meaning and interpretation.Higher self-concept, idiosyncratic constructsand some social cognitive models deal with theinfluences on experience and ways of thinking.Exploring the psychological models could be athesis in itself, so perhaps one should restate thatalthough the humanistic tradition has problemsof definition in the rather loose concepts used, it

inevitably can be grounded in a phenomeno-logica! framework which is more consistent witha pyschology ofthe person (Henry 1986). Simi-larly, in sociology some particular perspectiveslend themselves to be more relevant for the con-cept ofthe person, for example the interactionistapproach, ethnomethodology, phenomenologyand the areas of sociology that certainly overlapwith social psychology when studying aspects ofrole, attitude and social perception, all higherorder person features.

Taking the assumption that the social sciencesought to concentrate on either a psychology orsociology of the person is not saying that onedisregards other approaches in the positivistictradition. They can still be useful conceptualschemes for application and for understandingparticular aspects of the person. It is only thatthe boundaries change somewhat and levels ofemphasis alter in order to encourage integrationof the concept of the person within the socialsciences.

In returning to the initial claim for morepurposeful guidelines for thinking about theconcept of the person and the need for more thanjust a common sense use. it is important to men-tion that a more formal and rigorous explorationhas already begun through the leaching of ethicsto health professionals. There is a need for somekind of preliminary introduction to the moralissues that surround actions and decisions madeby professionals and how the concept of theperson can be seen to be central.

Abelson (1977)claims that the term 'person* ispurely normative and evaluative like the term'good'. On the other hand, the term 'human'is semi-normalive and descriptive. The semi-normative element of the term 'human' indicatesaspects and characteristics that we value abouthumans and may link to the notion that in com-mon sense everyday use the terms 'human' and'person* can be used interchangeably. However,the descriptive element refers to species member-ship. The term 'person', on the other hand, isseen not only as unanalysable but is viewed asspecies neutral. Abelson (1977) states thatneither logic nor language can solve the problemof who should and should not be counted as aperson. It is an open-ended concept with moraland psychological predicates that are free frombiological classifications. Some philosopherslike Descartes (cited by Henry 1986), with

248 C.HrnrvantiA.C. Tuxiil

his separation of mind and body and attributionof mind as a central (>erson feature, held it tobe qiiite inconceivable that any material mech-anism could ihink Kant \ Mewpt>inl itevelopetlfurther and avoided the purely metaphysicalassumption of Descartes which saw the non-material mind as neither temporal nor spatial.Kant (cited by Rorty 1980) claimed that inreality the psychological aspects were at leasttemporal (Kant is associated with the origins of

Hampshire (l^S^j) aiul other ci>iitcmporaryphilosophers attribute features of self-reflection,intentions and language to persons as distinctfrom non-persons. This notion of attributingfeatures to persons can be conceptualized byDennett's (1979) proposal of six necessary butnot sutVicienl conditions of personhood. Briefly,these are rationality, states o\' consciousness(intentional and psychological), the social aspectof being treated as a person, being able toreciprocate in some way. language and self-consciousness. Dennett (1979) claims that hisview is only an ideal but having a conscious,rational, feeling agent is a necessary conditionfor moral personhood. This relates to thenotion that morality derives from rationalityand obviously relates to respect for persons.

Social context

There is also an alternative way of lookingat persons presented through a Wittgensteinapproach (cited by Teichman 1972). Thisemphasizes the importance of influences within asocial context. Wittgenstein avoids asking whatfeatures are applicable and states that, throughlanguage, what we mean lies in the way we useterms in different language games ('forms of life'that we share). Wittgenstein's viewpoint maywell explain our common sense usage of theterms 'human' and 'person' which we tend to useinterchangeably (especially if Teichman is rightabout the term 'human' being used as a startingpoint for the term ^person*). A very crudeexample of Wittgenstein*s explanation can beshown: within one language game betweenbiologists the term 'human' may specificallyrefer to species membership, in another languagegame between a social group the term 'human'

may be used to mean the same thing as (he term'person' or the two terms used interchangeably,

Of relevance for educators is recent researchihat attempts to identify common sense modelsol the person. I he younger child has a tendencyfor non-discrimination between 'human' and'person' and this may be explained by the factthat theehild is more context-bound and that theterm 'human' is indeed a starting point for theterm 'person'. A Wittgenstein viewpoint is againrelevant (cited by Teichman 1972). The problemarises, however, of whether it is always the casefor older subjects? Interestingly, older adoles-cents, although still showing variations in theirconcept of the person, appear less context-bound and more abstract in their thinking and,in some cases, approximate more to Dennett's(1979) idea! type o\' the concept of the person.Further, some adults from the professions ofnursing, teaching and medicine, display similartendencies. In relation to a curriculum for thecaring professionals both the ideal concept ofthe person, including moral personhood, andWittgenstein's viewpoint could be exploredmore fully.

CONCLUSION

To conclude, it is pertinent to mentionTeichman's( 1985) remark that, from her point ofview, it is only philosophy students that begin toattribute features of rationality, self-awareness,etc. to persons. Research shows that this is notthe case; adolescents and professionals alreadyhave abstract thoughts which approximate to-wards Dennett's (1979) ideal concept — perhapsinfluenced by their education generally. Why notharness this tendency in a more formal waywhich, in turn, will encourage an awareness ofthecentrality of personhood and perhaps, in thelong term, initiate a better quality of care?Finally. Teichman remarks that the moral view-point is important because it exists for humanbeings (persons). Midgley (1983) reminds us thatit also exists in order to give consideration tonon-humans, other animals and non-personstoo. What is important is that the person can beseen as being a moral agent (dependent uponbeing a rational, feeling and conscious agent)and, ideally, would not only extend moral

Concept of the person 249

consideration to its own 'rational species'(Teichman's term) but also other beings whowere not members. I his might include the fetus,the iiuliv idual w ho was on a life support machineand possibly with brain death, and even dolphinsor chimpanzees.

Rofcrcnecs

Ahclson R (1977) Persons .4 Stmiy in Philosophical P.sychohgyMacmillan. London,

Dcnnctl D. (1979) Brainstorms Harvester Press. Sussex.

GtihricI (" {I9H0)TheileveIopnien( of psychology us a science. InA !\-\thook nf /*.\\thology (Rudlord J, & Govicr E. eds),Sheldon Press. London,

Iliinipshirc S. (I9.S9) Thoughl and Acfion ChaKo and Windus,London,

M.irris (I9H5) The Wthw of Life. Roulledge and Kegan Paul.London

Henry LC {19H6) Conceptions of ihc nature of the persons: atheoretical and empirical sludy Unpublished PhD thesis,

Midgley M (19S1) Animals unil Why lhc\ Mallvr — a Journeyarowui the Species Barrel Penguin. Harmondsworlh,

Rorty R (WSO) Philosophy and the Mirror of Nature. BasilBlackwell. Oxford.

Sprague t (I97S) Metaphysical Thinking. Oxford UniversityPress. Oxford-

Teichman J, (1972) Wittgenstein on persons and human beings. Ini'mierstanding Wittgenstein. Macmillan, London,