Embodiment to Thinking Things and Back Again: Personhood and Cognitive Decline

Jeronimo Ayesta – Doctoral Candidate, Department of Philosophy, Boston College; Sofia Carozza, PhD, MPhil – Research Fellow, Neurology, Brigham and Women's Hospital; Michael Egan – Director of Operations, Hippocratic Society; Maria Kolesarova – Assistant Professor, Institute of Social Medicine and Medical Ethics, Comenius University

Abstract: Patients living with brain tumors (PLBTs) suffer from unique existential, physical, and emotional challenges. High-grade gliomas are incurable, and glioblastoma, its most aggressive form, has an overall survival of only 1.5 years from diagnosis. PLBTs experience both rapid cognitive decline and the existential connotations of an oncology diagnosis. Therefore, PLBTs face unique challenges navigating their daily activities of living and have a greater dependency on those around them. In this paper, we recount the shift, influenced by the Enlightenment, in the conception of human personhood from embodied rational animals (hylomorphic body and soul) to thinking things (Cogito, ergo sum), arguing that this trend has led Western societies to consider and treat patients as “less of a person” when their cognition deteriorates. Stepping back from Enlightenment assumptions, we highlight a different approach to PLBTs. Drawing on the perspectives of Alasdair McIntyre and Hans Jonas, we recall the philosophical approach that emphasizes radical dependence, vulnerability, and embodied relationality as essential to personhood. We explore their understanding of personhood as a means for PLBTs to flourish in the context of their relationships, as they contribute to the development of MacIntyre’s “virtues of acknowledged dependence.” Finally, we describe the implications of this model for the clinical treatment of PLBTs and the patient-physician relationship, reviewing empirical evidence from a systematic review of non-cognitive therapeutic interventions that can prepare cognitively impaired patients for end-of-life. We argue that the current interventions aimed at PLBTs are inadequate in promoting the relationships in which PLBTs participate and flourish

Keywords: Personhood, Cognitive Impairment, End-of-Life Care