The ordeal of reminding: Traumatic brain injury and the goals of care

Hastings Center Report

Volumn 36, Issue 2, 2006, Pages 29-37

  Jennings, Bruce ^a  

^a NONE

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; AWARENESS; BRAIN INJURY; CAREGIVER; CULTURAL FACTOR; DISABLED PERSON; ETHICS; HEALTH CARE AND PUBLIC HEALTH; HUMAN; HUMAN RELATION; MEDICAL ETHICS; MORALITY; PERSONAL AUTONOMY; PERSONHOOD; PSYCHOLOGICAL ASPECT; QUALITY OF LIFE; REHABILITATION; TRUST; UNITED STATES;

HEALTH CARE AND PUBLIC HEALTH;

AWARENESS; BRAIN INJURIES; CAREGIVERS; CULTURAL CHARACTERISTICS; DISABLED PERSONS; ETHICS, CLINICAL; HUMANS; INTERPERSONAL RELATIONS; MORAL OBLIGATIONS; PERSONAL AUTONOMY; PERSONHOOD; QUALITY OF LIFE; REHABILITATION; TRUST; UNITED STATES;

EID: 33645952009     PISSN: 00930334     EISSN: None     Source Type: Journal    
DOI: 10.1353/hcr.2006.0026     Document Type: Review

References (24)

1. W.J. Winslade, Confronting Traumatic Brian Injury (New Haven, Conn.: Yale University Press, 1998). Unless otherwise noted, the data and clinical information about TBI mentioned in this paper comes from this work.
2. L. Thomas, The Lives of a Cell: Notes of a Biology Watcher (New York: Viking Press, 1974).
3. Winslade, Confronting Traumatic Brian Injury, 11.
4. In formulating this distinction I do not intend to embrace a metaphysical dichotomy or to return to some version of ontological dualism, such as Descartes' distinction between thinking substance and material substance. The way I think about the relation between the brain and the mind can best be explained by use of the following analogy. Consider a set of wooden chess pieces. The game of chess relies on the existence of the chess pieces as a kind of medium through which the game is played, but the wooden pieces do not create the reality of the game of chess. The rules of chess and the agency of the players in devising various styles and strategies of play within the rules do that. Rules and agency constitute the game of chess. If wooden pieces were not available, some other material medium could be found with which to play the game. The brain is certainly the biochemical and electrical medium through which mental processes take place, but they are no more "reducible" to this medium than the game of chess is reducible to the wood or plastic or ivory of the pieces. Neither dualism nor reductionism are the best way to think about this relationship. The brain is the precondition for the mind, but something else-consciousness, agency, self-identity, language and other semiotic systems, social and cultural rules-constitutes it. This way of thinking owes much, I believe, to the work of George Herbert Mead, L.S. Vygotski, and Ludwig Wittgenstein. I have been particularly influenced in my own thinking by the more recent work in this tradition by Rom Harré and Grant Gillett. See R. Harré, The Singular Self (London, U.K.: Sage Publications, 1998)
5. and R. Harré and G. Gillett, The Discursive Mind (Thousand Oakes, Calif.: Sage Publications, 1994).
6. This is parallel to the perspective developed by Eric Cassell: bodies experience pain; persons suffer. See The Nature of Suffering and the Goals of Medicine (New York: Oxford University Press, 1991).
7. Quite a good example and account of the process of recognizing how conventional responses are inadequate, and yet also all one has, is given by Cathy Crimmins in her account of her husband's TBI in Where Is the Mango Princess? (New York: Alfred E. Knopf, 2000).
8. J. Irving, The World According to Garp (New York: Ballantine Books, 1990 [1976]).
9. The World According to Garp Ibid., 15-31.
10. W. Stevens, "The Idea of Order in Key West," The Collected Poems of Wallace Stevens (New York: Vintage Books, 1990), 128-30.
11. N.V. March et al., "Caregiver Burden at 1 Year Following Severe Traumatic Brain Injury," Brain Injury 12, 12 (1998): 1045-59.
12. D. Parfit, Reasons and Persons (New York: Oxford University Press, 1984), 493-502;
13. and D. Brock, "Quality of Life Measures in Health Care and Medical Ethics," in The Quality of Life, ed. M.C. Nussbaum and A. Sen (New York: Cambridge University Press, 1993), 95-139.
14. The preceding account is drawn in part from B. Jennings, "A Life Greater than the Sum of Its Sensations: Ethics, Dementia, and the Quality of Life," in Assessing Quality of Life in Alzheimer's Disease, ed. S.M. Albert and R.G. Logsdon (New York: Springer, 2000), 165-78.
15. In the analysis contained in this section, I have been influenced principally by the work of Rom Harré, cited above in note 4, and by J. Roessler and N. Elian, eds., Agency and Self-Awareness (Oxford, UK: Oxford University Press, 2003);
16. E. Tugendhat, Self-Consciousness and Self-Determination (Cambridge, Mass.: MIT Press, 1986); .
17. J.L. Bermudez, A. Marcel, and N. Eilan, eds. The Body and the Self (Cambridge, Mass.: MIT Press, 1998) ;
18. and J. Radden, Divided Minds and Successive Selves: Ethical Issues in Disorders of Identity and Personality (Cambridge, Mass.: MIT Press, 1996).
19. For parallel lessons from the experience of Alzheimer disease, see T. Kitwood, Dementia Reconsidered (Buckingham, UK: Open University Press, 1997);
20. J. Killick and K. Allan, Communication and the Care of People with Dementia (Buckingham, U.K.: Open University Press, 2001);
21. S.R. Sabat and R. Harré, "The Construction and Deconstruction of Self in Alzheimer's Disease," Ageing and Society 12 (1992): 443-61;
22. and A. Jaworska, "Respecting the Margins of Agency: Alzheimer's Patients and the Capacity to Value," Philosophy and Public Affairs 28, 2 (Spring 1999): 105-38.
23. T. Kitwood, Dementia Reconsidered, 144.
24. I have discussed these issues at greater length in "Freedom Fading: On Dementia, Best Interests, and Public Safety," The Georgia Law Review 35, 2 (Winter 2001): 593-619.