Ideas You Didn’t Know You Had: Who Are You?

There is a common type of case study presented in many bioethics textbooks. It concerns a person (usually a woman, for some reason) who is suffering from somewhat advanced dementia. She is often described as having been someone who was highly intelligent, who had a professional career in which she accomplished much, and who would have, in her earlier incarnation, seen her current condition — no longer able to read a book, follow a conversation, or express her desires — as a personal version of hell.

Drawing from René Descartes' (1596-1650) in "Treatise of Man," Public Domain, via Wikimedia Commons

Drawing from René Descartes’ (1596-1650) in “Treatise of Man,” Public Domain, via Wikimedia Commons

However, the person she now is seems reasonably content, enjoying her dessert, painting simple pictures, watching TV. We are then asked the question: if she develops pneumonia or the flu, should she be treated or should she be allowed to die? The person she used to be would have preferred to die rather than continue to exist in her present state – but can we be sure that the person she is now would give the same answer?

As bioethicists struggle with this question, it very quickly becomes clear that any answer we might give depends entirely on who we understand her to be: if we understand her to be a continuing self, we will see her as someone who has lost most of the capacities that made her the individual she was and for whom life is therefore no longer worth living. On the other hand, we might decide that while the old person is lost, a new person has taken her place and that new person would like to continue to live.

Whatever answer readers of The Cape Breton Spectator are inclined to give to the question of whether or not she should be treated, I want to note that there is something deeply mysterious here: who is this person, and where is her mind? Further, what is the connection between personal identity, mind, brain and embodiment? To answer these questions, we need to turn to the explorations of the concepts of mind, body, brain and personhood engaged in by philosophers.

Philosophy is sometimes thought by non-philosophers to be an esoteric discipline, concerned with abstract questions that only a few odd philosophers might be interested in. However, as the case study described above makes clear, this is not true: how we understand ourselves as persons will shape the way in which we answer questions as practical as whether or not we should honor the prior wishes of people who develop dementia – and not only whether or not we will treat them for pneumonia, but also whether or not we will insert feeding tubes if they become unable to eat normally, or use any other life-extending measures.

Philosophy, then, from its earliest beginnings to many of the issues with which it grapples today, engages with questions that are fundamentally important to how we understand ourselves, and to how we live our lives, both as individuals and as members of communities. Moreover, it is no exaggeration to say, I think, that most non-philosophers actually hold ideas that are, at their heart, deeply philosophical, and which can, in their origins, be traced to the work of particular philosophers writing in distinct historical periods. To demonstrate the legitimacy of these claims to readers, I have decided to write an occasional series of columns on the theme of “Philosophical ideas you may not have known you had,” along with a follow-up piece (or two) to explore the implications of these ideas in the “real” world that exists outside of philosophical texts and classrooms.


The first philosophical idea I expect most of my readers to share is that mind and body are distinct and separate from one another, and that our personality, identity, and all of the things which most fundamentally make us who we are are located, not in the body, but in the mind. Our bodies, that is to say, are merely a kind of organic machine that carries our minds around. It is this belief, of course, that makes dementia and the question of how we should treat those persons who suffer from this disease, medically-speaking, so mysterious: these people seem to both be there (as embodied creatures) and not there (as the particular persons they once were) at the same time.

After Frans Hals Portrait of René Descartes, 1596-1650, Public Domain via Wikimedia Commons.

After Frans Hals Portrait of René Descartes, 1596-1650, Public Domain via Wikimedia Commons.

The idea that mind and body are radically distinct from one another, however, far from being a natural way in which to understand ourselves, can actually be traced back to a thought experiment proposed by René Descartes. Descartes was trying to put all genuine knowledge on a firm foundation, a foundation he believed could be found if he doubted everything he possibly could until he reached a belief that could not possibly be false. To find this belief, he considered whether he was awake or dreaming, whether the information provided by his senses might be false, and even whether he could be certain that he had a body.

What he discovered was that, even if all his beliefs about the world, everything in it and his own embodiment turned out to be false, what he could know for certain was that he existed, at least as an entity that was able to doubt – as, we would say, a mind. While he eventually reconstructed the world, he also created a radical separation between mind and body: mind, he argued, is immaterial, and the contents of the mind relatively certain while the body is composed of physical material, and is a source of sometimes false information. Consequently, mind is more important than body for Descartes – and, because this thought experiment changed the way in which most people in the West understand themselves, we now tend to think that mind is, indeed, more important than body when it comes to thinking about who we are, and that our minds and bodies are clearly different from one another.

I shall explore some of the implications of Cartesian mind-body dualism (as this perspective is called) in subsequent columns, but let’s return to the sick patient with dementia. She presents us with a puzzle precisely because Cartesian dualism makes not only our minds puzzling (for example, what is the connection between immaterial minds and material bodies?) but our bodies as well. How, for instance, is embodiment connected to personal identity? Should we view the body as a kind of machine that carries disembodied minds around? Or should we refuse to distinguish mind from body in the way Descartes does?

Until we can answer these questions with some degree of certainty, it’s not at all clear what is morally required of us when people like the patient with dementia presented in the case study become physically ill and need medical treatment. Further, however, given that any of us may become those people for whom such decisions need to be made, how this question is answered is important for each of us.


Rachel Haliburton


Wolfville native Rachel Haliburton teaches philosophy at the University of Sudbury. She is working on a book that explores the ethical dimensions of detective fiction.