As I tell my students, the metaphysical question of personal identity has important moral implications. One scenario I use is a human in a persistent vegetative state. I say “human” rather than “person”, because the human body might no longer be a person. For a metaphysical dualist, if a person is her soul and the soul has abandoned the shell, then the person is gone.
If the human is still a person, then it seems reasonable to believe they have a different moral status than a body that that was once a person (or once served as the body of a person). This is not to say that a non-person human would have no moral status—I do not want to be misinterpreted as holding that view. Rather, my view is that personhood is a relevant factor in the morality of how an entity should be treated.
Imagine a human in that vegetative state. While the body is kept alive, people do not talk to the body and no attempt is made to entertain the body, such as playing music or audiobooks. If there is no person present or if there is a person present who cannot sense anything, then this would seem morally acceptable—after all it would make no difference whether people talked to the body or not.
There is also the moral question of whether such a body should be kept alive—after all, if the person is gone, there would not seem to be a compelling reason to keep an empty shell alive. To use an extreme example, it would seem wrong to keep a headless body alive just because it can be kept alive. If the body is no longer a person (or no longer hosts a person), then this would be analogous to keeping a headless body alive.
But, if despite appearances, there is still a person present who is aware of what is going on around them, then the matter is morally different. In this case, the person has been isolated—which is very bad for a person. They have, in effect, been sentenced to solitary confinement.
In terms of keeping the body alive, if there is a person present, then the situation would be morally different. After all, the moral status of a person is different from that of a body of merely living flesh. The moral challenge, then, is deciding what to do.
One option is, obviously enough, to treat all seemingly vegetative (as opposed to clearly brain dead) bodies as if the person was still present. That is, the body would be accorded with the moral status of a person and treated as such.
This is a morally safe option—it would presumably be better if some non-persons get treated as persons rather than risk persons being treated as non-persons. That said, it would still seem both useful and important to know.
One reason to know is purely practical: if people know that a person is present, then they would presumably be more inclined to take the effort to treat the person as a person. So, for example, if the family and medical staff knew that Bill is still Bill and not just an empty shell, they would, one would hope, tend to be more diligent in treating Bill as a person.
Another reason to know is both practical and moral: scenarios arise in which hard choices must be made, knowing whether a person is present is critical. That said, given that one might not know for sure that the body is not a person anymore it could be correct to keep treating the alleged shell as a person even when it seems likely that they are not. This brings up the obvious practical problem: how to tell when a person is present.
Most of the time we judge there is a person present based on appearance, using the assumption that a human is a person. Of course, there might be non-human people and there might be biological humans that are not people (living headless bodies, for example). A somewhat more sophisticated approach is to use Descartes’s test: things that use true language are people. Descartes, being a smart person, did not limit language to speaking or writing—he included making signs of the sort used to communicate with the deaf. In a practical sense, getting an intelligent response to an inquiry can be seen as a sign that a person is present. Or that the LLM is working well.
In the case of a body in an apparent vegetative state, applying this test is a challenge as this state is marked by an inability to show awareness. In some cases, the apparent vegetative state is exactly what it appears to be. In other cases, a person might be in “locked-in-syndrome.” The person is conscious but can be mistaken for being minimally conscious or in a vegetative state. Since the person cannot, typically, respond by giving an external sign some other means is necessary.
One breakthrough in this area is due to Adrian M. Owen. He found that if a person is asked to visualize certain activities (playing tennis, for example), doing so will trigger different areas of the brain and this activity can be detected. So, a person can ask a question such as “did you go to college at Michigan State?” and request that the person visualize playing tennis for “yes” or visualize walking around her house for “no.” This method provides a way of determining that the person is still present with a reasonable degree of confidence. Naturally, a failure to respond would not prove that a person is not present, the person could still remain, yet be unable (or unwilling) to hear or respond.
One moral issue this method can help address is that of terminating life support. “Pulling the plug” on what might be a person without consent is morally problematic. If a person is still present and can be reached by Owen’s method, then this would allow the person to agree to or request that they be taken off life support. Naturally, there would be practical questions about the accuracy of the method, but this is distinct from the more abstract ethical issue.
It must be noted that the consent of the person would not automatically make termination morally acceptable—after all, there are moral objections to letting a person die in this manner even when the person is clearly conscious. Once it is established that the method adequately shows consent (or lack of consent), the broader moral issue of the right to die would need to be addressed.
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