Truncated Autonomy: Neocortical Selves, Reverse Reductionism and End-of-Life Care

Abstract

In professional guidelines for palliative sedation in end-of life care, a particular notion of conscious life experience is associated with specific cognitivist notion of frontal lobe autonomy. Drawing on Turner and Fauconnier’s work in cognitive linguistics I argue in this chapter that even our most central notions like human subjectivity and autonomy are conceptual blends. This chapter explores the origins and emergence of these concepts and their entailments. It digs deep into the conceptual blending of the ontogenetic development of the individual with the phylogenetic history of life. This hyper-blend of the flesh is contrasted with the hyper-blend of an irreal, non-material deep, inner space that is co-extensive with consciousness and with the rational, operative agent constituting the human subject. The last part of the chapter explores the frictions and problematic entailments of these different hyper-blends for end-of-life care practices concerning brain death, persistent vegetative state and palliative sedation. Despite respect for a patient’s autonomy being first among the principles of medical ethics, cognitivist criteria used in the assessment of a patient’s decision-making competence reduce and constrain (truncate) the patient’s autonomy in a variety of ways in one of the situations in life where it should matter most, in dying.