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 patientâ€™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.
Part of the book: Bioethics
Drawing on recent work in cognitive linguistics and social studies of knowledge practices, this chapter explores the various ways in which the figure of a balance sheet frames arguments and positions in end-of-life care. Across arguments and positions, there are substantial differences in the kinds of matter that are balanced against each other and the values attributed to them, and which items are allowed as entries on the balance sheet and which are not. A common currency on the balance sheets is human suffering. Comparing Norwegian and Dutch end-of-life care practices, the argument is elaborated by looking at (a) the personal balance sheets of cancer patients, (b) the balance sheets of euthanasia, assisted suicide, and palliative sedation, and (c) the balance sheets that set patient’s right to self-determination up against health professional’s right to conscience. Finally, the different ways in which the balance sheets are operated are considered with regard to their impact on the level of constraints that the different end-of-life care policies put on patients and health professionals, and how these shape the material conditions of our dying.
Part of the book: Highlights on Several Underestimated Topics in Palliative Care