a girlfriend who is a professional
public speaker and he tends to end his
after-dinner speeches by saying
something along the lines of my name is
Graham Davis of whom it is often said
who now I like that not just because
it’s engaging these self-deprecating but
because it expresses one of the most
fundamental questions which we can ask
about ourselves one of the voices
fundamental one of the most challenging
one of the most repercussion one of the
most difficult is one which all
reflective people ask all the time that
supposed to be a photograph of me up on
the Left who is Charles Foster I don’t
know the boundaries of Charles Foster
are incredibly porous they bleed into
all other people and all other
circumstances in which I find myself
what is chance Foster answer he can only
be defined in terms of the nexus of
relationships in which he exists
Polonius said to thine own self be true
a very big ask it invokes a lot of
questions the Delphic Oracle said know
thyself very important very difficult
we’re obsessed by these questions or
should be if you search google for
personal authenticity you will have
millions of hits those questions are
interesting difficult tremendously
important but the law and medicine
disagree that they are either so the law
tends to see human beings not in that
porous relational way than I’ve
described but as atomistic billiard
balls with very hard boundaries the law
finds no difficulty in pointing to
Charles Foster and saying that’s where
he is that’s what he is it has a
narrowly contractual view of Charles
Foster it assumes that Charles Foster is
the same for all purposes and through
all phases of his life it assumes that
the person on the birth certificate is
the
whose name will be on the death
certificate and medicine is not much
more nuanced if you go to see a
psychiatrist
the psychiatrist will try to put you
back into your right mind it assumes as
a you which can be restored it assumes
that disease is something which takes
your soul away from you and that your
soul can be restored by giving you a bit
of medicine the doctor might say to you
you’re not looking yourself today
just think of the philosophical baggage
which that doctor has we have huge
brains why do we have huge brains
they’re very expensive the amount of
space within our head is very limited it
is prime real estate and accordingly to
develop a huge brain demands a massive
payoff the payoff is Association the
payoff is the ability to relate to one
another
which is a very difficult thing to do
but comes with massive selective
advantages so what are human beings the
most social of all animals answer to a
first degree of approximation they are
above everything else
relational animals you know what to use
the expression that I’ve used already
they are creatures with porous
boundaries and should be defined that
way that thought is reflected in medical
ethics typically by respect for the
notion of autonomy read lots of medical
ethical texts only think that that is
the only principle which should be in
play and very important it is to medical
ethics medical law without autonomy is a
terrifying frightening arena we got to
ask whose autonomy am I really
autonomous I didn’t have anything to do
with my own conception I didn’t have
anything to do with my own gestation I
didn’t have much to do with my own
upbringing when I came here yesterday in
a magnificent Swiss air jet I was
entirely I’m at the hands of the pilot
and the people who programmed the
computers which made that plane fly
I wear lots of hats and my preferences
differ massively my identity to some
extent arguably differs massively with
watch which hat I’m wearing sometimes I
am a father sometimes I am a barrister
sometimes I am a tedious academic at the
University of Oxford sometimes I’m a
fearful mortal poised queasily I’m on
the edge of eternities precipice and
what I say about myself and the things
that I say are important to me will
differ depending on which hat I’m
wearing I want to tell you a few stories
I invite you to use these stories as a
way of interrogating your own
presumptions about what you think you
are about what you think identity is the
first relates to deep brain stimulation
so for various conditions like
Parkinson’s disease or
obsessive-compulsive disorder you can
stick an electrode into your brain when
the current is switched on your brain is
electronically tickled and the
Parkinson’s and symptoms abate or your
obsessive-compulsive disorder gets
better when the current was switched on
in one man and he acquired a passion for
the music of Johnny Cash he went out and
spent all his savings on the records of
Johnny Cash when the comb was switched
off the passion abated who is the
patient the Johnny Cash lava with the
current switched on or the normal person
with appropriate taste with the current
switched off
another perhaps more serious example a
woman treated my way of deep brain
stimulation for obsessive-compulsive
disorder when the current was switched
on she previously monogamous faithful
woman acquired an electric passion for
her psychiatrists tried to seduce them
when the carton was switched off she
went back to becoming a monogamous woman
who’s the patient current off or current
on a woman with anorexia she was asked
what would you be like if we cured your
anorexia she said I can’t imagine that
happening
take away my anorexia and he would take
away an awful lot of what I a friend of
mine who’s probably the most rational
man I know had a wife who suffered from
anorexia and he described her condition
as akin to demon possession it was as if
she had been pushed out by this invading
parasite who’s the patient the parasite
or the pre morbid personality one of my
sons tom has the tremendous gift of
dyslexia that means that he sees the
world in a much more realistic way he
uses much more data in constructing the
world I am a left brain dominated nerd I
reduce the world to sets of propositions
Tom doesn’t do that if he looks at a
situation he has a holistic appreciation
of it the world is much more colorful
much more charismatic and he has much
more accurate representation of it
because he uses so much more information
in interpreting the world to himself he
was diagnosed with dyslexia at about the
age of six and a well-meaning friend
said to us wait you’ve caught it
since you’ve caught it so early and
probably he can be cured
insensitive language biologically
illiterate language but we were
terrified cure
Tom’s dyslexia and you’d kill Tom what
will be left imagine that I can take a
pill which increases my IQ by a hundred
points Charles Foster with an IQ of a
hundred greater points would arguably
not be Charles Foster at all is there
any difference between giving me that
enhancement pill and giving me a lethal
injection what’s the difference if any
between enhancement and the ordinary
therapies which we’re happy about so if
you give someone a new hip for extremely
painful osteoarthritis of the hip yes
you’ll make them walk better but you’ll
also change lots of other attributes
that feel better about themselves
they’ll be a different person you tend
to characterize that as all good what’s
the difference between that and the
enhancement pill who is the patient
pre-operation paste operation lots of
consultant psychiatrist s– don’t agree
that there is such an entity as
dissociative personality disorder but
something that there is inside one skull
there is the homicidal mr. Hyde and the
gentle mr. jackal let’s say that you can
pharmacologically assassinate to the
homicidal mr. Hyde leaving the skull
inhabited only by dr. Jekyll should he
gentle teetotal author disillusioned by
his book sales drinks a bottle of
whiskey and stabbed his wife to death
the evidence is that he will never touch
alcohol again he will remain entirely
gentle
safe and happy he’s put into prison
who’s the man sitting in prison is it
the man who really killed his wife who
existed for a moment while the alcoholic
mandus was on him but will never exist
again or some other entity a ward a
mental hospital takes the Ward out for a
walk by some sea cliffs one of the
patients makes a run for the edge of the
cliff a nurse tackles the patient stops
them jumping over a few weeks later the
patient writes to the nurse and says
thank you so much for saving my life I
wasn’t in my right mind when I made the
attempt to jump off the cliff who is the
patient the one who wrote the letter or
the one who made the run for the cliff
edge permanent vegetative state a man
has a stroke he’s lying on a hospital
bed he it doesn’t have to be
artificially ventilated but he has to be
fed by nasogastric tube if the diagnosis
is right he has no capacity for any
sensation either pleasurable or painful
he has no possibility ever of any
relationship his relatives visit him
every day but eventually there comes a
time when they say enough is enough
please withdraw the nasogastric feeding
and let him die why because he really
died
a long time ago the person who we knew
as John was killed by the stroke so just
think what’s going on there they’re
saying that identity consists in or at
least is associated with the function of
some brain tissue which was destroyed
when blood stopped flowing properly
a few years ago I had a dislocated
shoulder and they took me to hospital
and they gave me gas and air as they
tried to relocate it and as I breathed
in the gas and air I in inverted commas
rose out of my own body and looked down
at the nurses struggling to relocate my
shoulder it’s an experience which is
quite common many of you will have
probably had such experiences the eye
hovering of my own body was interested
in what was going on who was the person
the observer or the body writhing in the
someone is desperately frightened of
Alzheimer’s disease and so much so that
they make an advance directive saying
that if they get Alzheimer’s disease
they want all life-sustaining treatment
to be withheld from them they get out
finds disease and it seems contrary to
all their fears to be the best thing
that’s ever happened to them they’re
stripped yes of a lot of their cerebral
cortex but they’re also stripped of lots
of the neuroses which make life
miserable for lots of people they sit in
the corner of the ward playing cards
with the nurses they watch the daytime
TV which they previously despised with
enormous pleasure and then they get us
just in chest infection all that’s
necessary in order to treat that
infection is five days of antibiotics if
they didn’t get the antibiotics they
will die the daughter who is the sole
beneficiary under the will let’s say
says that the doctors if you give my dad
those antibiotics I will sue you to
kingdom come
look there’s an advanced directive what
should happen there should a warrant of
execution made by a person who’s
effectively ceased to exist or have they
be allowed to kill someone who’s risen
out of the ashes of that person
it looks doesn’t it as if person a has
died person B
entirely unrelated to the earlier person
who just happens to talk about her body
composed at the same cell cells has come
instead now dementia at least in the
early stages is a process of disorder of
memory retrieval you can’t get hold of
memories which might define you or help
to define you but other people can help
you to put back the missing pieces of
memory jigsaw carers relatives it’s as
if you have in dementia a sort of out
sourced mind then we in fact all have
outsourced minds
lots of our memories are stored on our
computers in our notebooks in our
libraries isn’t the dementia situation
just a special case of the general
principle which I was suggesting before
which is that we all are defined by
reference to our relationships there are
some signs that eventually the law is
catching up with this basic biological
and sociological reality a man had
Huntington’s disease that meant that any
of his children had a 50% chance of
Huntington’s disease his doctors tried
to persuade him to give them permission
to tell his pregnant daughter that she
might have the disease too he refused
was there a duty on the doctors
nonetheless to breach the
confidentiality and tell the daughter
that she might be affected answer said
the English court very recently well
there might be the English courts are
finally catching up with a fact that
relationships have to be taken into
account in defining what we are but
those boundaries are porous that all our
information particularly if we’re
connected to a particular person by way
of genetic information is held in a
joint account I’m glad that the law is
finally catching up thank you very much [Applause]
public speaker and he tends to end his
after-dinner speeches by saying
something along the lines of my name is
Graham Davis of whom it is often said
who now I like that not just because
it’s engaging these self-deprecating but
because it expresses one of the most
fundamental questions which we can ask
about ourselves one of the voices
fundamental one of the most challenging
one of the most repercussion one of the
most difficult is one which all
reflective people ask all the time that
supposed to be a photograph of me up on
the Left who is Charles Foster I don’t
know the boundaries of Charles Foster
are incredibly porous they bleed into
all other people and all other
circumstances in which I find myself
what is chance Foster answer he can only
be defined in terms of the nexus of
relationships in which he exists
Polonius said to thine own self be true
a very big ask it invokes a lot of
questions the Delphic Oracle said know
thyself very important very difficult
we’re obsessed by these questions or
should be if you search google for
personal authenticity you will have
millions of hits those questions are
interesting difficult tremendously
important but the law and medicine
disagree that they are either so the law
tends to see human beings not in that
porous relational way than I’ve
described but as atomistic billiard
balls with very hard boundaries the law
finds no difficulty in pointing to
Charles Foster and saying that’s where
he is that’s what he is it has a
narrowly contractual view of Charles
Foster it assumes that Charles Foster is
the same for all purposes and through
all phases of his life it assumes that
the person on the birth certificate is
the
whose name will be on the death
certificate and medicine is not much
more nuanced if you go to see a
psychiatrist
the psychiatrist will try to put you
back into your right mind it assumes as
a you which can be restored it assumes
that disease is something which takes
your soul away from you and that your
soul can be restored by giving you a bit
of medicine the doctor might say to you
you’re not looking yourself today
just think of the philosophical baggage
which that doctor has we have huge
brains why do we have huge brains
they’re very expensive the amount of
space within our head is very limited it
is prime real estate and accordingly to
develop a huge brain demands a massive
payoff the payoff is Association the
payoff is the ability to relate to one
another
which is a very difficult thing to do
but comes with massive selective
advantages so what are human beings the
most social of all animals answer to a
first degree of approximation they are
above everything else
relational animals you know what to use
the expression that I’ve used already
they are creatures with porous
boundaries and should be defined that
way that thought is reflected in medical
ethics typically by respect for the
notion of autonomy read lots of medical
ethical texts only think that that is
the only principle which should be in
play and very important it is to medical
ethics medical law without autonomy is a
terrifying frightening arena we got to
ask whose autonomy am I really
autonomous I didn’t have anything to do
with my own conception I didn’t have
anything to do with my own gestation I
didn’t have much to do with my own
upbringing when I came here yesterday in
a magnificent Swiss air jet I was
entirely I’m at the hands of the pilot
and the people who programmed the
computers which made that plane fly
I wear lots of hats and my preferences
differ massively my identity to some
extent arguably differs massively with
watch which hat I’m wearing sometimes I
am a father sometimes I am a barrister
sometimes I am a tedious academic at the
University of Oxford sometimes I’m a
fearful mortal poised queasily I’m on
the edge of eternities precipice and
what I say about myself and the things
that I say are important to me will
differ depending on which hat I’m
wearing I want to tell you a few stories
I invite you to use these stories as a
way of interrogating your own
presumptions about what you think you
are about what you think identity is the
first relates to deep brain stimulation
so for various conditions like
Parkinson’s disease or
obsessive-compulsive disorder you can
stick an electrode into your brain when
the current is switched on your brain is
electronically tickled and the
Parkinson’s and symptoms abate or your
obsessive-compulsive disorder gets
better when the current was switched on
in one man and he acquired a passion for
the music of Johnny Cash he went out and
spent all his savings on the records of
Johnny Cash when the comb was switched
off the passion abated who is the
patient the Johnny Cash lava with the
current switched on or the normal person
with appropriate taste with the current
switched off
another perhaps more serious example a
woman treated my way of deep brain
stimulation for obsessive-compulsive
disorder when the current was switched
on she previously monogamous faithful
woman acquired an electric passion for
her psychiatrists tried to seduce them
when the carton was switched off she
went back to becoming a monogamous woman
who’s the patient current off or current
on a woman with anorexia she was asked
what would you be like if we cured your
anorexia she said I can’t imagine that
happening
take away my anorexia and he would take
away an awful lot of what I a friend of
mine who’s probably the most rational
man I know had a wife who suffered from
anorexia and he described her condition
as akin to demon possession it was as if
she had been pushed out by this invading
parasite who’s the patient the parasite
or the pre morbid personality one of my
sons tom has the tremendous gift of
dyslexia that means that he sees the
world in a much more realistic way he
uses much more data in constructing the
world I am a left brain dominated nerd I
reduce the world to sets of propositions
Tom doesn’t do that if he looks at a
situation he has a holistic appreciation
of it the world is much more colorful
much more charismatic and he has much
more accurate representation of it
because he uses so much more information
in interpreting the world to himself he
was diagnosed with dyslexia at about the
age of six and a well-meaning friend
said to us wait you’ve caught it
since you’ve caught it so early and
probably he can be cured
insensitive language biologically
illiterate language but we were
terrified cure
Tom’s dyslexia and you’d kill Tom what
will be left imagine that I can take a
pill which increases my IQ by a hundred
points Charles Foster with an IQ of a
hundred greater points would arguably
not be Charles Foster at all is there
any difference between giving me that
enhancement pill and giving me a lethal
injection what’s the difference if any
between enhancement and the ordinary
therapies which we’re happy about so if
you give someone a new hip for extremely
painful osteoarthritis of the hip yes
you’ll make them walk better but you’ll
also change lots of other attributes
that feel better about themselves
they’ll be a different person you tend
to characterize that as all good what’s
the difference between that and the
enhancement pill who is the patient
pre-operation paste operation lots of
consultant psychiatrist s– don’t agree
that there is such an entity as
dissociative personality disorder but
something that there is inside one skull
there is the homicidal mr. Hyde and the
gentle mr. jackal let’s say that you can
pharmacologically assassinate to the
homicidal mr. Hyde leaving the skull
inhabited only by dr. Jekyll should he
gentle teetotal author disillusioned by
his book sales drinks a bottle of
whiskey and stabbed his wife to death
the evidence is that he will never touch
alcohol again he will remain entirely
gentle
safe and happy he’s put into prison
who’s the man sitting in prison is it
the man who really killed his wife who
existed for a moment while the alcoholic
mandus was on him but will never exist
again or some other entity a ward a
mental hospital takes the Ward out for a
walk by some sea cliffs one of the
patients makes a run for the edge of the
cliff a nurse tackles the patient stops
them jumping over a few weeks later the
patient writes to the nurse and says
thank you so much for saving my life I
wasn’t in my right mind when I made the
attempt to jump off the cliff who is the
patient the one who wrote the letter or
the one who made the run for the cliff
edge permanent vegetative state a man
has a stroke he’s lying on a hospital
bed he it doesn’t have to be
artificially ventilated but he has to be
fed by nasogastric tube if the diagnosis
is right he has no capacity for any
sensation either pleasurable or painful
he has no possibility ever of any
relationship his relatives visit him
every day but eventually there comes a
time when they say enough is enough
please withdraw the nasogastric feeding
and let him die why because he really
died
a long time ago the person who we knew
as John was killed by the stroke so just
think what’s going on there they’re
saying that identity consists in or at
least is associated with the function of
some brain tissue which was destroyed
when blood stopped flowing properly
a few years ago I had a dislocated
shoulder and they took me to hospital
and they gave me gas and air as they
tried to relocate it and as I breathed
in the gas and air I in inverted commas
rose out of my own body and looked down
at the nurses struggling to relocate my
shoulder it’s an experience which is
quite common many of you will have
probably had such experiences the eye
hovering of my own body was interested
in what was going on who was the person
the observer or the body writhing in the
someone is desperately frightened of
Alzheimer’s disease and so much so that
they make an advance directive saying
that if they get Alzheimer’s disease
they want all life-sustaining treatment
to be withheld from them they get out
finds disease and it seems contrary to
all their fears to be the best thing
that’s ever happened to them they’re
stripped yes of a lot of their cerebral
cortex but they’re also stripped of lots
of the neuroses which make life
miserable for lots of people they sit in
the corner of the ward playing cards
with the nurses they watch the daytime
TV which they previously despised with
enormous pleasure and then they get us
just in chest infection all that’s
necessary in order to treat that
infection is five days of antibiotics if
they didn’t get the antibiotics they
will die the daughter who is the sole
beneficiary under the will let’s say
says that the doctors if you give my dad
those antibiotics I will sue you to
kingdom come
look there’s an advanced directive what
should happen there should a warrant of
execution made by a person who’s
effectively ceased to exist or have they
be allowed to kill someone who’s risen
out of the ashes of that person
it looks doesn’t it as if person a has
died person B
entirely unrelated to the earlier person
who just happens to talk about her body
composed at the same cell cells has come
instead now dementia at least in the
early stages is a process of disorder of
memory retrieval you can’t get hold of
memories which might define you or help
to define you but other people can help
you to put back the missing pieces of
memory jigsaw carers relatives it’s as
if you have in dementia a sort of out
sourced mind then we in fact all have
outsourced minds
lots of our memories are stored on our
computers in our notebooks in our
libraries isn’t the dementia situation
just a special case of the general
principle which I was suggesting before
which is that we all are defined by
reference to our relationships there are
some signs that eventually the law is
catching up with this basic biological
and sociological reality a man had
Huntington’s disease that meant that any
of his children had a 50% chance of
Huntington’s disease his doctors tried
to persuade him to give them permission
to tell his pregnant daughter that she
might have the disease too he refused
was there a duty on the doctors
nonetheless to breach the
confidentiality and tell the daughter
that she might be affected answer said
the English court very recently well
there might be the English courts are
finally catching up with a fact that
relationships have to be taken into
account in defining what we are but
those boundaries are porous that all our
information particularly if we’re
connected to a particular person by way
of genetic information is held in a
joint account I’m glad that the law is
finally catching up thank you very much [Applause]
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