Abstract

The present essay aims to respond to recent arguments which maintain that persons with severe cognitive impairments should not enjoy the full moral status or equal dignity as other "cognitively-able" humans. In the debate concerning moral standing and worth, philosophers Singer and McMahan have argued that individuals with certain impairments should not be granted full moral status and therefore, by extension, should not be awarded the same inviolability as humans without cognitive impairments. In response, I argue that an overlooked social ability — the capacity to narrate — provides grounds for the full moral status of individuals with severe cognitive impairments, and thus provides a defense and support for individuals with such "disabilities" to play a robust role in moral action and contribution to human living.


I. Introduction

Who should enjoy full moral standing? When one considers Koko the gorilla and interspecies communication, one must ask whether Koko should share in equal dignity with other humans.

Like many humans, Koko wants to be a mother. 1 She watches movies and cries in anticipation of her favorite scene. She gives hugs and can express her desires to her caregivers through a basic sign language. Koko, however, because she is not a human, has not been granted full moral standing (FMS) or moral personhood. As a result, she is not awarded the same rights as a human. Quite unlike Koko, there is the fate of little Thomas, the "Brave Preemie." He was born by cesarean section at 27 weeks, 3 days gestation, with a weight of 2 pounds, 6.5 ounces. 2 Should he be considered a person and Koko not be? Because of his early birth, his development and intelligence would not be superior to Koko's using "standard" measurements. Finally, one might consider Ashley the so-called "Pillow Angel." As a "Pillow Angel," her "cognitive and mental development level" will "never exceed that of a 6-month old child," and it is unlikely that she will ever "be able to walk or talk or in some cases even hold up [her] head…" 3 Allison Kafer, in Feminist, Queer, Crip, has argued that the rhetoric behind the term "pillow angel" both "reflects and perpetuates this linking of disability with infancy and childhood. Ashley's parents explain that they 'call her our Pillow Angel since she is so sweet and stays right where we place her-usually on a pillow.' This phrasing paints a picture of infant-like dependency and passivity; it makes it difficult to imagine Ashley as a teenager or a woman-to-be." 4 This linking of disability with infancy and childhood has a problematic history of linking adulthood to independence, autonomy and productivity, something that would be unachievable for Ashley. Furthermore,- specialists "expect no significant cognitive improvement." 5 Thus, the cases like Koko, Thomas and Ashley prompt a serious question: if animals are more capable, then why do we elevate babies and those with severe intellectual disabilities above them?

There is broad agreement among philosophers and non-philosophers that humans have a higher moral status than other animals such as monkeys, dolphins or dogs. Moral status grants protection to those with it insofar as it is morally wrong to harm them to some degree. Full moral status, as the highest degree of moral status, grants an inviolability to those who have it. Humans have usually taken for granted their full moral status, but the lesser moral status of animals has become a grave concern with respect to the treatment of livestock, such as raising calves for veal (Malarek 2014) or maiming the beaks of chickens (Animal Planet 2009), the killing of wolves or deer in response to overpopulation (Nosowitz 2012), and the near-extinction of the great apes of Africa due to their rapidly diminishing habitat space (Ghosh 2012). For some animals (e.g., dolphins, elephants, and great apes), the ethical question of their treatment has become an issue because they possess cognitive sophistication that is relatively close to humans. Since these animals possess sophisticated intellectual capacities that seem to be on par with or are superior to the cognitive capacities of infants and some individuals with profound cognitive impairments, certain philosophers, notably Peter Singer and Jeff McMahan, have been motivated to adopt a graduated view of moral status to protect animals and to consider it a lesser wrong to allow infants with cognitive disabilities, such as Down's Syndrome, to die (Singer 2009; McMahan 2009).

This attempt to conceive of a graduated moral standing has a troubling history. Within the last century, certain members of society were not regarded as having any moral status, or if they were granted some status, it was not full moral standing. One need only recall the plight of those who have been members of oppressed social groups including "foreigners," racial minorities, women and those with disabilities to have reservation about adopting a graduated view of moral standing. Within the history of the United States, the practice of slavery made use of a graduated view, granting "slaves" only three-fifths status as persons. Moreover, the practice of racial segregation which continued in medical practice with cases such as the Tuskegee Syphilis Experiments enacted a grave moral wrong, and equally the children with "severe" cognitive impairments were subjected to horrors at Willowbrook State School on Staten Island, New York in the 1960s (Purcell 2014: 199-200). Today, on account of social justice and societal change, a human's status is rarely explicitly and directly denied on principled moral grounds, and this history suggests it might be ill-envisioned to remove this protection.

These considerations pose a challenge for moral philosophers: how is one to accommodate our apparently conflicting intuitions on Full Moral Status? How is one to draw a line between humans, including infants and adults with profound cognitive impairments, and (at least most) non-human animals? This challenge today remains still unmet. The present essay aims to meet it by providing a new ground for moral status that argues for the full moral status of babies and those with severe cognitive impairments or mental illness. While philosophers have considered sophisticated intellectual capacities thus far in this discussion, I turn instead to an overlooked social capacity: the capacity to narrate. Defined as a threshold concept rather than a graduated one, the capacity to narrate can be taken as a sufficient ground for full moral status and therefore the granting of equal dignity. 6

The additional significance for providing this argument is twofold. First, I provide a viable defense and re-construction of narrative identity, which has been attacked as insufficient to confer moral standing (DeGrazia 2005; McMahan 2002). I argue that by viewing the capacity to narrate as a sophisticated social capacity, rather than a temporal constraint, narrative can and does provide a sufficient ground for FMS. Second, by extending the sense of a shared narrative to the role of proxy in medical ethics, it becomes possible to understand one's role in terms of co-authorship with one's loved ones. Caring for the other's "would be" wishes could be understood through co-authorship as "speaking with" others, rather than solely "speaking for" them.

The backdrop for my argument draws from the metaphysics of identity and from contemporary empirical studies. I begin with a review of the challenge facing people with disabilities in the moral status literature before turning to the empirical evidence of levels of narration in babies, children and people with cognitive impairments. I then provide an argument for the sophisticated capacity to narrate as an adequate defense.

II. Should we all share "Equal Dignity?"

One explanation philosophers have given to demarcate the difference in moral standing between humans and animals has been cognitive capacity. Using cognitive capacity as a determining criterion, however, has proved problematic in distinguishing babies and those with severe cognitive impairments from dogs, monkeys, and other animals. This account, usually called the Sophisticated Cognitive Capacity Account, encounters problems trying to designate which cognitive capacity is relevant: should it be the capacity to reason, 7 to care, 8 or to be self-aware? 9 To overcome this difficulty facing the Sophisticated Cognitive Capacity Account, other philosophers have proposed alternatives for designating moral status, which include species membership, 10 special relationships, 11 appealing to potentiality, 12 and most recently, person-rearing relationships. 13 The result is that, if the agent has any one of these capacities or qualities, the agent is granted FMS. By having full moral standing, a being morally matters to some degree for the being's own sake. Stated differently, by having FMS, a being shares equal dignity with other persons.

Certain philosophers, however, have used intellectual capacities as a way to reconsider the dignity of babies, people with cognitive impairments and those with mental illness or personality disorders. 14 Specifically, Singer and McMahan have made arguments against the commonsense intuition that all human life should be of equal value in order to provide a view of moral status that would include non-human animals. Simply put, they argue that any argument for moral status that relies on "biological commonality" to grant superior status of humans over those that are not members of our species is morally problematic and "speciesist" (Singer 2009: 572). Singer has argued that the following philosophical view is the most promising and should be adopted: we should "[a]bandon the idea of the equal value of all humans, replacing that with a more graduated view in which moral status depends on some aspects of cognitive ability, and that graduated view is applied both to humans and nonhumans" (575). McMahan holds to a similar position and, like Singer, argues for the use of cognitive abilities to differentiate along a more graduated view of moral worth (McMahan 2009).

To make their case for a graduated view of moral standing, Singer and McMahan rely upon a comparison of intellectual abilities between non-human animals and certain individuals with cognitive impairments:

Vast numbers of chimpanzees and other "higher" primates are used in painful and often lethal research for the benefit of human beings. Although there are strong objections to specific primate research programs and research on specific primates, there is broad agreement that most primates research is acceptable if it has the potential to contribute significantly to human health, and if the harms and risks to the animal subjects are minimized. In contrast, cognitively-disabled human beings are no better able than those primates to understand the aims of the research or to consent to participation cannot be enrolled in potentially harmful research unless they themselves are likely to benefit, the risk of harm is negligible, and their legal representatives consent to their participation (SEP 2012).

Singer compares certain intellectual skills of animals, like Koko who have basic language skills and score between 70-95 on the IQ test, with people who have severe cognitive disabilities. To strengthen his argument for why a graduated view of moral standing makes sense, Singer cites intellectual capacities listed with the American Association on Intellectual and Developmental Disabilities: (1) Intellectual Quotient (IQ), (2) the need for supervision, (3) capacity for speech, (4) following simple directions, and (5) social isolation (Singer 2010: 338). Like Singer, McMahan has expressed his moral reasons for questioning the "common belief that the cognitively limited share the inviolability of cognitively normal human beings as a fixed point in the set of our moral convictions in order to criticize common beliefs about animals as inconsistent with it" (McMahan 2009: 583-4). McMahan has endorsed a similar argument for a graduated view of moral standing, not only because of the need to provide justice for animals, but also to "demand a moral caution" to those who think that they can hold consistently to the superior dignity of "the cognitively limited" over that of animals with "comparable cognitive endowments" (584).

Some philosophers have admirably tried to respond to the earlier challenges of Singer and McMahan by relying upon relationships or appealing to potentiality, but none has yet adequately met the challenge of FMS without running into significant philosophical difficulties. 15 So, in order to address this challenge against people with disabilities and resolve these difficulties, in this next section, I consider the empirical difference between humans and animals concerning narrative abilities in order to lay the foundation for a philosophical argument for the capacity to narrate for moral standing.

III. Narrative Abilities in Humans and Animals

As humans, we are unique insofar as we tell stories. When we understand our lives, according to psychologists and philosophers alike, we construct a narrative, which provides a format for "linking together" a sequence of events in time. Many of the narratives we create are socially dependent; that is, we co-author stories with others by being major actors in their lives just as much as they are in our own. What I aim to review in what follows are the empirical grounds for this ability, the age of which we learn it, and why most or all other animals do not have this capacity to narrate.

Neuroscientists have begun to identify "brain correlates of one particular component of storytelling in humans. The component is called episodic memory" (McAdams 2006: 78). 16 Episodic memory concerns the ability to recall specific events (episodes) from the past. This form of memory differs from semantic memory (the ability to recall information) and the difference between the two forms can be illustrated in the following way: episodic memory is when one remembers one's wedding day, one's first day in school or yesterday's argument with one's partner, one is recalling scenes or episodes from one's past; semantic memory, alternatively, is when one tries to recall what the capital of New York state is (Albany!). In the case of semantic memory, an event or episode is absent and is not associated with this knowledge. Thus, episodic memory includes the recalling of a particular event with the memory. Some cognitive scientists believe that

semantic memory is more basic than episodic and probably goes back much further in human evolution. They suggest that episodic memory may have evolved out of semantic, as a kind of specialized skill that only humans have. It is a skill that enables us to travel backward in subjective time and to link remembered events to imagined future episodes (79).

Episodic memory provides the "personal experience of time" that one uses when one engages in storytelling (Ibid). Severe damage to particular parts of the brain, however, as in a particular form of amnesia, can result in the loss of one's episodic memory. Research on amnesiacs has demonstrated that damage to one's medial temporal lobes can affect one's episodic memory. Within the temporal lobes lies the brain's hippocampus, which facilitates the storing of new memories. The hippocampus appears to facilitate storing memories by "creating new interconnections with the cerebral cortex as each to-be-remembered experience takes place" (80). If the hippocampus is damaged, the brain may lose its ability to "lay down the elements of the event so that they can be retrieved later" (Ibid). 17 Finally, the prefrontal cortex, according to new studies of brain imaging, may be involved in the retrieving of the event once it has been stored in memory.

Episodic memory typically only goes back to when one is around 3 or 4 years of age. According to Damasio, "Consciousness begins when brains acquired the power, the simple power I must add, of telling a story without words, the story that there is life ticking away in an organism" (1999: 30). Research has shown that most children by the age of 2 have developed a primitive autobiographical self. As a 2-year-old, "I now know that my lived experiences — the things I do and feel and think — belong to me, that they are part of my life evolving over time. In a self-conscious manner, I can now observe my own experience. I can think about me"(McAdams 2006: 81). By ages 3-4, children grasp human motivational behavior: people do things because they want to (Age 3) and because of what they believe (Age 4). By preschool age, extensive research has shown that children have a basic "theory of mind;" in other words, they understand that "people have desires and beliefs in their minds and that they act upon these desires and beliefs" (82).

But telling stories is not something that is innate for humans. Rather, we learn to tell stories through our interactions with our caregivers. It is those who care for us who help to provide a "script" for us both to comprehend human interaction and to participate in human living. Furthermore, one can actively participate in narrating action either by bodily or by linguistic means. Much like a pantomime telling a story, this bodily dialogue of narration begins when an infant is around 2 months old and is most evident in what developmental psychologists call the "mirror game" (Baldwin 2005).

The mirror game forms the introductory basis or early "building blocks" for the development of narrative tone and event representations. Narrative tone, which eventually leads to event representations, provides the foundation for storytelling for a child in between the ages of 2-5. Within the first year of development, psychologists have observed that babies take on a narrative tone in their interpretation of life's events from this experience with their caregivers. If the experience is primarily positive, children form a secure attachment and develop a positive narrative tone (for instance, secure emotional display and general trust that "events will work out"). In contrast, if the experience is a primarily negative one, children do not form a secure attachment (for instance, they may be anxious, ambivalent or even disorganized in their emotional display) and they have a tendency to form a negative narrative tone. After the age of one, children usually begin to develop what psychologists Narvaez and Lapsley call the "basic building blocks" of human development: event representations (Narvaez and Lapsely 2005). These representations are "scripts" which later help the child interpret and construct events within the world through schemas into stories (Narvaez 1998, 2002; Narvaez and Gleason 2007). The child, then, learns to think of himself as an "I" who is the lead character in the "story of his life" which involves other characters and events over time. This story encompasses how he is able to construe meaning and a sense of self within a society and its traditions. Thus, the child learns from the beginning that just as others have played primary, secondary and even tertiary roles in the co-authorship of his life, so he may play those roles in the lives of others as well through co-authorship.

Similarly, there has been evidence of narrative storytelling in the specific case of intellectual disability as well. Researchers H. Young et al. (2011) have used multi-sensory storytelling of life transitions for adolescents with profound intellectual disabilities to help the adolescents understand their own bodily changes. These narratives about the adolescents' identities were co-authored with their parents and caregivers. The narratives were told repeatedly as the adolescents reacted and understood, and gained knowledge of their own bodily transitions in life in such cases as puberty.

Telling stories is a particular function of what humans do. It is something we learn at a very young age and is initiated by those around us. It is how we understand ourselves in time and in relation to others. This is the motivation for why looking at human narration as a capacity can be considered sufficient for moral standing. In other words, what gives us moral relevance is not what can be determined by the performance of tasks or a high IQ; to the contrary, it is the story we live that enables us to flourish.

But what about Animals?

When we consider the case of the mirror game, in which an infant develops narrative tone, we need to consider why most animals would not possess the capacity to narrate. My pet cat, Socrates, enjoys watching the Disney Life series narrated by Oprah Winfrey. He likes to watch the lion and cheetah scenes especially. After watching these scenes, often Socrates will run around the room playing and pouncing on things. And then when he gets tired, he takes a nap.

Now, I would like to think that Socrates is "playing pretend" that he is a lion or cheetah from the movie, but that is not necessarily what is happening in Socrates' mind. As a cat, Socrates does not perform narrating activities. He does not construe and intend his life as a series of narrated events. Instead, Socrates is playing rather than "re-enacting" the Disney scenes, and therefore, he is not constructing a story. While it may be argued that Socrates has the intelligence and developmental level of a human two-year old, he cannot and does not narrate his life. He does not narrate his life because cats do not interpret the meaning of their events through stories, while we as humans do.

Many animals may appear similar in the cognitive abilities of a human agent who engages in the narrative activity of "narrative tone." It is well known that both cats and dogs engage other animals and humans through bodily dialogue to communicate. Furthermore, many animals, such as the African grey parrot, have the ability to learn basic human languages. However, bodily dialogue and basic language are not necessarily activities included in narrative co-authorship. Without their inclusion, the animal's activities do not count as participation in the construction of a life understood as a narrative unity or the development of the basis of that narrative through narrative tone.

A two-month-old baby, by contrast, would possibly be able to perform the "mirror game" with a caregiver and construct a narrative tone. No matter how I might wish to interpret my cat Socrates playing and jumping, what matters is that he does not interpret his action narratively, and so does not construct a narrative tone. This lack of capacity sets him apart from the two-month old infant and Young's adolescents with intellectual disabilities.

It should be noted that the construction of a narrative should not be confused with or reduced to perception or interpretation. As a cat, Socrates can perceive where I am in a room and what I am doing. Also, Socrates is capable of interpreting another cat's body language as aggressive or friendly. Similarly, Socrates may misinterpret a dog's friendly tail wagging as something potentially hostile. But in either instance, Socrates has not acted as a narrative co-author in another cat or dog's life. This is because an act of narration requires that a narrating activity has been performed. A narrating activity grants meaning to the act in relation to a larger shared life story.

To co-author a narrative, individuals in Thomas's and Ashley's cases would be guided by a caregiver in the development of their narrative tone. Their construction of a narrative tone, while minimal, is still part of an interdependent narrative guided by their caregivers. Thomas and Ashley depend upon the narrative tone initiated by their parents. For example, Ashley's parents (2007) describe their interaction with their daughter in the following way:

Ashley is alert and aware of her environment; she startles easily. She constantly moves her arms and kicks her legs. Sometimes she seems to be watching TV intently. She loves music and often gets in celebration mode of vocalizing, kicking, and choreographing/conducting with her hands when she connects with a song (Andrea Boccelli is her favorite — we call him her boyfriend). She rarely makes eye-contact even when it is clear that she is aware of a person's presence next to her. Ashley goes to school in a classroom for special needs children, which provides her with daily bus trips, activities customized for her, and a high level of attention by her teachers and therapists. (Ashley's Mom and Dad, March 25, 2007).

Both Thomas and Ashley participate in their parent's lives by playing significant roles in the life stories of their parents, because they are necessarily intertwined. In describing her own experience of motherhood, Linnéa E. Franits notes that constructing a narrative is a two-way street: "mothers construct narratives of disability for a variety of reasons and in a variety of ways, yet the disability experience can write stories of motherhood, too" (Loc. 1601). Thus, just as the caregiver initiates the narrative tone in the child, so the child impacts the lived story of the caregiver. This is not the case of most pets. An owner's relation to his pet does not take the form of shared narration; rather it takes the form of pet "ownership," or better, pet care. While pet care is a form of caregiving, a pet owner makes the decisions for what he thinks is best for his pet and this includes his pet's episodes within his own narrative life as a Carer. These decisions may include the choice of food, the daily habits such as playing and exercise and also obedience practices. The pet, however, does not develop a narrative tone with the potential to be the author of its own life. Animals, whether they are pets or live in their own communities in the wild, do not flourish through participation in narrative co-authoring activities. Instead, they flourish by developing the characteristics typical of their species. Shared stories supported by a community's culture, practices and traditions are characteristically human alone.

If the analysis of the case I have sketched is correct, and it is subject to empirical revision, then, because individuals such as Thomas and Ashley are able to participate in narrating activities such as the mirror game, they would differ from most animals. Through this minimum capacity, they would be considered narrative co-authors. It is in this way that Thomas and Ashley contribute to the stories of their parents, family, friends and community — a distinctly human contribution.

IV. Narrative and Moral Personhood

Having made an initial case for the capacity to narrate as a threshold concept for moral standing, it will be necessary to make four clarifications to appropriately situate this argument as an adequate defense against the challenge that people with disabilities should have a lower moral status than cognitively-able humans, and thereby should not be granted full moral status.

The first clarification concerns the kind of "sophisticated capacity" under which narration is categorized. We as human beings, according to many philosophers and psychologists, are unique insofar we tell stories about our lives. That is, we stand out from other species because we narrate. The view that our identities can be constituted through narrative is a view that is widely, though not universally, accepted in the metaphysics and philosophy of mind. The sophisticated capacity to narrate involves an ability to participate in a story as either (a) the lead author or (b) a co-author. Individuals such as Thomas and Ashley, because they are dependent upon a community who supports and sustains their narrating activities through medical care, accessible buildings and common cultural practices, would participate as co-authors. Thus, this participation in shared narration may be performed excellently or only minimally, but as long as the participation has occurred, there is evidence of the sophisticated capacity in the individual.

The second clarification concerns the actualization of the capacity to narrate, rather than possessing the mere potentiality. The capacity to narrate is actualized when one's participation in narration is construed in terms of a larger story that links together a sequence of events or episodes. I choose to rely solely upon the actualization of this capacity rather than the potentiality for the capacity, because potentiality is known to face a difficult objection. Moral worth should not be built upon counterfactual obligations to what has not yet been established as a moral person. For example, "a potential U.S. President has neither rights nor even a claim to command the military; likewise in the case of potentially cognitively sophisticated beings and the rights associated with moral status" (Feinberg 1980: 193). Establishing why these two cases are different is difficult. It is motivated by a difficulty in the Sophisticated Cognitive Capacity Account, when that capacity is taken to be rational reasonability, as measured by tests such as the IQ. If one should use that criterion, then it would appear that infants do not enjoy FMS. Since infants do have narrative tone, the present account has no such similar need to move from an actual capacity to a potential one. Because narrated events are dependent upon social contexts, relationships and human living, the capacity to narrate is actualized when it is performed with others, even at a minimum level.

The third clarification for the capacity to narrate concerns what kind of concept this capacity is: should it be a threshold or a more graduated view? Singer specifically endorses a graduated view (2009, 2010). While this might be appealing, since one can narrate stories excellently or poorly, I argue, instead, for a threshold concept. My aim here is to provide neither a robust sense of narrative unity nor a scalar progression of moral standing. Rather, to possess the capacity to narrate is to be able to participate in narration "just enough" to engage in human living. A narrative co-author must be capable of performing and engaging in some of the features of narrating — even if very minimum — which are part of a culture.

The fourth and final clarification concerns whether the capacity to narrate is sufficient or necessary or both to ground moral standing. I argue that the capacity to narrate is sufficient, but not necessary, to confer FMS. The sophisticated capacity to narrate, which transforms an agent into a co-author, is not only valuable, but also is of the same type of value that most philosophers already grant confers moral status. It is sufficient because it plausibly typifies human living, and it is generally accepted that able-bodied humans deserve FMS.

Participation in narrating activities may be performed with others as any of the following and is sufficient to confer equal dignity:

  1. Construing the meaning of one's life in terms of a narrative identity shared with others in a social context
  2. Understanding or give meaning to an event through a social schema or life script
  3. Interpreting human behavior according to event representations
  4. Developing a narrative tone

A being's intelligence level is not sufficient to determine the meaning of a series of events; it also matters whether she performs narrating activities; the capacity to perform narrating activities is not determined by one's IQ. By participating in a narrative activity, one actualizes one's capacity to narrate. A narrating activity may be performed alone or with another. This actualization of one's capacity to narrate indicates that one has full moral standing.

V. Some Critical Comments on Alternative Proposals and Possible Objections

The social capacity to narrate provides a response to the challenge to equal dignity in moral worth put forth by Singer and McMahan. While a grey parrot or dog may be able to complete certain tasks or use basic language, each lacks the capacity to share in narration with another. A two-month old baby, by contrast, can develop and participate in the construction of narrative tone with a caregiver. This intuitive difference between the baby and the dog is clarified by appealing to the capacity to narrate. Furthermore, the capacity to narrate enables humans to be active participants in human culture and human customs or mores. This capacity is shared with people with disabilities such as "Autism" and "personality disorders" and therefore gives grounds for their contribution as moral actors.

Both Singer and McMahan have argued that a graduated view of moral standing is superior to a threshold view that grants a being full moral standing. I think, however, that a graduated view of moral standing runs into both philosophical and empirical problems that a threshold view avoids. A graduated view runs into the following philosophical challenge: where and in what ways does one demarcate the various stages of moral standing without these demarcations being morally arbitrary? To meet this challenge, Singer and McMahan must show which events or factors involve changes that are morally relevant.

Singer has cited the following possible factors that could be combined and used to determine a being's moral worth: (1) IQ and cognitive ability, (2) the (lack of) need for supervision, (3) capacity for speech, (4) following simple directions, and (5) social isolation. Let us consider a case in which (1) the IQ, (3) the capacity for speech and (4) the ability to follow directions are met. Suppose, for example, that a computer program was written that could solve advanced math equations, win at chess matches, meeting (1) and could advise us navigationally through speech, meeting (3) and (4). Using these demarcating factors, the computer program would be given higher moral worth than a cognitively able adult who had received a limited education. One would surely not say that the computer had a higher moral standing than the cognitively able adult, and that, as a result, it is a greater moral wrong to harm the computer than to harm the adult human. Consequently, it seems difficult to support such cognitive abilities as determining factors that have moral significance.

Second, suppose we move away from cognitive ability and move toward graduated levels of skill ability such as (2) lack of supervision, i.e., autonomy and (5) social isolation. Would this position prove more promising? I think that a being's autonomy (in this sense) is morally arbitrary: the fact that a being is less physiologically dependent on another being or a set of resources for survival is irrelevant to whether the being should have superior moral worth. We need only consider the modern predicament of the human species. In our current global society, many adult humans do not possess the ability to farm, fish or hunt. Furthermore, most cannot build structures of shelter to protect themselves from the elements. Instead, they utilize resources such as supermarkets to feed themselves, and they are broadly supervised by authority figures including police officers, judges, financial institutions, educational institutions and medical doctors. Would we say that a wild bear, which required no supervision, could catch its own food, and lived on its own, should be granted a higher moral status? I doubt that this position would be tenable. Thus, the critical point philosophically facing a graduated view of moral standing is that it would be difficult to name a morally significant event or factor that could demarcate this change in status. Singer and McMahan would need to name this morally significant factor to make their position defendable.

I also think that holding a graduated view of moral standing runs into an empirical difficulty: what about temporary states of developmental change? Singer and McMahan have assumed that "cognitive disability" is a permanent state for an individual. While this may be true for some cases, this does not explain many cases of those with cognitive impairments. Occasionally an impairment is episodic. Consider, for example, an individual who receives head trauma or experiences a stroke. While one's speech, autonomy, and other cognitive abilities might be impaired for a period of a few weeks to a few years, this individual's condition would not be life-long. Would it make moral sense for this individual lose her superior level of moral standing during her time in therapy? For a graduated view, her superior moral status would reflect the episodes of her condition. Thus, the central empirical assumption McMahan and Singer make in their proposal of a graduated view is that the demarcating factors they chose would remain unchanged in the particular beings. Empirically, however, this is unfounded.

Some philosophers, however, may have some concerns about the capacity to narrate as an alternative foundation for Full Moral Status. After a review of these concerns, though, I think that the capacity to narrate provides the most fruitful and promising grounding for moral worth in comparison to alternative proposals. First, specifically concerning the idea of narrative, certain philosophers have raised the objection that a narrative identity is not sufficient in itself to sustain moral status because a longer story is more robust, and so older adults would have a higher moral status than children and those whose lives are cut short. Part of this objection is that a narrative identity presupposes a numerical identity, because the identity we construct is dependent upon the experiences we accrue over time. 18 In other words, what is assumed is that having lived a longer life means that one has a better story. Philosophers have argued that this position cannot be held in consistency with the position that holds a loss of a child or teenager is more tragic than the loss of an individual with advanced age.

Like philosophers, doctors and bioethicists, as well as Ashley's parents, falsely assumed that the longer time of a narrated life is a better life. Ashley's disconnection between her mind and body both alarmed and concerned her parents and physicians. Kafer's discussion (2013, Ch. 2) of Ashley's futurity illustrates this point. Kafer argues that Ashley's case stands out as a disruption in our temporal field because of the asynchrony of our framing of the mind in relation to the body. Supporters of Ashely's treatment have argued that her body was maturing faster than her mind. This asynchrony between the mind and body created an image of Ashley as both temporally disjointed and grotesque. Ashley's asynchrony between her body as entering "adulthood", on the one hand, and her mind permanently fixed in "childhood," on the other hand, seemed to require an "intervention" to close this gap. Described by Dr. Diekema as a "baby in a much larger body," Ashley's body was framed in terms of temporal and developmental misalignment that needed to be "made right" (as cited by Kafer, 2013). This disconnection was not only "wrong," but it was also "grotesque." The solution, then, was to unite this disconnection by infantilizing Ashley's body through treatment.

Doctors and bioethicists made a second false assumption about the lived narrative of one's life: that the only meaningful experiences are ones that can be measured by our labor and contribution to society. Gunther and Diekema stressed that Ashley is "an individual who will never be capable of holding a job, establishing a romantic relationship, or interacting as an adult" (as cited by Kafer, 2013). These rich experiences, however, Kafer has argued, have been conflated with productivity. Put more simply, the valuable life experiences Ashley would miss were experiences valued and measured for one's labor. Ashley's parents and doctors thought that Ashley's lack of being able to hold a job, i.e., being productive to society, and being able to bear children, i.e., being evolutionarily productive, have kept Ashley from living a life of "quality" or fulfillment. Moreover, her reproductive organs and breast buds were deemed unnecessary by her parents, and as a result, were removed. Thus, doctors and bioethicists thought that Ashley's future life experiences were of lesser value because she neither could nor should physically and sexually labor.

My response to these false assumptions is that although Ashley's life may appear to be cognitively poor, her life story as lived is one that is rich in meaning. One must not forget that often pleasure, care and love, not just labor, ground most of our meaningful relations within our lived world. Moreover, the length of our futurity does equal its depth. While Thomas' life may have been cut short, his narrative co-authorship in his parents' lives was profound. To borrow an aesthetic analogy, the shortness of a life span does not lessen the meaning of it just as the shortness of a film does not make it any less good. 19

Singer has raised a second concern with regard to most attempts to grant individuals with cognitive impairments with FMS: he argues that these accounts contain a latent speciesism. This charge might be a concern for the capacity to narrate as well. I do not think, however, that speciesism is present in the account for the following reasons. To begin, the individual's moral status is not granted solely by being a human being. If it were shown that animals, such as Koko, do perform acts of narration, then they would be granted FMS. In particular, Koko has a favorite movie and when watching this movie, she anticipates scenes and cries before she sees them. This may possibly be evidence that Koko in particular is capable of producing a narrative tone. If this were the case, she would be granted the status of a narrative co-author. I think this provides grounds for the need to conduct more research on other animals concerning narration. As for now, though, the evidence we have indicates that animals in general do not have the capacity to narrate. Thus, the narrative account of personhood retains simplicity and consistency while avoiding the charge of speciesism.

A third concern might be the charge of "underinclusiveness" in the case of newborns, preemies, and children born with diseases or impairments who are likely to die after a short time (say, within two months). Sophisticated Cognitive Capacity accounts are often charged with "underinclusiveness." The capacity to narrate, however, can be shared with others in as a narrative tone. In the cases of newborns, preemies and children with diseases or impairments, their cases would be understood by extension as "proxy" through co-authorship with their caregivers. While they would not hold FMS, they would still be supported by a "shared story" with those who care for them. This "proxy" status is not on par with the moral status of dogs and rabbits, so the grounds for this intuitive objection are removed. The case of proxy supported by a "shared story" in the case of newborns, preemies and even those in a vegetative state provides reason for their higher moral status relative to other beings. Furthermore, while I have argued for an actualized account of the capacity to narrate, one could still extend its reach by amending to include potentiality for the capacity to narrate.

A fourth concern for this account may be its use of a threshold concept, which may be incompatible with the equal wrongness thesis. This particular thesis states that, "other things being equal, the killing of persons is equally wrong, regardless of age or future prospects of the person" (Lang 2005). In the sophisticated capacity to narrate, any being who meets this threshold of narrative tone is granted full moral standing, or is a "person." Because this standing is "full," a being cannot achieve anything higher. Thus, the capacity to narrate is aligned with the equal wrongness thesis, since killing a teenager and an elderly person would be considered equally wrong if they both possessed the capacity to narrate. Additionally, FMS should not be confused with moral accountability. By FMS, I mean that this being shares in "equal dignity" and therefore can be morally wronged as a person. Moral accountability, by contrast, should be considered in a graduated way. While the capacity to narrate must be "just enough" for the agent to confer a higher moral status, the agent's accountability for moral actions is determined by the level of the narrative one has lived. Thus, agents who have only the capacity for a narrative tone (e.g., a two month old baby) are not held at the same level of culpability as an agent who has the capacity to construe one's life in light of the larger social context of society (e.g., a cognitively unimpaired eighteen-year old).

As humans, we create meaning through narrating stories. The capacity to narrate varies according to degrees and these different levels have been documented in nursing practice, special education, medical research, neuroscience and developmental psychology. Furthermore, there is wide agreement among philosophers of mind, and others, that narrative identity is typical of human life. My insight is to shift our understanding of a sophisticated cognitive capacity away from an individual intellectual ability and focus on a social ability: the capacity to narrate. Thus, it is our ability to tell stories with others that contributes to our human living. It is this shared contribution that sustains human flourishing.

VI. Conclusion

Philosophers such as Singer and McMahan have argued that individuals with certain cognitive disabilities should not be on par morally with cognitively-able humans. The aim of this paper has been to provide defense against the challenge that babies and those with severe cognitive impairments or mental illness should not share in "equal dignity" with cognitively-able humans, specifically by making the case that the capacity to narrate sets humans apart from animals such as dogs and rabbits. This defense provides a unique position in the "cognitive disability and moral status" debate as well as an alternative virtue ethical position for animal rights (SEP 2012). While philosophers such as MacIntyre (1999) and Nussbaum (2006) have been pioneers in bringing accounts of flourishing as a central aim for people with disabilities in society into political theory, their reach has not yet been extended to moral standing. My hope is that by construing personhood in terms of the capacity to narrate, this account of personhood will prompt more research to be done in the consideration of animals for care and medical research. Our intuitions tell us that there are great differences between chickens, dogs, and chimpanzees. Research conducted on whether animals do narrate or have episodic memory may shed new light on how to develop protective rights for animals.

From this new capacity for moral personhood, two consequences for further studies follow. One consequence from the development of the narrative account is a better understanding of moral development in ethical debates. By understanding one's personhood as co-authored, the logical extension is to consider one's moral agency along a scale of moral progression, which can be affected positively or negatively by one's upbringing. A second consequence, which follows from this model, concerns the role of proxy in medical ethics. Often, the role of proxy in the cases of the healthcare power of attorney and living wills can be confusing, painful, or undesignated. Through narrative, "speaking with others" in "proxy" could be understood as a shared story we sustain with the ones we love.

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Elizabeth Purcell, PhD, is a lecturer in the philosophy department at the State University of New York at Cortland.

Endnotes

  1. For Koko's interspecies communication captured on video, see Koko's Website, http://www.koko.org/index.php.
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  2. Discenza (p. 400), recounts Thomas' tragic story of his complicated birth as a preemie and then, due to severe disabilities, his struggle to live until the age of 3.
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  3. This quote was taken from Kafer, p. 52; Quote is originally from Ashley's Mom and Dad, The "Ashley Treatment" March 25, 2007 .
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  4. (Kafer, 55; see also Licia Carlson (2010) for this history of treatment).
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  5. For the medical account of Ashley's story, see Daniel F. Gunther, & Douglas S. Diekema. Some philosophical accounts consider Ashley's case with regard to moral status: Jaworska and Tannenbaum, (2014, 259), argue for the FMS of Ashley while Singer (2009) uses her case to argue for a graduated view of moral status.
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  6. I would like to thank the members of the Values in Medicine, Science and Technology Conference, at the University of Texas at Dallas (2014), for their valuable feedback which aided in the development of my argument.
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  7. Immanuel Kant (1998) is associated with this view.
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  8. Jaworska (2007) argues that the capacity to care is sufficient but not necessary for FMS; see also Kittay's (2005) argument against using the cognitive capacities of animals as evidence for equal moral status between animals and human beings.
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  9. For different versions of this argument see p. 44 in Tooley (1972) and pp. 45 and 242 in McMahan (2002).
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  10. See Cohen (1986) proposes this argument.
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  11. For cognitive and biological relationships, see Quinn (1984). For social relationships, see Warren (1997) and for "being someone's child" as a special relationship to enhance moral status, see Steinbock (1992) and see Kittay (2005; 2008).
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  12. See Stone (1987), for the "potential" account and Marquis (1989; 1995), for the loss of a "future like ours."
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  13. For the most recent account of the capacity to care adapted to "Person-Rearing Relationships," see Jaworska and Tannenbaum (2014).
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  14. For example, please see (Snow 2010) and (Curzer 2012). These philosophers have argued that certain individuals with impairments should not be considered moral actors. Snow has argued that virtuous social intelligence is necessary for a person to act as a moral agent. To appear consistent, she has claimed that people with "Asberger syndrome" [sic] do not count as moral actors (Snow 2010, 96). To make her case, she specifically uses the case of the boy with "Autism" from Mark Haddon's novel The Curious Incident of the Dog in the Night-Time as an example of a person who would not be considered virtuous by her account and instead would be considered a "moral zero" due to his "cognitive-affective impairment" (78, 96). In addition to excluding people with disabilities along the "Autistic Spectrum", Snow includes other "disabling challenges" and claims that a person with depression could have a virtuous motive, but be unable to achieve the right action (92). For Curzer, the line of moral differentiation takes one step further than Snow. Curzer's aim is to refresh the Aristotelian virtues from a contemporary perspective, and by extension, reconstruct Aristotle's sense of moral development. In this reconstruction, he has argued that "enslaving natural slaves is Aristotle's way of providing palliative care for people with certain personality disorders" (Curzer 2012, 79). By "natural slaves," Curzer intends "not only people living in institutions or dumpsters, [but the term] also refers to some unfortunate people we occasionally encounter among our family, friends and students" and can include "some people of very low intelligence, some psychotics, and so on" (Ibid).
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  15. I have in mind the relationship-based accounts such as Kittay (2008) and Carlson and Kittay, (2009) and potentiality accounts such as Feinberg (1980). Most of these accounts, however, run the risk of being "over-inclusive" for caring relationships or could be guilty of the philosophical problem of"infinite regress" in the case of potentiality.
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  16. McAdams has documented empirical evidence of the construction of a narrative identity in children and adults in longitudinal studies in the following literature: McAdams (1987, 1989, 1992, 1993, 1994a, 1996, 1997, 2006, 2008, 2009a, 2009b; McAdams, Diamond, St. Aubin, & Mansfield 1997), -.
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  17. Ibid.
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  18. Specifically, some philosophers think that the idea of a numerical identity undergirds a narrative identity and thus creates a problem for establishing personhood, because it must assume a numerical identity across time. Philosophically, we must ask what the conditions are in which a person at one point in time is properly reidentified at another point in time? I think this objection misses its mark. A narrative is not constructed by two different events, but rather by the unifying theme that connects those events.
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  19. I would like to thank Sebastian Purcell for his helpful dialogue concerning this response.
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