Personhood is a concept that has been widely used to raise awareness of people as being intrinsically worthy of respect and dignity. Most commonly, personhood has been invoked in discussions concerning highly vulnerable populations, particularly those individuals at the start and end of life. With respect to aging, the concept of personhood has helped to shift our understanding of dementia from a technical or medical framework to one that is more humanistic.
Promoting the Concept of Personhood in Practice, produced and directed by Anju Joshi, is a 35-minute DVD that highlights a number of key issues related to personhood of older adults. Divided into 12 segments by topics, such as personhood defined and the role of care providers in promoting personhood, the DVD is intended to teach about personhood and how to apply personhood concepts in practice. The target audience includes students and health and social care providers working with older adults in community and long-term care settings.
In Promoting the Concept of Personhood, participants from multiple backgrounds and disciplines present thoughts about, and experiences with, issues concerning the personhood of older adults. Participants include older persons, care providers and clinicians, program managers, geriatricians, nurses, academics, and a gerontology alumnus. One participant, E. Mary Buzzell, a previous VON nurse who has led many caregiver support groups, has been teaching about personhood for more than 30 years. A vignette in a long-term care setting helps illustrate concepts of personhood such as the importance of knowing and appreciating past life experiences in order to understand present actions.
The DVD’s first segments feature participants explaining their understanding of personhood, which reveals a wide range of definitions and also highlights that an individual’s personhood evolves over time. Later segments and participant discussions focus on a number of concepts other than personhood, such as hope and optimism, vulnerability and exclusion, choice and risk, and powerlessness and autonomy. Although these concepts are certainly related to personhood, the link between these concepts and personhood could be more clearly articulated or explained. Similarly, the DVD’s segment on valuing diversity – culture, ethnicity, and lifestyle, for instance – is accompanied by minimal discussion. Within the context of diversity, consideration of personhood, its meanings, characteristics, and implications for practice is vitally important given the varied nature of Canadian society and, indeed, of older adults.
Recent research and published literature on personhood has focused particularly on dementia among older adults (Kontos & Naglie, Reference Kontos and Naglie2007; Malloy & Hadjistavropoulos, Reference Malloy and Hadjistavropoulos2004; Murray & Boyd, Reference Murray and Boyd2009). Although the DVD briefly references personhood in dementia care, it would have been valuable if this topic were addressed in more detail, given the prevalence of dementia and the challenges associated with promoting personhood in such situations. For example, in Canada, researchers at the Centre for Research on Personhood in Dementia, led by Dr. Deborah O’Connor at the University of British Columbia, have been particularly active in this area, conducting a number of studies and publishing papers and a book on the topic (O’Connor & Purves, Reference O’Connor and Purves2009; O’Connor, Phinney, Smith, Small, Purves, Perry et al., Reference O’Connor, Phinney, Smith, Small, Purves and Perry2007).
Whereas the concept of personhood has been the subject of widespread attention, much less regard has been accorded the strategies and approaches to promote personhood among older adults in health and social care contexts. The DVD advances this latter agenda in that participants, often through stories of personal experiences, identify a number of realistic and practical strategies that health and social care providers could use to promote personhood among older adults. Participants suggest important strategies that are otherwise not well identified in the literature, such as listening to and acknowledging metaphorical language used by older adults, and asking questions such as “What is most important for me to know about you?” and “When do you feel most like yourself?” Participants also explain the importance of exploring – with older adults, regardless of their age – these adults’ dreams and hopes for the future. There is an important emphasis in the DVD, consistent with other literature, on focusing on people’s strengths and assets rather than on their limitations, even when they are living with self-limiting conditions such as dementia.
The DVD also contains a short segment on a personhood-friendly workplace, where the power balance is flattened; where creativity, generosity, and resilience are fostered; where there is respectful teamwork and management support of staff, and where people can feel free, in effect, to be themselves. The idea of a personhood-friendly workplace has not received much attention in the literature, but similar concepts, such as healthy workplace environments which encompass these characteristics, have been described (e.g., Registered Nurses Association of Ontario, 2010). The notion of a personhood-friendly workplace is one that deserves more discussion and consideration, particularly when we recognize that the professionals who provide care to older adults are themselves an older and aging population and often work in environments that are insensitive to their own personhood.
The guide accompanying the DVD includes discussion questions for each section and a list of references. The questions can help viewers reflect on issues and experiences with personhood and can also be used to stimulate group discussion. The reference list contains classic references to the personhood literature but ends at the year 2000, thus missing more of the recent work that has been done, particularly in the area of dementia and personhood. Further, there is a rich body of literature about personhood in the areas of bioethics and philosophy (e.g., see the American Journal of Bioethics, 2007, volume 7, number 1) that would be likewise valuable to identify for viewers of the DVD. This latter body of literature reveals ongoing controversies about definitions and characteristics of personhood, how it can be assessed or measured, and why it is important. For example, controversy related to the definition of death and treatment decisions for vegetative patients is related to the differences in our views about criteria of personhood (Farah & Heberlein, Reference Farah and Heberlein2007).
This DVD is a valuable and comprehensive introduction to the topic of personhood from multiple perspectives. Participants’ personal stories add richness and will help students and providers better grasp how to integrate the concept of personhood in their practice. In closing, one of the DVD’s quotes, stated by E. Mary Buzzell, is particularly apt: “We may know what is best for another person’s health, but we are arrogant if we assume we know what is best for another person’s life.”
