1 Otago University
Patients with severe head injury are a challenge to our moral sensibility as much as to our clinical skills of neuro-rehabilitation. They implicitly demand to be recognised before we can even begin to act ethically towards them. Chief among those needs is to be reconnected with the world, to be included in the kingdom of ends as the person who they were before the injury effaced their ability to self-present. The recognition is the beginning of a long journey of becoming re-acquainted with an enigma – a mystery whose character is not independent of the way we act towards him or her. This makes vivid and urgent Levinas’ “ethics as first philosophy” whereby the metaphysics of identity and subjectivity emerges from an ongoing ethical encounter and is shaped by the quality and commitment of that encounter. Only with the emergence of a person from the process of restorative encounter can the issues associated with supported autonomy and the negotiation of treatment course and limits meaningfully be addressed.
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