More On Human Dignity (1)
I have discussed something about human dignity and “death with dignity” in October 2005 postings. A Working Paperwas written by Adam Schulman, Ph.D. for the December 2005 meeting of the President’s Council on Bioethics. While it was prepared by staff solely to aid discussion and does not represent the official views of the Council or of the United States Government,nevertheless, the portion I have reproduced here helps to point to the conflicts people have in explaining what behaviors or acts support or deface human dignity. This can be the start of further discussion.
“Human dignity”: is it a useful concept in bioethics, one that sheds important light on the whole range of bioethical issues, from embryo research and assisted reproduction, to biomedical enhancement, to care of the disabled and the dying? Or is it, on the contrary, a useless concept—at best a vague substitute for other, more precise notions, at worst a mere slogan that camouflages unconvincing arguments and unarticulated biases?
Although the Council has itself made frequent use of this notion in its writings, it has not undertaken a thematic exploration of human dignity, its meanings, its foundations, and its relevance for bioethics. In the meantime, at least one critic, noting that “appeals to human dignity populate the landscape of medical ethics,” has recently called into question whether human dignity has any place in bioethical discourse at all.1 It would seem timely, then, for the Council to take up the question of human dignity squarely, with the aim of clarifying whether and how it might be a useful concept in bioethics.
The purpose of this working paper is to help the Council focus its discussion of human dignity and its proper place in bioethics. To that end, it will first give some examples of how human dignity can be a difficult concept to apply in bioethical controversies. It will then explore some of the complex roots of the modern notion of human dignity, in order to shed light on why its application to bioethics is so problematic. Finally, it will suggest, tentatively, that a certain conception of human dignity—dignity understood as humanity—has an important role to play in bioethics, both now and especially in the future.
1. The problem of human dignity in bioethics: some examples
That human dignity might be at least problematic as a bioethical concept is suggested by the many ways it gets invoked in bioethical debates, often on different sides of the same issue. Consider, for example, a question raised in the Council’s recent exploration of ethical caregiving at the end of life:2 Is it morally acceptable for an elderly patient, diagnosed with early Alzheimer’s disease and facing an inexorable decline into dementia and dependency, to stop taking his heart medicine, in the hope of a quicker exit, one less distressing to himself and his family? One possible answer discussed in our report is that it is morally permissible (and perhaps even admirable) for such a patient, who finds the prospect of years of dementia humiliating or repellent and who is reluctant to become a burden to his family, to forgo medication and allow heart disease to carry him off in a more dignified and humane way. Another possible answer is that it is morally impermissible, because deliberately hastening the end of one’s life, even by an act of omission, is incompatible with the equal dignity and respect owed to all human life. A third answer is that respect for the dignity and autonomy of all persons requires us to defer to the personal choice of a competent individual in such intimate matters, regardless of how he or she might decide. Note that all three answers (and perhaps others that could be given) are grounded in part in some appeal to human dignity, though they reach quite different conclusions.
Or, to take an example from the beginning of human life, consider a question that might arise in a neonatal intensive care unit: What medical interventions are appropriate to save the life of a critically ill premature infant who is likely to survive, if at all, only with severe mental defects? One possible answer is that, because human dignity rests on our higher mental capacities, it is wrong to bring a person into the world burdened with a devastating lifelong mental incapacity. Another answer might be that every reasonable measure should be taken, because the equal dignity of all human life forbids us to declare some lives “not worth living.” Yet a third answer might be that, out of respect for their dignity and autonomy, the parents must be left free to resolve this moral dilemma for themselves.
Or, again, consider an example of biomedical “enhancement” examined in the fifth chapter of Beyond Therapy:3 If science were to develop memory-blunting drugs that could free us from the emotional burdens of intrusive and painful memories, would it be ethically permissible to give such drugs freely to people who have suffered grievous disappointments or witnessed horrifying events? One answer might be that such an invention, with its promise of liberating miserable people from the emotional tyranny of past misfortunes, ought to be embraced as an unqualified enhancement to human freedom, autonomy, and dignity. But another answer might be that human integrity and dignity require of us that we confront our painful memories and learn to deal with them (if possible) and not just “flush” them away by taking a pill. A third answer would be that this decision is properly left to the individual, whose dignity and autonomy entail the right of voluntary, informed consent.
In each of these examples, a variety of strong convictions can be derived from powerful but conflicting intuitions about what human dignity demands of us. Little wonder, then, that some bioethicists are inclined to wash their hands of “dignity” entirely, in favor of clearer and less ambiguous ethical concepts.
[References for this section of the Working Paper:
1. Ruth Macklin, “Dignity is a useless concept,” BMJ 327: 1419-1420, 2003. Dieter Birnbacher, another skeptic on the usefulness of human dignity as a bioethical concept, observes that there is a “nearly worldwide consensus that reproductive cloning is incompatible with human dignity and should be prohibited by law.” See his “Human cloning and human dignity,” Reproductive BioMedicine Online 10(Suppl. 1): 50-55, 2005.
2. The President’s Council on Bioethics, Taking Care: Ethical Caregiving in Our Aging Society, Washington, D.C.: Government Printing Office, 2005, chapter 4, pp. 154 ff.
3. The President’s Council on Bioethics, Beyond Therapy: Biotechnology and the Pursuit of Happiness, Washington, D.C.: Government Printing Office, 2003, chapter 5, pp. 214 ff.]
I plan to present this paper in piecemeal segments so that we can cone down on the information presented to us. Looking at the conflicting examples suggested in the paper, I wonder how my visitors might accept one view but reject the other. Would anyone want to comment on which view of the examples given above the visitor accepts and why? ..Maurice.