Editorial: Human Dignity and Biomedicine

 

Arguably, one of the best extended contemporary discussions of human dignity and its implications for biomedicine was commissioned under President George W. Bush and convened by his President’s Council on Bioethics. The council’s two reports, Being Human (2003) and Human Dignity and Bioethics (2008), are the results of more than a few public meetings, thousands of pages of expert testimony, and the work of two physician-scholar-chairmen, Leon Kass, MD, and Edmund Pellegrino, MD. The work of the council provoked bioethicist Ruth Macklin to brand human dignity a ‘useless concept.’ Cognitive scientist Steven Pinker even assailed the notion of dignity as ‘stupidity.’

Nevertheless, both the term and the idea for which it stands continue to possess significant currency not only in the popular imagination but especially in medicine and law. In fact, Roberto Andorno, Senior Research Fellow and Lecturer at the Institute of Biomedical Ethics of the University of Zurich, maintains that the notion of human dignity is so ubiquitous in intergovernmental documents in biomedicine that ‘It is therefore not exaggerated to characterize it as the “overarching principle” of international biolaw’ (‘Human dignity and human rights as a common ground for a global bioethics’, Journal of Medicine and Philosophy 34 (2009): 223–240).

How does one account for this discrepancy? Can human dignity be at once both profound and indecipherable? Can it be both ubiquitous and useless? What happens if we expunge human dignity to the dustbin of incoherence, as Macklin and Pinker would have it? The implications of these questions for biomedicine, human rights, and public policy are difficult to overestimate.

Will our posthuman progeny one day see human dignity as a quaint historical artifact of our speciesist predilections? Perhaps. But removing human dignity from the table only seems to move the question of human rights to the foreground. Whence come human rights if not from human dignity? The United Nations’ Universal Declaration of Human Rights of 1948 affirms that ‘recognition of the inherent dignity and of the equal and inalienable rights of all members of the human family is the foundation of freedom, justice and peace in the world . . . .’ If human rights are merely a result of a social contract, humanity as we know it will survive only so long as the contract remains unaltered. In light of the history that gave new birth to this tradition—namely, the Nazi eugenics movement and the violations of human dignity that resulted from it—forfeiting the idea of inherent human dignity would seem potentially disastrous.

Alternatively, if human dignity turns out to be just a placeholder for rational autonomy, then another precarious state of affairs may follow. What of those at the margins? Patients in a persistent vegetative state, those with end-stage Alzheimer’s, unborn children, and others, would lack dignity and, therefore, human rights. But this seems counterintuitive. Why should one’s ability to exercise free and rational choice be the ground of human dignity? As Patrick Lee and Robert George have recently argued, ‘the criterion for full moral worth is having a nature that entails the capacity (whether existing in root form or developed to the point at which it is immediately exercisable) for conceptual thought and free choice—not the development of that basic natural capacity to some degree or another.’ Most of us would be able to say without any cognitive dissonance that the rape of a severely retarded person is a violation of his or her dignity as a human being quite apart from his or her ability to exercise rational, autonomous choice. How can this be so unless membership in the human species, not the exercise of rational and volitional abilities, is the ground of our notion of human dignity?

Human dignity is so robustly enshrined in international biolaw and policy, it seems unlikely that its appeal will fade away any time soon. Instead, we should take the current controversy as an opportunity to reinvigorate its meaning.

We must understand human dignity, therefore, as a first principle. That seems to be one of the significant ways we use the term in both ordinary language and in international policy. This, of course, does not resolve every difficulty. We may certainly ask questions of human dignity. What sort of thing is it? Why should we believe in it? What would follow if we do? What would follow if we do not? But beginning with human dignity as a properly basic notion rooted in our species membership and as the ground of human rights goes a long way toward an operational definition that helps us make meaningful decisions about how we treat one another and what obligations we owe to whom. Whether one is an atheist, Muslim, Christian, or Buddhist, there seems to be a very important overlapping consensus that what we share as a species should be the basis for solidarity, justice, humanitarianism, and moral medicine.

 

Editor’s Note: This editorial originally appeared in Ethics & Medicine: An International Journal of Bioethics 27 no. 1 (2011) and is used with permission.

 

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