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BIOETHICS

What’s Human Dignity Got to Do With Bioethics?

Council on Bioethics Report Fails to Answer the Question

Cover of Report on Human Diginity and Bioethics SOURCE: bioethics.gov Report to the president fails on both academic and public policy levels to shine a meaningful light on human dignity and bioethics.

George W. Bush’s Council on Bioethics released its long-awaited volume on human dignity this past month.[1] But for those hoping for public policy guidelines on biological developments in, say, stem cell research or abortion or end-of-life decisions, Human Dignity and Bioethics did not oblige. Instead, we were offered a series of academic essays on the meaning, origin, and basis of the concept of human dignity. After plodding through 500-odd pages, we find ourselves right back where we started: with progressive Albert Einstein College of Medicine bioethicist Ruth Macklin’s provocative assertion that dignity is a useless concept in bioethics.[2]

As co-editor and Council on Bioethics executive director F. Daniel Davis notes, this President’s Council, as opposed to the National Bioethics Advisory Commission established under President Clinton, was not asked to produce “deliverables” on particular policy issues. Instead, the Council was set up to provide “a forum for public discussion and to foster understanding of bioethical issues.” Human Dignity and Bioethics, he suggests, sets out to do just that while attempting to refute Macklin’s deflationary claims. Yet, if we take Davis at his words, we are left wondering what possessed the Council to think an academic anthology could achieve those goals.

Is a public forum on bioethics really the place to hash out metaphysical disputes?

Instead of providing a forum for public discussion, the essays engage in highly academic (if not always rigorous or illuminating) debates suited mainly for other academics already well-versed in the relevant controversies. Indeed, this volume is more about metaphysics—and not always good metaphysics at that—than it is about political philosophy or bioethics. Important topics of the day are barely gestured at in concluding sections to long theoretical discussions, leaving readers puzzled. Is a public forum on bioethics really the place to hash out metaphysical disputes? If this is all the President’s Council is willing to do, then where are we going to go for actual policy guidance?

The volume is also punctuated by vitriolic commentaries, thus dispelling the illusion of a mutually respectful discussion. Gilbert Meilander’s commentary on Patricia Churchland’s contribution is an especially egregious example. (Meilander is Richard and Phyllis Duesenberg Professor of Christian Ethics at Valparaiso University and a member of the President’s Council. Churchland is University of California President’s Professor and Chair of the Department of Philosophy at UC San Diego.) Meilander’s commentary consists mostly of ad hominem attacks and ends with the suggestion that “the most dignified thing [for Churchland] to do would be to remain silent.”

Or consider Robert Kraynak, Professor of Political Science and Director of the Center for Freedom and Western Civilization at Colgate University, and Daniel Dennett, Austin B. Fletcher Professor of Philosophy and Director of the Center for Cognitive Studies at Tufts University, who exchange mutual attributions of arrogance. Bypassing all of Dennett’s arguments to the contrary, Kraynak asserts, again (he had already done so repeatedly in his essay) that there is a “contradiction” between scientific materialism and any claim to human uniqueness.

(The reader responds with extreme puzzlement, again. Rationality and the capacity for morality, as several of the contributors point out, are obviously unique to human beings, no matter why or how we have them. Perhaps Kraynak would prefer this not to be the sole basis for human uniqueness—but that is not a sound basis for calling something a contradiction.)

Dennett, on the other hand, devotes most of his comment to explaining, again, why citing scriptural texts does not an argument make. A plausible argument, but are the Kraynaks of the world going to be moved by it? Given that we already have a good statement of Dennett’s position from his own contribution to the volume, what is the value added by this additional commentary?

Then there’s Diana Schaub’s commentary on Nussbaum and Shell’s contributions, which begins with a blatant caricature of Nussbaum’s position that appears tone-deaf to any of its nuances. Martha Nussbaum, Ernst Freund Distinguished Service Professor of Law and Ethics at the University of Chicago, argues that “respecting human dignity requires informing people about their choices, restricting dangerous choices for children, but permitting adults to make a full range of choices, including unhealthy ones.” As a consequence, she suggests that sex work and recreational drug use should be decriminalized.

Granted, these are both vexed issues, and Schaub clearly disagrees with Nussbaum’s conclusions. But why stoop to an easy caricature of “heroin-addled ‘sex workers’” being entitled to “bicycle paths” when that is clearly not what Nussbaum is advocating? Why not give a fair statement of the position before attacking it?

Did we really need a President’s Council report for this type of back-and-forth? Aren’t we already all too familiar with it from the ongoing “debates” about abortion, stem cell research, and end-of-life decisions? Should we not expect the Council to take us beyond, if one of its goals is to create a public forum for (productive) conversations? Instead of fostering understanding of bioethical issues, the volume appears to make Macklin’s case for her, leaving readers who may not previously have been so inclined asking themselves whether human dignity is, after all, a useless concept in bioethics—at least from the point of view of public policy.

So is there anything of value in the volume? Well, as a collection of academic essays, parts of it are of some interest. University of Notre Dame Professor of Philosophy Paul Weithman’s excellent contribution deserves special mention. Many thinkers, including Thomas Hobbes, John Locke, Thomas Jefferson, and twentieth-century Harvard political philosopher John Rawls believed that citizens have rights (political entitlements) because of the existence of a mutually beneficial implicit agreement (a social contract) among them. According to Weithman, some thinkers who object to this idea look instead to human dignity as an independent basis for the existence of political entitlements. In an interesting tour de force, Weithman argues that however independent arguments from dignity to entitlement might seem, they also ultimately rest on a contractualist foundation.

Weithman concludes that dignity is a useful “second-level” concept that can garner agreement among adherents of divergent views, but is not a useful bedrock concept on which to ground claims about entitlements. Since virtually every other essay in the volume attempts to ground political entitlements in a conception of human dignity, Weithman’s challenge is a powerful one that goes right to the heart of the matter, effectively posing the question: Why is the President’s Council issuing a report on dignity if what we are trying to settle are issues of entitlement?

From a more pragmatic point of view, Boston College Professor of Political Science Susan Shell’s essay also deserves special mention. She starts with Kant’s central moral injunction to always treat human beings as ends, never merely as means. Kant thought that humans should always be treated as ends because of their rationality, and Shell argues that our rationality is inseparable from our bodily nature.

The crucial missing link in all of this is a sustained discussion of the role of government, and the implications of that role for what we can and cannot do with public policy.

Thus, a key to solving some bioethical disputes might lie in the individualized character of our embodied rationality. Shell makes two interesting observations. First, she highlights the difference between moral permissibility on the one hand, and legal permissibility on the other. Respect for our autonomy as embodied rational beings may require that not everything that is morally problematic be legally impermissible. Second, she suggests that we can draw from Kant’s “punctuated” account of human development to resolve questions about moral status. For example, a blastocyst can still divide into two separate entities. Thus, it is not yet a fully individuated human being. This would justify embryonic stem-cell research as well as early abortion.

As we flip through the pages, we find dignity discussed from a number of perspectives. We read about theological and secular views of dignity, about dignity based on achievements and dignity based on human nature, about dignity as a matter of degree and dignity as all-or-nothing, and even about dignity as grounds for promoting diversity and dignity as grounds for promoting uniformity. Distinctions abound. But, one wonders, would anything be lost if the President’s Council were to leave this discussion with all its niceties to the ivory tower and proceed directly to the policy issues?

Indeed, are we any closer to “full understanding” than we were before we began reading this volume? And isn’t a relevant aspect of the “full understanding” needed for public policy a willingness to attend to people’s experiences of and interests in dignity rather than to argue about metaphysics?

The last two essays, by Rebecca Dresser, Daniel Noyes Kirby Professor of Law and Professor of Ethics in Medicine at Washington State University, St. Louis and by Council on Bioethics President Edmund Pellegrino (Professor Emeritus of Medicine and Medical Ethics at Georgetown University’s Center for Clinical Medical Ethics), take a stab at this question. Dresser’s contribution is a particularly valuable attempt to look at concrete aspects of an ill person’s experience and assess how the norms governing physician-patient interactions can be modified to preserve a patient’s sense of dignity.

She suggests four empathetic ways of mitigating the effects of patients’ vulnerability, thereby mitigating their sense of a loss of dignity: minimizing and compensating for the unavoidable loss of privacy that comes with being a patient; making sincere efforts to communicate with patients in a respectful manner; honoring a patient’s experiential knowledge of her own illness; and finally, understanding and seeking to mitigate the special dependence brought on by illness through a balanced commitment to patient autonomy. Her thoughtful essay takes up less than half the space of anybody else’s contribution: a mere eight pages to, say, David Gelernter’s 18-page treatise on religion and dignity.

Gelernter’s is not the longest essay in the volume, but it is without contest the most exasperating. The reader struggles to find a coherent argument among his many assertions and scriptural quotations, but to no avail. Gelernter, National Fellow at the American Enterprise Institute and Professor of Computer Science at Yale University, repeatedly stipulates as obvious the extremely questionable claim that, if one believes murder is wrong, then one (“ipso facto,” as he likes to keep saying) believes in God. This confused idea seems to have its source in Gelernter’s peculiar belief that the only two available positions on morality are theistic absolutism or radical relativism.

Public policy is not about defending metaphysical positions. Most fundamentally, it is about finding ways to live well together.

He then, with some flourish, puts forward a chaotic articulation of the suggestion that we must replace a “morality of rights” with a “morality of duties,” seemingly laboring under the illusion that this is an original point. In fact, if he were paying attention to contemporary ethics and moral philosophy, he would know that insightful and sophisticated articulations of this idea have been put forward and defended by two of the most preeminent moral and political philosophers of our day: Oxford and Columbia University Professor Joseph Raz, and Cambridge Professor Onora O’Neill. So much for Gelernter’s claim that “it barely exists on philosophy’s agenda.”

Gelernter grandly concludes with the following gem: “Bioethics touches every life. This field can’t possibly be allowed to develop in the secular ghetto where modern intellectuals lives [sic.].” Well, Mr. Gelernter, in my secular ghetto we think forums for public discussion require arguments, not mere assertions.

All this to say that, while there is certainly much value to academic analyses of the background issues underlying contemporary bioethical disputes, the President’s Council on Bioethics is not best placed to undertake this activity. It is neither best placed to do so from the perspective of academic quality, nor from the perspective of its self-declared goal of providing a public forum to promote debate and understanding.

What understanding can be gained from the claim that we all live in a “secular ghetto?” How is this going to provide us with any insight as to how we should make public policy on controversial issues?

The crucial missing link in all of this is a sustained discussion of the role of government, and the implications of that role for what we can and cannot do with public policy. No matter what one’s position on the role of government is, surely part of its job is to be responsive to the interests of its citizens; if we did not think so, we would not favor democracy over all other forms of government.

This job cannot be done without consulting those citizens on what they take their interests to be. And surely one fundamental way in which dignity manifests itself is in the relationship one has to oneself—in one’s sense of one’s own moral standing, in one’s own eyes, at crucial junctures in one’s life. Should we not then engage in a more careful exploration of what conditions are necessary for persons to be able to maintain their sense of dignity? And should this not nudge us away from one-size-fits-all assertions about what it is to live or die with dignity, away from assertions about the dignity of things that cannot possibly have an experience of dignity, and toward a more nuanced understanding of human differences and the political requirements placed on us by those differences?

Whether or not we find ready answers to these questions, the fact remains that dignity at its best serves as a backdrop—a way of asserting that human beings have a particular kind of moral status we all take as given, even as we disagree about how to honor that status. Unfortunately, this makes the concept of dignity especially amenable to being used as a tool for obfuscation—something we pull out of our hats as an excuse not to engage in difficult substantive discussions or produce rigorous arguments for our views. Instead, we restate our favorite metaphysical positions and stipulate as a consequence our favorite answers to crucial policy questions.

Admittedly, some essays in this volume do more than merely restate those metaphysical positions. They at least try to defend them. But public policy is not about defending metaphysical positions. Most fundamentally, it is about finding ways to live well together. This goal is not advanced by focusing on exactly those background issues about which we will never agree.

We would therefore all be much better served if the President’s Council on Bioethics would spend a little less time elaborating on the backdrop and a little more time developing coherent positions on the policy issues we urgently need to resolve.

Sirine Shebaya is a Greenwall Fellow with the Berman Institute of Bioethics.

Notes

[1] Human Dignity and Bioethics, Washington, DC: President’s Council on Bioethics, 2008.

[2] Ruth Macklin, “Dignity is a Useless Concept,” BMJ 327 (2003): 1419 – 1420. This article serves as the punching bag for most of the essays in the Council’s volume.

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