Few terms or ideas are more central to bioethics or less clearly defined than human dignity. Although the core idea of human dignity has to do with the worth of human beings, the precise meaning of the term is controversial. Respect for human dignity is an ethical mandate to which both sides of many bioethical debates appeal. For example, the state of Oregon legalized physician-assisted suicide by passing the Death with Dignity Act, but opponents claimed that legalizing that practice would undermine the dignity of elderly, disabled, and dying patients. Similarly, in response to claims that respect for the dignity of those patients demands the pursuit of cures through the production of embryos by means of cloning for embryonic stem cell research, others claim that producing human beings in embryonic form and destroying them for the benefit of others is an affront to human dignity.
Views of Dignity
This term also is surfacing more frequently in important bioethical and other public documents. It has played a role in the constitutions of a politically diverse array of countries, including Afghanistan, Brazil, Canada, Costa Rica, the former Federal Republic of Germany, Greece, Guatemala, Ireland, Italy, Nicaragua, Peru, Portugal, South Korea, Spain, Sweden, and Turkey. In some of those countries, such as Germany, the role of human dignity is substantial. Affirming that "the dignity of the human being is inviolable," the German constitution recognizes various human rights that the law must respect. Even in countries where the term has not been influential in constitutional language, it has come to play an important role. For example, the U.S. Supreme Court has employed the term in its deliberations over the meaning of the First, Fourth, Fifth, Sixth, Eighth, and Fourteenth Amendments to the Constitution.
International documents that are relevant to issues in bioethics also have affirmed the critical importance of human dignity. The United Nations, whose charter celebrates the "inherent dignity" of "all members of the human family," issued a Universal Declaration of Human Rights in 1948 whose preamble contains the same language. Article 1 specifically affirms that "all human beings" are born "equal in dignity." Two other documents—the International Covenant on Economic, Social and Cultural Rights and the International Covenant on Civil and Political Rights—were joined to that document in 1966 to constitute the so-called International Bill of Rights. All three documents ground the various rights of all human beings in their human dignity. In line with this outlook, the Council of Europe's 1996 Convention on Human Rights and Biomedicine was designed explicitly to "protect the dignity" of "all human beings."
These documents reflect the primary sense in which human dignity is invoked today: as an attribute of all human beings that establishes their great significance or worth. The word dignity comes from the Latin words dignitas ("worth") and dignus ("worthy"), suggesting that dignity points to a standard by which people should be viewed and treated. Although the standard usually has an egalitarian bent today, in ancient Greece and Rome the standard more commonly was attached to inegalitarian traits such as physical prowess and intellectual wisdom, as exemplified in figures such as Hercules and Socrates. People differed in dignity according to the degree to which they manifested the relevant traits, and the honor due them varied accordingly. This sense of dignity persists today when one speaks of dignitaries who warrant special honor or behavior that is dignified or undignified. Dignity in this sense can increase or decrease, can be gained or lost (Spiegelberg).
Dignity can refer to something that is variable in other ways as well. There is a difference between having dignity, on the one hand, and having an awareness of dignity or being treated with dignity, on the other hand. Someone may not be aware of having dignity though possessing it nevertheless; someone may not treat people in a particular group as having dignity though they may possess it. Such variability, however, should not be confused with the contemporary concept of dignity that is beyond the perceptions or actions of particular individuals and is rooted in what all human beings have in common. This is the concept that typically is operative when human dignity is invoked as the basis for the ways in which human beings should be viewed or treated.
Respect for human dignity is connected to a virtue as well as an ethical standard. A virtue-oriented approach to human dignity may take different forms. For example, exhibiting human dignity (usually referred to simply as dignity) can be a virtue in a way that is reminiscent of the notion of dignified behavior discussed above. To say that certain people exhibit dignity or are dignified can be a way of commending their courageous attitudes or actions in the face of adversity. However, the virtue of human dignity may refer to a person's capacity to recognize and live in accordance with a particular standard of human dignity. This form of the virtue serves as a reminder of how important it is that respect for human dignity be lived out in practice rather than existing only as an abstract concept. Exercising such a virtue still requires specifying what human dignity is.
People most commonly view human dignity in one of two basic ways. Some see it as grounded in particular characteristics of human beings; others view it as attached to being human per se. Both understandings are examined below, and then this entry surveys some of the bioethical implications of those views. First, it is necessary to clarify the significance and meaning of the concept by noting arenas in which it has been denied.
Challenges to Human Dignity
In the twentieth century perhaps the most widely decried denial of human dignity took place under the fascist regime in Germany; this accounts for the emphasis on dignity in the German constitution and the international and European documents discussed above. Millions of people were forced to be subjects of experimentation against their will or were tortured or killed for other reasons. As a result, the importance of human freedom and bodily integrity became much clearer and the danger of compromising them in the interests of the larger society became widely evident.
A tension necessarily exists between the idea of human dignity and ethical outlooks, such as utilitarianism, that, at least in their more popular and influential forms, affirm human dignity only to the degree that doing so is recognized to be sufficiently beneficial. Although the good of society is important, it potentially can justify doing anything to certain individuals, no matter how destructive, unless some standard of human dignity prevents that from happening. From a utilitarian perspective, what ultimately matters is the benefit itself (e.g., pleasure or preference satisfaction), not the individuals who benefit.
Others who are not well disposed to the notion of human dignity reject its high regard for freedom of choice or bodily integrity. Those who are most skeptical about freedom of choice include some in the social and biological sciences. Psychiatrists and psychologists who follow Sigmund Freud, for example, argue that freedom of choice is an illusion: Choices are driven largely by unconscious and irrational forces. Behaviorists who follow B. F. Skinner see such freedom as illusory because in their view behavior is driven more by environmental stimuli than by freely willed choices. Some biologists are skeptical about attributing any special dignity to humans because they are less impressed by any apparent differences between the abilities of people and animals to make free choices than they are by biological similarities between humans and animals. Those similarities go beyond the ability to experience pleasure and pain to encompass certain genetic, physiological, and other mental similarities.
Those who are skeptical about the high regard for bodily integrity in the notion of human dignity include socalled postmodernists and posthumanists. Postmodernists reject the "modernist" notion of a universally binding objective truth that has a wide range of implications for the ways in which people should be treated. Many postmodernists would characterize as oppressive the idea that certain applications of technology to the human body are inherently unethical (i.e., violations of human dignity). Posthumanists, in contrast, doubt the value of the human body. Bodily form is seen as an accident of history that eventually will be replaced through developments in cybernetics and artificial intelligence. According to this view, because human beings have no lasting significance, human dignity is an illusion.
Characteristics That Give Humans Dignity
In the face of such challenges there has persisted a widely shared commitment to human dignity: the conviction that human beings have a special worth that warrants respect and protection. The big question is: For what reason? Many people have addressed this question, and their responses are basically of two types. The first type of response maintains that human beings have dignity because of one or more characteristics that are typically human. This view can be traced back at least to Marcus Aurelius and earlier Stoic philosophers who held that human beings have a basic equality that is rooted in their common ability to reason. It can be spotted occasionally in later periods—for example in Renaissance thinkers such as Pico della Mirandola and Enlightenment philosophers such as John Locke.
A full-blown account of human dignity rooted in reason took on its most complete form in the work of Immanuel Kant, especially in his Groundwork of the Metaphysics of Morals, where he argues that "morality, and humanity so far as it is capable of morality, is the only thing which has dignity" (p. 102). In other words, human beings do not have dignity simply because they are human but because and to the extent to which they are capable of morality. Because for Kant "morality lies in the relation of actions to the autonomy of the will" (p. 107), he concludes that "autonomy is therefore the ground of the dignity of human nature" (p. 103). Simply put, human beings have dignity because autonomous reason rather than impulses or the pursuit of personal or social benefit governs their actions.
According to Kant's principle of autonomy, a human being "is subject only to laws which are made by himself and yet are universal" (p. 100). Both parts of this principle are essential. Moral decisions must be self-made rather than imposed by others, even by God, but they also must be decisions that could be made consistently and acted on by everyone rather than products of an individual's personal view of reality, as in postmodern autonomy. In Kant's words, "all merely relative" ends are excluded: "The principle of autonomy is 'Never to choose except in such a way that in the same volition the maxims of your choice are also present as universal law'" (p. 108). Because they have autonomy, human beings have dignity, as opposed to price: "Everything has either a price or a dignity. If it has a price, something else can be put in its place as an equivalent; if it is exalted above all price and so admits of no equivalent, then it has a dignity" (p. 102). Accordingly, human dignity requires that a human being be treated "never merely as a means" but "always also as an end" (p. 105).
Deryck Beyleveld and Roger Brownsword, among others, have tried to go beyond Kant and develop a reason-based approach to human dignity together with its implications for bioethics. They affirm Kant's attempt to root human dignity in people's reason and capacity to be moral agents, but they prefer to follow Alan Gewirth in adopting an understanding of agency that is focused more on choice. For Beyleveld and Brownsword "the essence of the dignity of agents resides in their capacity to choose, to set their own ends" (p. 5). Consequently, they prefer to see human dignity more as empowerment than as constraint. Whereas Kant's emphasis on people as "ends in themselves" fosters significant attention to limits on the ways in which people may be treated, even by themselves, these authors see the protection of each individual's right to choose as the primary mandate flowing from the rooting of human dignity in reason.
Despite the preoccupation with individual rights in many discussions of human dignity, especially in the West, the focus on the individual as opposed to the community is not inherent in the concept. A communitarian approach can champion human dignity in various ways. For example, it can establish respect for autonomy and choice as the hallmark of what should characterize a society. However, it also can promote a vision of how people should and should not be treated that limits individual choices.
Regardless of its individualistic or communitarian bent, any attempt to root human dignity in human characteristics such as reason and autonomy faces at least two important hurdles. First, it is possible for a living human being to lack such characteristics yet still be recognized as a human being. Are there human beings who lack human dignity? If having human dignity requires possessing the ability currently to exercise moral capacity or autonomy, for example, those who have mental disabilities, are comatose, are children, or are still in the womb do not have human dignity even if they are recognized as human beings (Gaylin). Often these are the individuals who are most in need of the protection that a concept of human dignity is designed to give.
Proponents of autonomy-based approaches have tried to give at least partial status and protection to those human beings in various ways. For example, Gewirth ties the level of a being's moral status to the degree to which that being has the necessary characteristic or characteristics. However, if human dignity is something one either has or does not have, as is affirmed typically, and if autonomy is the characteristic on which human dignity is based, then anyone without true autonomy does not have human dignity. Beyleveld and Brownsword agree but think it possible to grant those persons moral status on the basis and to the degree to which they may be moral agents who have autonomy. However, in cases in which there is a significant possibility that beings with autonomy are present, many people would consider it better to recognize and respect their human dignity rather than giving partial respect even to the simplest life forms under the assumption that they may be autonomous beings.
The second hurdle for this approach to human dignity is the plausibility of holding that what matters about human beings can be reduced to specific characteristics. Kant, for example, has been criticized for reducing what ultimately matters about human beings to the mind—to the rational—for that demeans bodily existence, which is essential in matters of bioethics (Kass). In fact, the focus on characteristics is vulnerable to the very criticism that it uses against its alternatives: It reduces human beings to what people in general or a particular community values about them and so in principle invalidates ascribing human dignity to them. The view that a particular characteristic such as moral capacity or autonomy is a sufficient basis for granting human beings an exalted status called human dignity may seem intuitively plausible to many, but it does not seem so to others. Accordingly, this approach is "based upon an anthropological 'creed'—not necessarily a religious creed" (Hailer and Ritschl, p. 99).
Dignity Rooted in Being Human
Because basing human dignity on particular human characteristics has difficulties, it may be preferable to root that dignity in being human per se. One way to do that is to focus on a basis from which all characteristics may be said to flow, such as the human genetic code. The 1997 Universal Declaration on the Human Genome and Human Rights of the United Nations Educational, Scientific, and Cultural Organization, for example, affirms that all human beings are equal in dignity because of the underlying unity provided by the human genome. Although this commonality may suggest a basic equality in all human beings, it does not address the significance of all human beings.
If their significance cannot be rooted in who people are, that is, in the specific characteristics discussed above, perhaps it can be found in something or someone beyond themselves. One candidate would be the sort of universal force acknowledged in Buddhism (Inoue). Because that force is in all living things, though, whatever dignity it imparts is not particularly human. However, if there is a God who establishes a special relationship with human beings that confers special worth on them, all people may be said to have a dignity that is distinctively human.
No such account of human dignity has had greater influence than the one portrayed in the authoritative writings of several major religious traditions, in which human beings are described as the "image of God." In addition to its role within religious traditions such as Judaism (Cohn), Christianity (Moltmann), and Islam (Bielefeldt et al.), this account has had a substantial impact on public formulations of the concept of human dignity (Bayertz). For illustrative purposes, this entry will consider this notion as it appears in the Christian Bible, since much of the Bible's relevant content is shared by other religious traditions.
The Bible uses two basic terms for image: the Hebrew tselem/Greek eikon (generally translated as image) and the Hebrew demut/Greek homoiosis (generally translated as likeness). Although there have been attempts to distinguish the two terms, it generally is recognized that they are used almost synonymously throughout the Bible. Usually one or the other appears, but occasionally, as in the account of the original creation of humanity in Genesis, both are employed. The sense conveyed is that of an image that is truly representative of God (Bray). In this view human dignity is not tied to a claim that human beings are divine or inherently worthy apart from God, and it is not because of human autonomy independent of God that people assume the authority to declare their own worth. Instead, human dignity is grounded in humanity's unique connection with God, by God's own initiative. This connection has three aspects: creation, alienation, and renewal. The first two have special significance for human dignity as an ethical standard, and the third for human dignity as a virtue.
In terms of creation, Genesis 1 (with a reaffirmation in Genesis 9) indicates that the image of God attaches to that which is human as opposed to that which is animal or plant. As a human child was considered the tselem of a parent (Genesis 5) and a tselem in the ancient Near East could refer to a statue reminding people of a king's presence (Westermann), human beings were created to have a special, personal relationship with God that includes their being God's representative in the world. Accordingly, the Bible speaks of human beings not only as being created in the image of God but also as being the image of God. This is striking because images of God are strictly forbidden in the Bible (e.g., Deuteronomy 4). However, the consistent message is that people are not to fashion images to make God the way they want God to be any more than they are to be God themselves. They are to manifest God to the world in accordance with the way God has made them and continues to direct them to be.
There have been attempts to attach more specific content to being the image of God. Some have seen its essence as involving humanity's (like God's) ability to reason, relate to others, or rule the world. However, others have maintained that those interpretations are read into the biblical text rather than read from it. For instance, Genesis does identify creation in God's image as unique to human beings, as opposed to other living things, and does instruct people about their responsibility to exercise stewardship over the rest of creation. However, the second instruction, some note, is not part of the description of what creation in God's image is; it is a separate matter that exemplifies what can be expected of one who is created in God's image. Similarly, they add, it is not surprising to find rational and relational abilities in those created in God's image, but they are never identified as what constitute that image (Cheshire). Angels, for instance, appear to have similar abilities but never are identified as being created in God's image. The picture presented in the biblical writings is that human beings themselves, not particular attributes or functions, are through God's creation the image of God.
The Bible goes on to record, however, that human beings were not and never have been content simply to be who God made them to be. In deciding to do things their own way, to give in to the temptation to "be like God" on their terms rather than God's (Genesis 3), they have experienced alienation not only from God but also from their own best selves, other people, and the rest of creation. Their capacities to reason, relate, and rule well have been damaged severely (Psalm 14, expanded in Romans 1, 8), and people now seek to create images to worship (including themselves) because they have lost sight of the fact that they are images of God created to reflect and direct worship toward God rather than to be worshiped themselves.
Even in this alienation human beings remain the images of God, for God will not allow all connection with their Creator to be broken. The ethical standard of respect for human dignity gains its force precisely from this ongoing connection, for those who are dealing with human beings are dealing in a significant sense with God. Killing an innocent human being is equivalent to destroying an image of God without warrant from God and for that reason is unacceptable (Genesis 9), as is the attempt to tear down a human image of God verbally through cursing (James 3). Human dignity as constraint thus joins human dignity as empowerment once alienation has occurred and protection of human beings has become necessary.
The ethical standard of respect for human dignity rooted in the biblical accounts of creation and alienation, as was noted above, is affirmed in various religious traditions, as is the virtue of recognizing the dignity of human beings in words and actions, along with the difficulty of doing that once one is alienated from God. What the remainder of the biblical story adds is a particularly Christian account of how that marred image of God can be renewed, and with it the ability to live out the virtue of human dignity. For alienation to be replaced by reconciliation—for renewal to occur—according to this account, people literally must undergo a new creation (2 Corinthians 5). They must recognize the hopelessness of their alienation, give up all attempts to improve their situation through their own (futile) efforts, and invite God to re-create them in the image of God revealed in Jesus Christ. Although the creation is new, the image on which it is based is not, for Christ is identified not only as the image of God but also as God who created humanity in God's image in the first place (Colossians 1).
The new creation is portrayed as both ontological and logical. It is ontological in that it is an event in time that involves a change in being; it is logical in that it involves a process that flows logically from that event. People become in practice who they already are in being. This is said to be God's doing—people "are transformed" into the image/likeness of Christ (2 Corinthians 3)—but it also requires them to "be who they are" and "put on the new self, created to be like God" (Ephesians 4).
When people are renewed "in the image of their Creator," the result is described in terms of not only renewed individuals but also a renewed community: "Here there is no Greek or Jew, circumcised or uncircumcised, barbarian, Scythian, slave or free" (Colossians 3). Differences no longer divide; they disappear or in some cases can even enhance community, in which the human dignity of all is recognized. Those who are renewed images of God warrant no better treatment than does any other human being in this view because all human beings have human dignity by virtue of their original creation in God's image. However, those who are renewed images are characterized as increasingly more capable of exercising the virtue of human dignity than they would be otherwise.
God makes covenants with human beings, became a human being in Jesus Christ, retains that humanity eternally, died in humanity's place to pay the penalty for human rebellion against God, and will appear personally to bring humanity into an unending celebration of life with God, at which point people finally will understand all that being in the likeness of God entails (1 John 3). All these historical developments fill out the biblical account of human dignity but also rest on the basis that human beings are images of God, which some identify as the essence of what it means to be human (Berkouwer).
Rooting human dignity in being human, like basing it on specific human characteristics, faces at least two important hurdles. First, although it avoids the problematic idea that there could be human beings without human dignity, it begs the question of who is a human being. Does anyone with a human genome qualify, and if so, how much of the human genetic code must be missing or nonfunctional before status as a human being is lost? Are certain capacities instead or in addition what constitute a human being, and if so, must the exercise of those capacities be actual or may it be potential?
The second hurdle for this approach also has to do with its plausibility. Those who reject the existence of God or the notion of the image of God necessarily reject this approach. Some go further and find the idea of according a special dignity to the human race per se to be a form of "speciesism" that is ethically akin to racism or sexism (Singer). Just as that critique is not necessarily a religious one, attempted refutations do not necessarily depend on religious argument (Chappell). In any case, as was noted above, every approach to human dignity rests on some form of an anthropological creed whose plausibility must be assessed.
Specific Implications for Bioethics
As has been suggested here, people most commonly invoke human dignity in situations in which the worth of human beings is brought into question when they are used, forced, or injured. Human beings should not be used because their dignity requires that they be treated as having intrinsic, not merely instrumental, worth. They should not usually be forced because their dignity mandates that their wishes be respected. They should not normally be injured because their dignity entails that their well-being be preserved.
In some bioethical issues these dignity-related concerns argue persuasively against other considerations and typically claim to trump them. For example, in evaluating a form of human experimentation people commonly insist on obtaining the informed consent of participants lest the participants' dignity be violated when something is done to them against their wishes. No amount of benefit to society warrants such a violation. In matters of resource allocation some people invoke human dignity to argue that the allocation producing the greatest overall social benefit is not the right one if the burden that certain individuals must bear to bring it about is too heavy. Not only may some people be injured, the very process by which anything can be done to them if it results in greater benefit to society is demeaning. Human dignity also is invoked to protest the injury involved in human cloning for reproductive purposes as long as animal studies show that attempts to clone humans almost certainly would result in the birth of children who eventually would develop serious deformities.
In other bioethical debates human dignity is not so unambiguously on one side of the issue. The reason for this is that more than one anthropological creed is influential, leading to competing conceptions of human dignity. Sometimes the clash involves a conflict between those concerned about injuring people and those concerned about forcing people. In the debate over abortion, for instance, people who consider the freedom to choose as central to human dignity often see no conflict. In regard to the mother and the fetus there is only one human being with the ability to choose, and so her decision prevails. Opponents of abortion with a different view of anthropology may hold that two human beings are present. Accordingly, they see the situation as a conflict between two affronts to dignity in which a greater violation would be done by fatally injuring the unborn child than would be done by forcing the mother to carry the child to term. The debate over embryonic stem cell research can be construed similarly, with supporters championing the dignity (choice) of researchers and the potential beneficiaries of the research and opponents decrying the greater violation that would occur if embryonic human beings were destroyed.
Other bioethical debates are even more complicated in that two elements of human dignity—preventing people from being injured and preventing people from being used—are in conflict with a third element: preventing people from being forced. For this reason the groups of people on each side of these debates are not the same groups as those in the debates mentioned above. For example, in the debate over germline intervention to enhance future generations of human beings those who see the only threat to human dignity as the limitation of people's choices tend to favor giving parents and society freedom to pursue such avenues. Others, more concerned to protect people against injury even if their choices are limited in the process, identify a threat to human dignity in subjecting young human beings to such procedures when the potential negative effects of genetic alterations for enhancement purposes are not well understood. That opposition is strengthened for many by seeing not just the potential injury involved but also the fact that the people doing the enhancement unacceptably use other human beings by altering them to exhibit traits that parents or society may like but that the ones who are altered may not. Similar issues arise in the debate over the genetic determination of human beings through cloning; the indignity involved is made worse for some if the cloning is done with the intentional injury, that is, death, of the cloned embryo in view.
In end-of-life debates a similar complex of considerations involving human dignity commonly arises. On one side are those who insist that human dignity requires that people have all choices open to them at the end of their lives, including physician-assisted suicide. On the other side are those concerned that the dignity of patients will be demeaned by overt or subtle pressures to give up their lives or by the necessity for them to justify their continued existence in the face of familial and societal burdens. As some see it, patients who are mentally disabled may even be injured directly by inadequate treatment or acts of euthanasia.
Human dignity plays a significant role in many bioethical debates. Because human dignity can be invoked on both sides of various issues, there is a pressing need for those who use that term to clarify what they mean by it. At some point they also need to defend the plausibility of the anthropological creed that underlies their view.
john f. kilner
SEE ALSO: Aging and the Aged; Autonomy; Care; Compassionate Love; Competence; Confidentiality; Dementia; Death: Cultural Perspectives; Disability; Emotions; Environmental Ethics; Life, Quality of; Life Sustaining Treatment and Euthanasia; Moral Status; Palliative Care and Hospice;Reproductive Technologies; Research Policy; Transhumanism and Posthumanism
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