Human Dignity in Bioethics and Law (review)

For years, Beauchamp and Childress’ “principalism approach” was seen as the most applicable—and possibly only—way to resolve dilemmas arising from situations in medical ethics and bioethics. This approach suggested four guiding principles for the resolution of bioethical conflicts: autonomy, beneficence, nonmaleficence, and justice. In the context of health care maleficence decision-making, autonomy took the spotlight as the paramount value.

Charles Foster shakes up this historical paradigm ingrained in medical ethics. While not wholly rejecting the application of these aforementioned principles, he suggests that we have to look elsewhere for a methodological framework to resolve both “really hard cases” and easier bioethical cases. Specifically, he elevates human dignity as the key principle that “unlocks all problems in medical ethics and bioethics. It is the bioethical Theory of Everything.”¹ Certainly, Foster is well aware of the concept’s main limitation, that is, its vagueness. Thus, his definition of dignity aims at overcoming this problem. As he explains, dignity is inherently something that connects to (objective) human flourishing: “[it is] what makes humans tick, and what makes them tick well: what makes them thrive.”² This definition builds on our common intuition and, importantly, requires that we take into account not only the individual but also one’s nexus, including relationships, and, more broadly, one’s social, political, and physical environment.

To establish this argument, Foster takes the reader on a journey comprised of twelve chapters, an Epilogue, and a foreword by Lord Justice Munby, running from the history of dignity since the early Homo sapiens, passing through Judaeo-Christian tradition, the Middle Ages and Renaissance, the Enlightenment era, modern day and on to the future (in the context of human enhancement and cloning technologies).³ On the way, he summarizes, evaluates, and dissects the various efforts that have been made by philosophers and scholars, who think that dignity is useful, and of those who think that it is not (Chapters 3 and 4, respectively). In chapter 5, Foster incorporates the ethical standards regarding dignity that are required by various healthcare-related associations. Importantly, he also discusses “the view from the ward,” i.e., what patients themselves think about the notion of patients’ dignity. This latter discussion aims not only at illustrating that patients think there is a right way to do things, which is intuitively consistent with dignity as a matter of human thriving, but also to dismiss the traditional principles of bioethics as being able to explain or justify those intuitions felt by patients.⁴ He insists that, ultimately, “dignity (whatever it is) is what lies as deep within people as one can drill.”⁵

In chapter 6, Foster examines a bio-legal anthropological approach to dignity. He suggests that “what makes people thrive” is an empirical question, but that it transforms into a normative one that allows making “correct ethical (and, by extension, legal) decisions.”⁶ In the following chapter, Foster provides an overview of how the notion of dignity has been included in national and international instruments that specifically deal with healthcare and bioethics—although without defining it—as well as the inconsistent manner in which courts, including in particular the European Court of Human Rights (ECtHR), addressed this notion in an array of cases to conclude in a negative manner that “there is no authority that forces us to read dignity in a way that precludes the version I am advancing.”⁷

Finally, Chapters 8 through 12 revolve around more specific areas of medicine and bioethics and Foster’s application of dignity in their regard—from issues of consent and privacy to human enhancement, reproductive choices, end of life dilemmas, and organ transplants. Not all of these latter discussions are comprehensive. The discussion on medical research, for example, is merely a paragraph, and the discussion on reproductive choice is merely a page-and-a-half, (possibly also because of Foster’s extensive references to his previous book), but overall they are interesting to follow.

Foster’s book is...