Dignity in the Discourses of Bioethics

The language of “human dignity” features prominently in seminal documents in the human rights literature, in a variety of recent declarations and conventions, in many traditional and more recent statements from religious bodies and working groups, and in bioethics writings of the past several decades (Cochrane 2009; Davis 2008; Schmidt 2006). Appeals to human dignity have buttressed arguments on a wide range of particular bioethics topics, often from quite diverse perspectives—from debates about “appropriate” forms of conception (e.g., techniques of assisted reproduction, surrogate parenting, and reproductive cloning) or about the moral status of nascent forms of human life (e.g., the use of embryonic stem cells and fetal tissue) to questions about appropriate decision making at the end of life (e.g., the status of particular interventions, especially artificial nutrition and hydration; judgments about treatment for patients in persistent vegetative state; and issues of euthanasia and physician-assisted suicide). Perhaps less prominently, or implicitly rather than explicitly, notions of human dignity also inform discussions of allocation and triage, undergirded by judgments about what constitutes a “natural life span” (Callahan 1995) or the implications of a “prudential life span account” for health care trade-offs (Daniels 1985). In addition, human dignity has been emphasized as a central value in several reports by George W. Bush’s Council on Bioethics, especially during the tenure of Leon Kass as its chair, as well as in Kass’s own writings on biotechnology, enhancement, and human cloning (see Kass 2002; President’s Council 2002, 2008).

Clearly, then, in bioethics and elsewhere, we do not lack for rhetorical examples of human dignity as an appeal. But if the concept is rhetorically familiar, its apparent richness often seems to complicate rather than to clarify arguments, with end-of-life decision making a particularly powerful example of such complexity. Claims of human dignity are asserted from opposing sides with dramatically different meanings and substantive commitments. It is, apparently, no accident that Oregon’s statute on physician-assisted suicide is labeled the “Death with Dignity Act,” because the dignity ascribed to such a choice is linked directly to claims about extending the ambit of autonomy from a competent patient’s right to refuse unwanted treatment to his or her right to physician assistance in suicide, primarily for reasons of controlling the circumstances and timing of death. Alternatively, recent Roman Catholic teaching on so-called life issues judges assisted suicide and euthanasia to be fundamental violations of human dignity (see John Paul II 1995, 18), because in the Catholic tradition autonomy is both legitimated and constrained by broader judgments about the intrinsic immorality of the direct taking of innocent human life.

More broadly, dignity appears to vary in its stringency or weight as a moral appeal depending on sociocultural and institutional differences. Dignity has featured prominently as an independent factor in a number of European Court judgments, on matters ranging from the “indignity of public dwarf-tossing” as entertainment, despite the consent of the dwarf being tossed (United Nations Human Rights Committee 2007, 111–14), to German cases that affirm “human dignity” as “an attribute of unborn human life” at all stages of development, (Constitutional Court [1993] 2012, 203) in contrast to the absence of that ascription in U.S. court decisions since the time of Roe v. Wade.

Whether one looks, then, at specific debates within a particular society or at the interpretive standards at work in different cultural and jurisprudential traditions, dignity emerges as a contested notion. For some analysts, despite its apparent imprecision, it functions usefully as a cluster or umbrella term meant to constellate core features of our shared anthropology—including intuitions about the distinctive nature of human beings and the choices and actions that comport, or fail to comport, with that status. Leon Kass, for example, invokes the language of dignity to capture a holistic vision that emerges as greater than the sum of its parts. For Kass, appeals to dignity involve both rationality and virtue, both natural sentiment and inculcated sensibility, both moral perspicacity and intuitive judgment. Moreover, for Kass, concerns about dignity are often negatively...