Human Dignity and Bioethics: Essays Commissioned by the President's Council on Bioethics
The President's Council on Bioethics
Part 3: Dignity and Modern Culture
Chapter 9: human Dignity and Public Discourse
Dr. Adam Schulman's thoughtful overview (in the introduction to this volume) of the problems posed by bioethics and human dignity begins with a succinct description of what might be called the state of the question. His words bear repeating:
Human dignity-is it a useful concept in bioethics, one that sheds important light on the whole range of bioethical issues, from embryo research and assisted reproduction, to biomedical enhancement, to care of the disabled and the dying? Or is it, on the contrary, a useless concept-at best a vague substitute for other, more precise notions, at worst a mere slogan that camouflages unconvincing arguments and unarticulated biases?
To begin the discussion by reference to what is "useful" or "useless" does not necessarily imply a thoroughgoing utilitarian calculus, but it does invite the question, Useful or useless to what end? The statement of the state of the question says that "useful" means that it sheds important light on various bioethical issues, while "useless" means that it is less useful than "more precise notions" or, worse, that it is misleading and deceptive. Clearly, "light"-i.e., wisdom, knowledge, truth, guidance-is what we desire. Since the subject is bioethics, the kind of light we are looking for is ethical or moral light.
We need not enter into the debate over whether there is a qualitative difference between the ethical and moral. It is argued by some that the ethical deals with right and wrong while the moral deals with good and evil, with right and wrong being defined by us while good and evil are discovered in the way things really are. With respect to the actions addressed by bioethics, perhaps all can agree that the goal is to do the right thing , with most claiming that the right thing is the moral thing. In the history of Western civilization's reflection on ethics and morality, the most elementary maxim is, "Do good and avoid evil." For purposes pertinent to the questions addressed by bioethics, this can also be phrased as "Do right and avoid wrong." The first principle of practical (moral) reason, in obedience to that maxim, is to direct one's will in accord with the human good.
To be sure, it is argued by some that in some circumstances it is permissible to do evil-a "necessary evil," as it is called-in order to do the right thing, meaning in order to achieve the right result. This touches on the divide between the utilitarian and deontological lamented by Dr. Schulman. From one viewpoint, it is at least doubtful that an act is evil if it is indeed necessary to achieving a good (i.e., doing the right thing). From another viewpoint, assuming that good and evil are antithetical, it is allowed that good may result from an act or course of action that will foreseeably result in a circumstance that it would be wrong to intend, but the good result is despite and never because of the doing of evil. The relevance of this brief excursus on the distinction between ethics and morality, including the distinction between right and wrong, on the one hand, and good and evil, on the other, will become evident in due course.
The stated subject is the usefulness of the concept "human dignity." The better phrase is "the dignity of the human person." "Human dignity" may suggest the collective and include efforts such as taking technological charge of the evolution of the human species. "The dignity of the human person" places the accent on the individual, albeit, to be sure, the individual situated in community. The dignity of the human person may entail an important, although limited, measure of autonomy. Dignity as autonomy features strongly in, for instance, arguments for "death with dignity." Morally, however, the dignity of the human person is affirmed most importantly not in the assertion of one's autonomy but in the protection of others who are most subject to having their dignity violated. Therefore, in bioethics as in medicine more generally, the first rule is "Do no harm." That first rule enjoins us to protect and maintain something that is recognized as good in its being.
That first rule is perceived by some to be a restriction on scientific and technological progress, and it is intended to be exactly that. More precisely, it is a frankly moral placing of limits on what some, driven by what is aptly described as the scientific or technological imperative, deem to be progress. Morality is not to be pitted against genuine progress, and we should be grateful for all the advances that have been made and no doubt will be made in "the relief of man's estate" (Bacon). But it is precisely the business of ethical and moral reason to make normative judgments regarding present and proposed measures aimed at such relief. This is true with respect to the dignity of the human person and with respect to more ambitious proposals aimed not so much at relieving as at transforming "man's estate." In this connection, Dr. Schulman's citing of C. S. Lewis's The Abolition of Man is entirely to the point.
Understanding of the questions before us has not been well served by the ill-defined discipline of bioethics. Militating against the task of normative moral judgment is not only the scientific and technological imperative, with all the fame and glory attending "breakthrough" achievements, but also the weight of inestimable financial interests. Think, for instance, of what those who can pay will pay for a significant extension of their life span or for the "perfect baby." It is only somewhat cynical to observe that institutions with the greatest vested interest in dubious advances have recruited the best bioethicists that money can buy.
One must acknowledge that bioethics as an intellectual institution is, in significant part, an industry for the production of rationalized-sometimes elegantly rationalized-permission slips in the service of the technological imperative joined to the pursuit of fame and wealth. Which is not to deny that such permission slips are also issued in the service of what some believe to be the relief of suffering and the enhancement of man's estate. Even when bioethics is conducted with intellectual and moral integrity, a question must be raised about the nature of the authority of those who are called bioethicists. This touches on politics and political legitimacy in addressing bioethical controversies.
Dr. Schulman notes the complaint that the idea of the dignity of the human person in international agreements and declarations in the aftermath of World War II "does not offer clear and unambiguous guidance in bioethical controversies." He says, correctly, that in such statements "the meaning, content, and foundations of human dignity are never explicitly defined. Instead, the affirmation of human dignity in these documents reflects a political consensus among groups that may well have quite different beliefs about what human dignity means, where it comes from, and what it entails. In effect, 'human dignity' serves here as a placeholder for 'whatever it is about human beings that entitles them to basic human rights and freedoms.'" He adds, "This practice makes a good deal of sense."
It makes a great deal of sense indeed. In a world indelibly marked and marred by the Holocaust, the Gulag Archipelago, Mao's Great Leap Forward, and myriad other crimes against humanity, a political consensus as a placeholder against great evils, no matter how intellectually rickety its structure, is not to be scorned. In A World Made New: Eleanor Roosevelt and the Universal Declaration of Human Rights,1 Harvard law professor Mary Ann Glendon describes the ways in which the drafters of the declaration were keenly aware that their goal was a political consensus, not a philosophical or moral treatise on human nature and the rights and dignities attending human nature. Given the enormous cultural, religious, intellectual, and ideological diversity of those involved, a political consensus was a great achievement. While rights and freedoms are positively asserted, they are largely defined negatively against the background of evils to which the declaration says, in effect, "Never again!" Thus was the morally elementary rule "Do no harm" given new specificity.
Nor should it be thought that a political consensus is somehow inferior to a coherent treatise on the moral and philosophical foundations of human dignity. In a world that continues to be characterized by what Saint Augustine called libido dominandi -the unbridled lust for power and glory-politics is an instrument for the restraint of great evil. In ethics, and in bioethics specifically, "politics" is frequently seen as an alien intrusion upon or a poor substitute for the search for "clear and unambiguous guidance." But the search for guidance through the controversies besetting us is precisely a political task.
Aristotle's Nicomachean Ethics and his Politics are both discourses on morality. From them we can derive this definition of politics: Politics is free persons deliberating the question, How ought we to order our life together? The "ought" in that suggested definition clearly indicates that politics is-in its nature, if not always in its practice-a moral enterprise. Our political vocabulary-what is fair or unfair, what is just or unjust, what serves the common good-is inescapably a moral vocabulary. Contra David Hume and many others, an ought can be derived from an is , and typically is so derived in the ordinary experience of individuals and communities. Neither agreement nor consensus is required on all the details of "whatever it is about human beings that entitles them to basic human rights and freedoms."
The political consensus of the Universal Declaration, although very important, undoubtedly rests upon a philosophically thin account of the dignity of the human person. That is in large part because the "international community" is not a community. It is not, in Aristotle's sense of the term, a polis in which free persons deliberate the question, How ought we to order our life together? Of course, there are many and interesting debates about whether the United States or its several states qualify as a polis . Without going into the details of those debates, it is beyond dispute that our constitutional order presents itself as a political community deliberating its right ordering on the basis of the political sovereignty of "the people" exercised through the specified means of representative democracy. The foundational principle here is the statement of the Declaration of Independence that just government is derived from the consent of the governed.
The question of the dignity of the human person is rightly understood as a political question. It is inescapably a political question. The resolution (always provisional and open to revision) of the great majority of political disputes does not ordinarily require delving into the foundational truths explored by philosophy, ethics, and theology. Our political discourse is guided, and frequently misguided, by custom, habits, and tacit understandings. Proponents of "natural law theory" rely heavily on moral reasoning attuned to "those things that we cannot not know." And of course other theories are advanced, both because they are held to be true and because they are thought to be useful for purposes of political persuasion.
In general, however, our political life is not heavily burdened by theory, or at least not by the explication of theory. That is because knowing and judging the good things of human life is not so burdened. In the realm of bioethics, however, and specifically with respect to the dignity of the human person, such explication is sometimes required. An obvious example is abortion, and the many issues inseparably tied to abortion. The most consequential political event of the past half century in the United States was the Supreme Court's Roe and Doe decisions of January 1973. Numerous political analysts have described how those decisions have dramatically reconfigured the nation's cultural and political life. And of course those decisions are intimately tied to many other "hot button" issues in bioethics. As an act of "raw judicial power" (Justice Byron White in dissent), Roe v. Wade removed a preeminently political, which is to say moral, question from public deliberation. The abortion decisions were a profoundly anti-political act and are accurately described as instances of the judicial usurpation of politics. And, of course, by attempting to remove the question, the Court turned it into something very much like the vortex of American politics.
The moral question is not, as the court majority supposed, about when a human life begins. That is a biological and medical question on which there is no serious dispute. The moral question can be put this way: At what point in its existence ought we, and for what reasons ought we, to recognize that a human life should be protected in law?
On this issue, if no other, Peter Singer has it right. As the noted Princeton advocate of infanticide said in a letter to the New York Times rebuking Mario Cuomo for his confused thinking about abortion, "The crucial moral question is not when human life begins, but when human life reaches the point at which it merits protection . . . Unless we separate these two questions-when does life begin, and when does it merit protection?-we are unlikely to achieve any clarity about the moral status of embryos."2
That moral question is also and unavoidably a political question.
One might make the case that it is the most fundamental of political questions. If politics is deliberating how we ought to order our life together, there can hardly be a more basic question than this: Who belongs to the "we"? Although ostensibly removing it from politics, the abortion decisions forced into the political arena an issue that was thought to have been settled in the centuries of civilizational tradition of which our polity is part. Namely, that it is morally wrong and rightly made unlawful deliberately to kill unborn children.
If a principle is established by which some indisputably human lives do not warrant the protections traditionally associated with the dignity of the human person-because of their size, dependency, level of development, or burdensomeness to others-it would seem that there are numerous candidates for the application of the principle, beginning with the radically handicapped, both physically and mentally, not to mention millions of the aged and severely debilitated in our nation's nursing homes. It may be objected that of course we as a people are not about to embark upon such a program of extermination. To think we might do so is simply bizarre.
As a culturally and politically contingent fact, that is true. But under the regime of Roe , a regime extended to embryonic stem cell research and other bioethical controversies, we have no "clear and unambiguous" agreed-upon rule precluding such horrors. We do have in our constituting texts, notably in the Declaration of Independence, a commitment to natural rights; and we do have deeply entrenched in our culture and politics a concept of the dignity of the human person.
The question is: Who belongs to the community for which we as a community accept responsibility, including the responsibility to protect, along with other natural rights, their right to life? This is a preeminently political question. It is not a question to be decided by bioethicists. Bioethicists, by virtue of their disciplined attention to this and related questions, are in a position to help inform political deliberations and decisions about these matters, but they are rightly and of necessity to be decided politically. They are rightly so decided because our constitutional order vests political sovereignty in the people who exercise that sovereignty through prescribed means of representation. They are of necessity so decided because in this society the views of moral philosophers-whether trained as such in the academy or acting as such on the bench-are not deemed to be determinative. Witness the democratic non-ratification of the Supreme Court's imposition of the unlimited abortion license.
To say that such decisions are rightly decided politically is not to say that the resulting decisions will always be morally right. Those who disagree with the decisions that are made must make their case in the political arena. The product of bioethics may be prescriptive in theory-resulting in "clear and unambiguous" guidelines-but, in this constitutional order, it has to be persuasive in practice. In fact, of course, disagreements among moral philosophers, including bioethicists, are as strong as those found in the general public, and probably stronger.
In the happy absence of philosopher kings, everybody enters the process of debate, deliberation, and decision equipped only with the powers of persuasion. Obviously, not everybody enters on equal terms, since powers of persuasion, access to the means of persuasion, and audiences inclined to be persuaded to one position or another are far from equal. This is a highly unsatisfactory circumstance in which the achievement of "clear and unambiguous" rules is rare and a "political consensus" resting on a moral point of reference as a "placeholder" may be deemed a great achievement.
The dignity of the human person-construed not, or not primarily, as the assertion of the rights of the autonomous but as the obligation to protect those whose autonomy is very limited-is such a point of reference. It is complained that those who defend that point of reference have an unfair advantage in that it is so widely shared in our culture. They are engaged, it is said, not in moral or ethical argument but in politics. As suggested earlier, however, politics is moral argument about how we ought to order our life together. After the June 1953 uprising in East Germany, the secretary of the Writers Union distributed leaflets declaring that the people had lost the confidence of the government and it would take redoubled efforts to win it back. To which the playwright Bertolt Brecht is supposed to have responded, "Would it not be easier in that case for the government to dissolve the people and elect another?" Our present day bioethicists, moral philosophers, and judges sometimes appear to want to heed Brecht's advice and dissolve the people that they have and who have proven so recalcitrant to their expertise.
The people who are the American polis are deeply attached to the concept of the dignity of the human person. For those who have a moral adherence to this constitutional order and the means it provides for addressing the res publica , that is a factor of considerable significance. Yet there are those who contend that such popular attachments are prejudices or unreflective biases that have no legitimate place in authentically public discourse. Well known is the proscription, commonly associated with John Rawls, of "comprehensive accounts" from authentically public discourse. The proscription is most rigorously asserted when such comprehensive accounts are perceived to be "religious" in nature.
The moral authority of those who would make the rules for what is to be admitted and what is to be excluded from public discourse is far from being clear to many students of these arguments and is totally baffling to the people who are the public. The perfectly understandable suspicion is that there is a self-serving dynamic in the efforts of some to appoint themselves the gatekeepers and border patrol of the public square, admitting some arguments and excluding others. The proscription of comprehensive accounts-especially when they are religious or associated with a religious tradition-gives a monopoly on the public square to accounts that are non-religious or anti-religious in character. Such accounts are, in fact, no less comprehensive, as has been persuasively argued by, among others, Alasdair MacIntyre in Whose Justice? Which Rationality?3 Conflicts that are described as being between reason and tradition are typically conflicts between different traditions of reason, each invoking its own authorities.
In the comprehensive accounts that would proscribe other comprehensive accounts, especially if they are perceived as "religious" in nature, the operative assumption is typically atheism. This is not to say that all who support such proscriptions are atheists. It is to say that, in their moral reasoning, they are methodological atheists. Only those arguments are to be admitted to public deliberation that proceed as if God does not exist. This is a non-rational prejudice in which the great majority of Americans do not acquiesce. Whether by invoking Pascal's Wager or some other argument, they believe it is a great deal more rational to proceed as if God does exist. In any event, they do so proceed. The politically sovereign people are free to acknowledge, and generally do acknowledge, a sovereignty higher than their own, and to give public expression to that acknowledgment.
For most purposes in the ordering of our common life, it is neither necessary nor wise to invoke an account of moral reality beyond what is required for the resolution of the issue at hand. Explicitly moral arguments are not to be expanded or multiplied beyond necessity. On most issues, a sustainable measure of political equilibrium can be achieved by appeal to a widely shared and "thin" account of moral reality that is far less than comprehensive. This is frequently not the case, however, in questions related to bioethics.
People who are themselves devoutly religious may in the public square advance arguments that are not distinctively religious in character. This is notably the case with proponents of natural law theory. They proceed on the basis that human beings are naturally endowed with a rational capacity to discern the truth, including the moral truth, of things. In public argument, they generally prescind from religious or theological claims, contending that agreement on the ultimate sources and ends of human reason is not necessary to the exercise of human reason.
Contrary to the critics of natural law theory, the theory and its practice is not discredited by the observation that many, if not most, of its practitioners do in fact have definite ideas on sources and ends. Nor is it discredited by being widely perceived as a distinctively Catholic theory. Its proponents can readily respond that a distinctively Catholic contribution to our common life is to have preserved a universal understanding of reason that is, being universal, in no way peculiarly Catholic. It is an understanding that has strong roots in the Aristotelian view of politics and public discourse under discussion here.
Not all Americans are as abstemious as natural law theorists when it comes to unfurling in public argument their ultimate and comprehensive truth claims. For the great majority of Americans, religion and morality are inextricably intertwined. Public arguments involve different publics or different parts of the public. To those publics who are presumed to share their comprehensive account of reality in its fullness, proponents of this position or that will make the arguments that they think will be most effective in persuading. This is inevitable, and those who have a problem with it have a problem with democracy. (Obviously, many thoughtful people, from ancient times to the present, have had and do have grave reservations about democracy.)
There is, of course, a necessary concern about unbridled populism, raw majoritarianism, and the dangers of demagoguery. The framers of our constitutional order were keenly aware of these problems. Thus our system of representation, checks and balances, staggered elections, vetoes, overrides, judicial review, and other mechanisms conducive to more sober deliberation of how we ought to order or life together. While this intentionally complex order slows the course of turning arguments into law and public policy, it in no way restricts the arguments that can be made.
Demagogic agitation for specific laws or policies is sometimes employed, for instance, by identifying one's policy preferences with the will of God. Such appeals are usually limited to audiences where it is thought they might be persuasive. There is also the demagoguery of appeals to the more general public that-for instance in the controversy over embryonic stem cell research-cruelly exploit human suffering and exaggerated or unfounded hopes for cures. Demagoguery will be always with us. Our constitutional order is not a machine that runs of itself. It depends upon the cultivation of restraint, civility, and disciplined reason, which are always in short supply. And we do well to keep in mind that the wisest of our public philosophers, from Tocqueville onward, cautioned not only against the tyranny of the majority but also against the tyranny of the minority. Today that caution is pertinent to the minority that would impose a rule that authentically public discourse must be methodologically atheistic.
Restraint, civility, and disciplined reason are seriously undermined by the hostility to "comprehensive accounts" in our public discourse-especially if they are perceived to be religious in nature. In most intellectual enterprises, and not least in ethics, there is a propensity to emulate the methodologies and exactitude associated with the physical sciences. Philosopher Thomas Nagel writes:
This reductionist dream is nourished by the extraordinary success of the physical sciences in our time, not least in their recent application to the understanding of life through molecular biology. It is natural to try to take any successful intellectual method as far as it will go. Yet the impulse to find an explanation of everything in physics has over the last fifty years gotten out of control. The concepts of physical science provide a very special, and partial, description of the world that experience reveals to us. It is the world with all subjective consciousness, sensory appearances, thought, value, purpose, and will left out. What remains is the mathematically describable order of things and events in space and time.. We have more than one form of understanding. Different forms of understanding are needed for different kinds of subject matter. The great achievements of physical science do not make it capable of encompassing everything, from mathematics to ethics to the experiences of a living animal.4
The concept of the dignity of the human person was arrived at, and is today sustained, by such a different form of understanding. It is a form of understanding that is carefully reasoned, frankly moral and, for most people who affirm it, is in fact, if not by theoretical necessity, inseparable from a comprehensive account that is unapologetically acknowledged as religious. The hostility to admitting this account to public discourse is longstanding. Indeed, it has long been argued by some that moral referents should be eliminated altogether from law and public policy, that ours is a strictly procedural polity devoted only to means and prescinding from ends, and especially from overtly moral ends. Oliver Wendell Holmes famously wrote that it would be a great benefit "if every word of moral significance could be banished from the law altogether, and other words adopted which should convey legal ideas uncolored by anything outside the law."5
But, of course, it was by ideas and experiences outside the law that the concept of the dignity of the human person was enshrined in the law. The word "enshrined" is used advisedly, indicating the sacred sources of that dignity. In religious thought, and in Christian thought specifically, the dignity of the human person has become the touchstone of ethical reflection. Pope John Paul II wrote on several occasions that the entirety of Catholic social doctrine rests on the understanding of the dignity of the human person.6 The Catechism of the Catholic Church devotes no less than 23 pages to explaining the concept and its implications. It is an explanation that in its essentials is embraced also by non-Catholic Christians, as is evident, for instance, in the recent statement of Evangelicals and Catholics Together, "That They May Have Life."7 It is a concept firmly grounded in the Jewish tradition and-although not without troubling ambiguities-in that of Islam.8
That concept, on which almost all Americans rely, with varying degrees of reflectiveness and consistency, in deliberating how we ought to order our life together can be briefly summarized: A human being is a person possessed of a dignity we are obliged to respect at every point of development, debilitation, or decline by virtue of being created in the image and likeness of God. Endowed with the spiritual principle of the soul, with reason, and with free will, the destiny of the person who acts in accord with moral conscience in obedience to the truth is nothing less than eternal union with God. This is the dignity of the human person that is to be respected, defended, and indeed revered.
That is beyond doubt a very comprehensive account of the dignity of the human person. I have referred to the political sovereignty of "the people" in our constitutional order. The location of sovereignty-the authority to which the polis holds itself finally accountable- has in the post-World War II been, one might say, personalized. Ours is a period that Karl Barth, the most influential Protestant theologian of the past century, described as one of "disillusioned sovereignty."9 The great disillusionment is with the sovereignty of the state.
If one asked almost all Enlightenment thinkers what is sovereign, they would not have answered "reason" or "the individual" or "science." The unhesitating answer would be "the state." The darkest and most relentless depiction of the modern political project was offered by Thomas Hobbes. He taught that the incarnate and resurrected God-man who lives and governs is to be replaced in the temporal world by a mortal god ( deus mortalis )-a machine-like man, mythologically known as the Leviathan. Engraved on the title page of the 1651 edition of his book by that title is Job 41:24: Non est potestas super terram quae comparetur ei -"There is upon the earth no power like his."10 After Auschwitz and the Gulag Archipelago, none can read those words without a moral shudder.
There is on earth Leviathan's like and, indeed, his sovereign: the human person. The concept of the dignity of the human person may be a "placeholder" in international covenants, but in the American political experiment, when public discourse is not arbitrarily constricted by methodological atheism, it is, with respect to bioethics and other matters of great moral moment , a concept richly and rationally elaborated and claiming overwhelming public support. It is, in sum, a concept that is indispensable to the political task of deliberating and deciding how we ought to order our life together.
1. Mary Ann Glendon, A World Made New: Eleanor Roosevelt and the Creation of the
Universal Declaration of Human Rights (New York: Random House, 2001).
2. Peter Singer, letter to the editor, The New York Times, June 23, 2005, responding
to Mario Cuomo, "Not on Faith Alone," Op-Ed column, The New York Times,
June 20, 2005.
3. Alasdair MacIntyre, Whose Justice? Which Rationality? (Notre Dame, Indiana:
University of Notre Dame Press, 1988).
4. Thomas Nagel, "The Fear of Religion," a review of Richard Dawkins's The God
Delusion , in The New Republic , October 23, 2006.
5. Oliver Wendell Holmes, "The Path of the Law," in Collected Legal Papers (New
York: Harcourt Brace, 1920), p. 179.
6. Luke Gormally, "Pope John Paul II's Teaching on Human Dignity and its Implications for Bioethics," in Christopher Tollefson, ed., Pope John Paul II's Contribu
tion to Catholic Bioethics (Dordrecht, Netherlands: Kluwer Academic Publishers,
7. "That They May Have Life," First Things , October, 2006.
8. For a discussion of different religious understandings, see David Novak's Natural
Law in Judaism (Cambridge: Cambridge University Press, 1998) and C. S. Lewis's
discussion of the Tao in The Abolition of Man (Oxford: Oxford University Press,
9. Cited by Russell Hittinger in "Human Nature and States of Nature in John Paul
II's Theological Anthropology," in Daniel N. Robinson, Gladys M. Sweeney, and
Richard Gill, eds., Human Nature in Its Wholeness (Washington, D.C.: Catholic
University of America Press, 2006), pp. 14-15.
10. Cited by Hittinger, ibid., p. 280, n. 16. I am indebted to Professor Hittinger for
directing me to unfamiliar literature on the historical development of the idea of
the dignity of the human person.