December 9, 2005
COUNCIL MEMBERS PRESENT
Edmund Pellegrino, M.D., Chairman
Rebecca S. Dresser, J.D.
Washington University School of Law
P. George, D.Phil., J.D.
William B. Hurlbut, M.D.
Leon R. Kass, M.D., Ph.D.,
American Enterprise Institute
Charles Krauthammer, M.D.
Peter A. Lawler, Ph.D.
Johns Hopkins University School of Medicine
Gilbert C. Meilaender,
Janet D. Rowley, M.D., D.Sc.
The University of Chicago
WELCOME AND ANNNOUNCEMENTS
CHAIRMAN PELLEGRINO: This morning our focus changes a
bit. We'll be talking about the concept of dignity. The Council
in its discussions, as well as in its published reports, has referred
to and used the word "dignity." It's one which raises
many questions, and we thought it might be a good idea to step back
and look at the implications, the denotations and the connotations
of this very, very important word.
I won't vex you by repeating over and over again how important
it is, but rather say that we're very fortunate to have two
experts in the area of if not dignity per se, the questions of the
fundamentals of bioethics and ethics generally, Dr. James Childress
and Dr. Paul Weithman.
SESSION 5: HUMAN DIGNITY AS A BIOETHICAL
CHAIRMAN PELLEGRINO: We will start with Dr. Childress, and anyone
who is in the field of bioethics knows Jim Childress, but if Jim
will allow me to repeat a few aspects of his career, but only a
few, as you know, he is co-author with Tom Beauchamp of the most
widely quoted text in biomedical ethics in the world today.
Jim is the John Allen Hollingsworth Professor of Ethics and
of medical education at the University of Virginia. He teaches in the
Department of Religious Studies and directs the Institute for Practical
Ethics and Public Life.
Dr. Childress earned his Bachelor's degree at Guilford
College, his divinity degree at the Bachelor's level from Yale
Divinity School, and his Master's and Ph.D. also at Yale
Jim is the author of innumerable articles, I would say. I
have already mentioned his work with Tom Beauchamp. Of course, on his
own he has published many papers. He serves on many national boards
and committees, the National Bioethics Commission which preceded this
one, and he currently chairs an Institute of Medicine committee on
increasing the rates of organ donation, which I understand from Jim
will have its concluding meeting next week, and we look forward to that
one as well because I know it will be of interest to the members of
DR.CHILDRESS: Thank you very much.
It is good to be with you and to see friends and former
colleagues and others whose work I've appreciated over the years.
And it is a pleasure and honor to share some reflections about
human dignity with the President's Council. As several of you
have heard me say in other settings, I greatly admire the work of
the President's Council since its origins and the kind of vision
that Leon Kass sketched for it. Even when I disagree with particular
recommendations or conclusions, I always find the reports, and in
addition, the transcripts of the meetings with their analyses and
argumentation and discussion quite illuminating, and you really
have provided a great resource for the field of bioethics.
Having served on the National Bioethics Advisory Commission, I
can appreciate the difficulties of getting recommendations enacted
into public policy since I'm not sure I can point to very many
that we ever got in place.
But apart from that, the contribution to public discourse
has been immense and a resource I direct students to all the time is
the Website for the Council.
As a participant in both academic and public policy debates
in bioethics and biolaw, I have long been interested in the role and
functions, possibilities, and limitations of principles like human
dignity, especially over against other widely recognized principles.
And human dignity has been evoked in the United States in
several debates, particularly about physician assisted suicide and
euthanasia, where it has been evoked on both sides. And then, of
course, it was evoked pretty widely about human reproductive cloning.
But on the whole, it has played a much more prominent role in
European and international contexts. In general, philosophers from
the Anglo-American analytic tradition tend to be more suspicious
of appeals to human dignity than philosophers in the Kantian tradition
or phenomenological tradition, and ethicists within particular religious
traditions or philosophers who are attuned to and are more sympathetic
with religious traditions have also tended to be more sympathetic
to appeals to human dignity, as are efforts to work with the international
human rights tradition.
Now, the appeals to human dignity internationally and then in the U.S.
in contexts such as discussion of death with dignity and discussion
of human reproductive cloning, those have aroused a lot of criticism,
criticism focused in part on the protean nature of human dignity.
You can appeal to it in so many different ways that some critics
have charged that it is simply a loose cannon, and as you know from
the paper that was circulated to you, some stronger criticisms and
one that I'll come back to a little bit later is that indications
of human dignity actually damage the quality of public discourse.
Well, some of the recent discussion about the possible role of
human dignity in bioethics discourse has focused on the report of
the Council on Human Cloning and Human Dignity, and some
of the criticisms that have emerged note that this report tended
to invoke rather than really use the idea of human dignity. There's
a contention that it tended largely to leave the idea unanalyzed
and the connections with human cloning undeveloped.
Now, if one looks at the report carefully, and I'll
just offer a comment about it, a couple of comments about it here at
the outset because I think in a way you can see how this serves as a
focal point for a lot of the current debate about the possibilities and
limitations of the use of the concept of human dignity.
Other than in the title and the running head, the phrase appears
about 15 times in the whole report and in the chair's letter
of transmittal, and even in the report the phrase several times
relates to research involving human subjects where there has been
historically specification of human dignity in such rules as voluntary
informed consent, and some of the other uses appear in a list of
Now, that's kind of staying on the body of the report. Obviously,
there are other uses I do not include in that count, in the Council
member's personal statements. Nevertheless, even though it's
not fully analyzed, even though the links are not fully established,
the very fact that it appears in the title and in the running head
frames the discussion.
And so this has led, I think, on the part of many who have
looked at the document to wonder whether it would be possible to make a
judgment based on the report that actually there is a cogent argument
for a ban on human reproductive cloning based on human dignity because
the links have not been established thoroughly in the report.
And that has led to a suspicion on the part of some, for
example, Steven Marks, that leaving the notion unanalyzed then permits
too much else to come in. For example, he would suggest a variety of
theological concepts might be working behind that, but to analyze it
would, indeed, expose that.
I think several of these criticisms are unwarranted, but
what I want to note is the way the notion was left unanalyzed in the
report can give rise to that sort of exaggerated, overstated
criticism. So it's good, I think, that the President's Council
is considering whether to return to this either directly by making this
a focal point of an examination or less directly by developing it more
fully in relation to particular topics.
So what I want to do is not defend or oppose a particular
conception of human dignity, but rather to raise a few questions,
identify a few distinctions that might be useful if you return to this
topic more fully, again, directly or indirectly.
And on the outline, I've listed a few of the things I
want to cover. You should have that at your seat.
I want, first, to think about human dignity, what I call "Conception
1," as a standard of duties and rights because this is one
particular way to think about human dignity or the principle of
human dignity or respect for human dignity, and I think it tends
to be the paradigmatic concept of human dignity. When someone appeals
to it, that's what I think people tend to think of first.
And it presupposes some property or characteristic or capacity
of human beings or persons that is the basis for dignity and respect
for dignity, and I think it appears in both duty-based and rights-based
approaches, and I don't think it's necessary to draw a sharp
line between those here. I think there are other variations that
are much more important in conceptions of human dignity as a standard
of duties and/or rights.
And one of those is whether we should think about human
dignity as an overarching foundational standard, to use two different
metaphors there, or simply one standard among others. I think this,
within this first conception, is a fundamental issue to face.
Now, clearly, there are frameworks, for example, in the
international covenants on civil and political rights or economic,
social and cultural rights where it appears that human dignity serves
as a foundational concept from which then specific rights are derived.
Louis Henkin, referring to these documents, says that the authors of
these documents in seeking a theoretical foundation for the
international human rights movement that would be acceptable to all
peoples, cultures, and political ideologies justified human rights by
relating them to human dignity.
And clearly, that is one approach to the notion of human
dignity. Do it as foundational or overarching.
But there's also another approach that's
widespread, particularly in European discussions. For example, often
you find four ethical principles in biolaw or bioethics, as these
discussions put them: autonomy, dignity, integrity, and vulnerability,
often set in the context of solidarity and responsibility, or another
variation in the European context, dignity, precaution, and
solidarity. Whatever the formulation, these approaches think about
human dignity as one among several principles.
Now, you can see that also in the recent universal
declaration on bioethics and human rights, where it says at one point,
"Human dignity, human rights, and fundamental freedoms are to be
respected," and they are in that context put alongside each other
rather than one viewed as foundational.
There are a variety of other related distinctions that
would need to be thought about, objective, subjective, as well as then
if you take this approach, the relation between human dignity and
various other conceptions. So how might one begin to think about
Well, one thing that would need to be done is to try to specify
the range in scope of the principle of human dignity or value of
human dignity, and this is in two different senses. One would be
to determine — and the Council has done a bit with this, for
example, in coming up with notions about the intermediate moral
status of the human embryo — questions about the entities
to which this principle refers or which entities get encompassed
under it, and there, of course, to develop this in a rich way and
rigorous way would require attention to the various qualities that
have been offered and determine which ones could actually be defended
in relation to the assignment of human dignity to various entities.
So that's important for trying to specify this broad
principle even when one is trying to bring it alongside others.
But then there are other questions about specification, and
that would somewhat have to do with trying to determine content, and
I've listed just a few examples in recent discourse, human rights
tradition. Clearly there's been an effort to specify quite a
number of human rights that could be seen as at least derivative from
or consistent with the notion of human dignity.
And then the tradition that tends to focus a lot on
avoiding objectification or instrumentalization as part of what it
means to respect human dignity or within the Roman Catholic tradition,
particular attention to the sanctity of life.
Well, all of these are possible ways and perhaps incomplete
ways of trying to specify the content to a principle of human dignity
understood now as one principle alongside a variety of others.
One of the big questions to raise in going this route would
be to try to determine when you have violations of specific duties and
rights derived from or backed by human dignity, and those are ruled
out; to ask what exactly does the appeal to human dignity capture
beyond that because, clearly, there is an attempt to say that
there's more involved even if you end up with the specification,
that there really is more involved in the appeal to human dignity.
Is it captured in some further notion of what might count as indignity
or insult or affront to human beings?
So the question is, once you get the specification of rights and
duties, what is the value that remains in relation to the notion
of human dignity.?
Well, that's one important dimension and to try to specify
the range or scope of a value or principle of human dignity. But
a second question that arises focuses on a second dimension, and
that is, if you recognize several different principles or values,
human dignity being one of them, then how would you think about
the relation among those principles and values if conflicts arise?
Is human dignity one that needs to be considered absolute? And
does that mean that that's at such a broad level of generality
that any time there's a conflict it captures enough that it
always wins, or is it rank-ordered as superior to the others, or
is it one among several, each of which would have independent and
presumptive value, but perhaps could be overridden in some cases?
Again, if you're going down the route of thinking about
human dignity as a standard of duties and rights, those are some of the
There is a second conception, and that conception is of human
dignity as a standard of virtue. Now, in getting into this, let
me draw on some comments by Deryck Beyleveld. In discussing reproductive
technology, he focused at one point on a set of considerations that
might be distinct from basic rights, but that might be said to concern
human dignity, and here's what he wrote.
"What I have in mind is that it might be argued that
certain uses of reproductive technology violate human dignity not in
the way in which they treat the human embryo, but in how they reflect
upon the character of those who wish to avail themselves of those
"In ordinary uses persons that are characteristically
said to act in undignified ways when they display weaknesses that they
ought not to display, for example, by failing to display fortitude in
the face of adversity or by seeming to evade responsibility for their
And then he goes on to say along those lines he could
imagine — and he's imagining this, not necessarily defending it —
an argument that the use of in vitro fertilization for
postmenopausal women is a violation of human dignity, again, in terms
of this standard of character.
PROF. GEORGE: Jim, could I interrupt just to ask who
you're quoting there? I didn't hear it.
Jim, it's Robby.
DR.CHILDRESS: I'm sorry.
PROF. GEORGE: Jim, it's Robby.
Who are you quoting there?
DR.CHILDRESS: Derick Beyleved. His name appears under
Introduction, third bullet.
PROF. GEORGE: Thank you.
DR.CHILDRESS: And he along with Roger Brownsword have
co-authored, I think, a very useful book on human dignity in the
area of bioethics and biolaw.
Now, I think that if Leon will forgive me, I think that his
approach also is one that often in his own writings can be seen as
human dignity as a standard of virtue and excellence, and I'm not
going to elaborate his position. Obviously he's here in the
Council meetings and can easily do that himself.
But it seems to me this conception is one that focused on violations
of human dignity that go beyond concerns about rights and duties
and they often focus more on the agents who act rather than the
humans who are acted upon, not that they are mutually exclusive.
They are not. I think it's a matter, in part, of which conception
tends to be taken as the starting point and perhaps even as the
Well, in contrast to the language of violation of rights
and duties that we find in the first conception, it seems to me the
primary valuative language in this second conception tends to be
dehumanization, degradation, debasement, et cetera, where people depart
from a standard that should apply to them as a standard of virtue and
And often, and we find this, I think, in some of Leon Kass's
writings, the emphasis may fall on the experience of repugnance
or repulsion, sometimes as an epistomological starting point for
trying to discern the content of the standard of virtue and excellence.
Now, a few points in drawing this to a close, begin
conscious of the time limit of 20 to 25 minutes that was indicated.
However powerful a conception of human dignity as a standard of virtue,
I think that it's harder to make the case for laws and public
policies reflecting this conception in a liberal, pluralistic society.
For example, harder to make the case to ban human reproductive cloning
from this standpoint.
Harder also, I think, to make the case for the ban on buying and
selling organs from this standpoint.
I think it's easier, given the framework of moral discourse within
a liberal, pluralistic society if we can develop an approach that
focuses on the human dignity as a standard of rights and duties.
For that you need, obviously, as I have suggested, an operational
definition of human dignity, along with a variety of specific arguments
that would connect those conceptions of rights and duties to, for
example, reproductive cloning or to buying and selling organs.
It seems to me one of the critical parts, again, is drawing those
connections and links.
Now, Carmel Shalev, a philosopher in Israel, observes that arguments
about human dignity do not hold up well under rational reflection,
and she's doing this in relation to human reproductive cloning.
But I'm not sure that is what the source of the problem is here,
and it may simply be, again, a failure on the part of defenders
of human dignity to develop the clear, careful, rigorous arguments
that would be required, and this would, in part, mean spelling the
matter out in a transparent way, but also building what I would
call an ethical bridgework or links to the activity that is being
brought into relation for critical purposes to the standard of human
Now, I noted at the outset that several philosophers in the analytic
tradition and others call on the society to avoid the rhetoric of
human dignity. Some even as I suggested recommend purging it from
our moral, social, political vocabulary.
I'm somewhat more optimistic about appeals to human
dignity and public discourse, not only recognizing that those appeals
tap into a variety of religious and philosophical convictions, as well
as ones that relate to the human rights tradition in our society.
But at a very minimum it seems to me that those who are appealing
to human dignity in debates about biotechnology, for example, need
to distinguish two conceptions and perhaps others as well of human
dignity as a standard in moral, social, and political discourse,
and here I distinguish again a standard of rights and duties versus
a standard of excellence and virtue.
And, again, in my judgment these clarifications are important
as a matter of transparency and also integrity in public discourse,
and one reason I would suggest this is important is that rhetorically
in our society appeals to human dignity gain considerable force
from the duty-based and rights-based approaches.
However, some of those appeals to human dignity may, in fact,
be based on another conception or other conceptions, such as a standard
of virtue and excellence. And it seems to me that we need to be
as clear and transparent as possible in public discourse when we're
invoking concepts such as human dignity.
So I think this first step is a crucial one if you decide
to go along the path of further explication and elaboration of human
dignity, and that is to determine what kind of standard it is or if the
appeal that you want to make is to both, to indicate exactly how
they're related and how much of the heavy work is done by which
Now, it seems to me that in the process of developing, explicating,
and elaborating the notion of human dignity after clarifying these
standards, it's also going to be important to avoid over-inflationary
and over-extended uses of the concept of human dignity. I occasionally
see in the bioethics discourse a view that human dignity can do
most of the work, if not all of the work that needs to be done in
this area, and I'm skeptical of that. I think that even if
we take it as a broad overarching or foundational concept, once
we spell out or elaborate or specify the various rights and duties
connected with that, I think that we'll see several of those
also have independent appeals, and it may be important to give them
due weight along with our notion of human dignity.
So I think that the discourse itself is likely to challenge
this as a single overarching principle or value that can do most of the
work for us.
Furthermore, I think in the process of explicating and
elaborating this notion it's important to avoid — and this is
connected with the previous point in some ways — appeals to human
dignity as a conversation stopper because sometimes — and there are
other concepts that ultimately work this way in our discourse as well
— sometimes it tends to function that way.
But, again, I'm suggesting that there's a lot more
analysis and argumentation that would be needed to enable us to appeal
to the principle or value or concept of human dignity in ways that can
really eliminate the issues that have to be faced in both public
culture, as these matters are debated; whether reproductive cloning or
buying and selling organs or assisted suicide, but also and perhaps
particularly at the point of trying to recommend public policies.
Thank you very much.
CHAIRMAN PELLEGRINO: Thank you very much.
I think what we will do is ask Professor Weithman to
comment next, and then the Council can direct its questions and
comments to both speakers, and they can exchange as well and have kind
of a mini panel.
So I would like to introduce next Dr. Paul Weithman, who is
Chairman of the Department of Philosophy at Notre Dame University. He
earned his first degree in philosophy from the University of Notre Dame
and his Master's and Doctoral degrees from Harvard University.
Among his many published books and articles, his "Religion
and the Obligation of Citizenship," from Cambridge University
Press. He was awarded the North American Society for Social Philosophy
Annual Book Award in 2003 and has thought very carefully about this
question and would like to relate it to the broader issues of the
Thank you very much, Dr. Weithman.
DR.Weithman: Thank you.
I'd like to thank you for inviting me here for your
session this morning. It's a real pleasure to be here.
I know that your time is scarce and valuable, and that I
have a time limit. It is a special honor to be here because your time
is scarce and valuable, but despite the fact that your time is at a
premium and that I have a time limit, I'd like to begin, if I
might, with a couple of preliminary remarks.
The first is that, to say the least, I am not an assiduous reader of
government reports. I'm not aware of what kind of work other
government committees do or the standards to which they hold themselves.
When I sat down all too recently, I confess, to read through the
reports that the Council has produced, I was, I must say, very impressed
with what you've done with your presidential mandate.
You've taken up a wide range of some of the most
difficult ethical questions of the day. You've clearly worked very
hard, where necessary, to educate yourselves about the science, the
medicine, the philosophy. You've produced reports and personal
statements that reflect a range of sophisticated reasoning and opinion
and that will, if assimilated, do a lot to raise the level of public
discussion and argument of the problems that you have taken up.
And I especially appreciate the searching humanism that
you've brought to the task. The questions before you are not
merely scientific questions or technical questions. They're
ethical questions. Those ethical questions cannot be answered simply
by pointing to the promise of medical benefits. They go, I think, to
what we are as individuals and as a people.
And questions that go so far, questions that go to what we
are as a people are questions that demand humanistic reflection, and I
think you have engaged in that, and I commend you for doing so.
If national discussion of issues and bioethics remains less
deep or sophisticated than it might be, that surely cannot be laid at
your door. As a teacher myself, I commend the way you've used your
mandate as an occasion to educate the public.
I am, as I said, a teacher, but I don't come before you
as a teacher of bioethics or of science. I come to you rather as a
student and teacher of political philosophy, and that you would include
a session on the notion of human dignity that is bound to be somewhat
philosophical and abstract itself bespeaks the depth you've tried
to give to your deliberations and to our national conversation.
And it's a special honor for me to be here precisely
because by inviting me, you've extended yourselves and construed
your mandate broadly in a way that I commend, and I hope that my
participation will be useful to you and worth your trouble.
Well, you've invited me today to join your discussion
about the concept of human dignity and its usefulness in deliberations
of the kind the Council has conducted and will conduct in the future.
It is a concept the utility of which can be doubted, as you know, and
doubted for a variety of reasons. Some of those reasons are good
ones; some are not.
The concept of human dignity is one of which the Council
has made a great deal of use. In relying on the concept in its
published reports, the Council has drawn on the descriptive and
rhetorical force of the concept and drawn out its normative
I had expected before I sat down to look through the reports that
the greatest reliance on the concept of human dignity would be in
the report on human cloning which bears the title Human Cloning
and Human Dignity. I was surprised to find the mention of
dignity and human dignity occur with greatest frequency —
search functions, search engines are wonderful things — occur
with greatest frequency in Beyond Therapy, and that many
of the occurrences of those notions are to be found in one of the
most sensitive appreciations of athletic performance of which I'm
There I thought many of the benefits of talking about human
dignity and the dignity of human action were evident, yet I gather from
Dr. Pellegrino and from reading around that your reliance on the notion
of human dignity has been subject to challenge, and those are
challenges you're interested in taking up.
So there are three questions that I want to take up this
morning. One, what are the benefits of talking about human dignity and
what are the problems of talking about it?
Second, in light of the benefits and problems, is the
notion of human dignity useful or illuminating?
And third, will the Council's future work benefit from
talking about or arguing in terms of human dignity?
Well, the notion of human dignity occurs frequently in
Catholic moral thinking, especially in some of the social teachings
issued in recent years and is, therefore, a notion that I've had to
confront regularly and with which I have had to grapple.
I have never felt I fully understood the concept of human dignity or
the conditions under which it should be applied, even though the
notion sometimes enables me to say some of the things I want to
say, leads me to some quite useful reflections, I think, and helps
me to express agreement with people with whom I would like to agree.
Well, let me begin with the usefulness of the notion of
human dignity. To say of human beings, to say of human adults,
normally functioning human adults to take an easy case, that they have
inherent dignity seems to imply that they have moral status, a status
which places them above other things, including other animals.
To say that their status is exalted sounds a little grand in our
democratic age, but I have always liked Immanuel Kant's remark
that implies that we are, in fact, exalted, his remark that human
beings are not the highest among the animals but the lowest among
the hosts. Kant said few enough poetic things that it is worth
searching them out and commending him when one can do so.
In fact, I think Kant isn't quite right, and we are
both the highest among the animals and the lowest among the hosts, but
let that pass.
Because of having the status that dignity suggests, it seems that human
beings have worth. Their worth and status have to be honored and
acknowledged. Human beings are, if talk of dignity is correct,
human beings are to be treated with the respect due to creatures
of such status. There are some things one cannot do to human beings
because to do such things to them would be inconsistent with their
status. It would be in many cases to treat them as beings of lesser
status than they have.
Such actions include those that degrade, demean or violate
human beings. So this much seems clear enough and suggests that the
notion of human dignity is a useful one when we want to call attention
to the status that human beings have and when we want to condemn
actions done to human beings and to say something about what makes
those actions wrong or objectionable.
Adherents of many moral and religious traditions have agreed that human
beings have special status and have agreed on some of the implications
of the status they have. The concept of dignity has proven useful
in expressing their agreement. That I think is an important point
about the concept and one to which I'll return.
But problems with reliance on the concept of human dignity are also
clear. First, even those who agree that human beings have dignity
can disagree about why it is that human beings have it. Those who
agree that human beings have a moral status that demands respect
can disagree about in virtue of what that status is attained or
Some people will think that we are worth what we are
because God loves us; others, because we resemble God or are images of
God. People have different stories to tell about in virtue of what we
image God. Is it because we have capacities for reason and execution,
for reason and will as Aquinas seems to have thought, or are there
other ways in which we image God instead?
Still others will think that we have dignity because we can
rise above the causal determinism of nature to give ourselves ends and
principles of action.
Still others may look at the highest achievements of the species,
the drawings of Leonardo, the cantatas of Bach, the fastballs of
Roger Clemens, and say that a species that can do that or that can
produce those things is a species that's worthy of respect.
Second, these differences will have — another problem appealing
to dignity, is that these differences have implications for the
question of who has dignity. Disagreement about the basis of dignity
leads to disagreement about its possession. If one thinks that
human beings have dignity in virtue of having a capacity to set
ends for themselves and act on those ends, then one may reach different
conclusions about just who has dignity or what to do when those
capacities are lost than somebody who has some quite different story
to tell about why we're dignified.
A third problem with appealing to the notion of human
dignity is that we can disagree about what human dignity and respect
for it demand. We can disagree about what actions if done to other
people violate their dignity, and we can disagree about what conditions
are incompatible with dignity.
Is the life of an elderly person with advanced dementia an
undignified life or not? If it is beneath human dignity, what can be
done about it?
As Jim noted, human dignity, the notion of human dignity is appealed
to by both sides on the debate about assisted suicide and by both
sides in many other ethical debates as well.
The difficulty of bringing some order to our judgments
about these matters is compounded by another difficulty. Not every
wrong done to people is wrong because it violates human dignity. Not
even every injustice is unjust because it violates human dignity. Not
every condition for which people should be helped or removed, not even
conditions in which they should be helped or removed as a matter of
justice is a condition from which they should be aided or in which they
should be aided because it's a condition in which their dignity is
I think an example from health care ethics makes this clear.
Reproductive technology, technology of assisted reproduction, including
pharmaceutical technology, is available, at least in many places,
available only to people with means. Insurance doesn't always
cover treatments, doesn't always cover the drugs needed to make
reproduction more likely.
One might think this is an injustice, but I don't think
that even if one does, one doesn't have to think it's an
injustice because infertility is an undignified condition. So
there's an example of a condition in which people should arguably
be aided as a matter of justice, but it's not a condition in which
their dignity is compromised or lacking, or at least it's not
So there's controversy about the grounds and the
implications of human dignity and about who has it. The concept of
human dignity is not self-explanatory. It's, therefore, not, I
think, foundational. It's not the sort of concept that is
appropriate to use as a moral foundation.
Rather, it's a concept the application of which draws
upon other moral considerations that are, I think, more fundamental.
It's also not a master concept, either. It's not one
such that if we get clear about it, we'll be able to answer
all of the questions we want to answer. Rather, human dignity,
if we can get clear about it, is one moral consideration, one important
moral consideration, among many. It's one that has to be weighed
against others, and the weighting will itself be a very difficult
Now, I am not at all sure that the conflicts about human dignity
and its implications or all of those conflicts can be explained
by appealing to the clash of a couple of different conceptions.
It does seem to me very useful to distinguish different conceptions
of dignity and the briefing paper that you commissioned, the very
fine briefing paper that you commissioned, I think does a wonderful
job mapping the various tributaries and streams of thought about
dignity that come together in contemporary use of the notion.
And I think it's that kind of detailed historical work and
much more of it that's needed to figure out just how many traditions
of thought about human dignity there are and about whether various
uses of it that seem to belong to different traditions, can, in
fact, sometimes be found in the same one.
And so sometimes discussions of human dignity that seem quite
closely tied to a rights conception of dignity also have within
them very moving passages that suggest an excellence or an aretetic
conception of human dignity as well.
Well, do these problems with human dignity imply that the
concept of human dignity is useless because it's empty or that it
masks disagreement or that it should be dispensed with?
To see that it should not be, I think that we need only ask what
moral reasoning would be like without it, and to explore that, I'd
like to digress for a moment. On a mention of human dignity in
one of the Council documents that I found especially interesting,
a remark in Reproduction and Responsibility, that fundamental
American law, unlike fundamental European law, doesn't speak
of human dignity.
Well, what does talk of human dignity add to talk about
rights, say? Reflecting on that for a moment might give us some idea
of just how useful the notion of dignity is, and I do think that talk
of dignity adds something to moral discourse that can't be captured
simply by talk about rights and liberties, and that talk about dignity
and talk about rights can pull apart.
For one thing, not every offense against rights is an
offense against human dignity. If one thinks with the philosopher John
Rawls that political rights and liberties should have fair value, then
the failure to guarantee the fair value of political rights and
liberties is an offense against rights. It's not clear to me that
it's an offense again dignity.
If one thinks with the philosopher John Rawls that it's
an offense against justice that people not have fair equality of
opportunity, then one will think it unjust if inequalities of
opportunity are not rectified, but I'm not sure that inequalities
of opportunity are offenses against human dignity.
So these seem to be cases in which talk of justice or talk
of rights might add something or draw our attention to important moral
considerations that talk of human dignity does not.
But there are also places where talk of human dignity can
add a great deal and take us beyond talk about rights, and that, too, I
think is worth noting.
For one thing, not all rights are created equal. The claim
that some act violates human dignity can call attention to the fact
that some violations of rights are special affronts to persons. Rights
violations which temporarily or permanently rob someone of the powers
of agency, for example, the violation of rights by torture, are
affronts to human dignity that I think affronts to property rights are
Some exercises of one's own rights are affronts to
one's own dignity. Having sex in a place that's publicly
visible is, for example. I think it may well be an exercise of
one's right, but I also think it's an example of people
exercising their rights to degrade themselves and rob themselves of
I think there are lots of ways to compromise one's own
dignity even if you can't violate your own rights, and so there,
too, is a set of cases in which talk about rights and talk about
dignity can pull apart, and then which talk of dignity can draw our
attention to important moral considerations of independent force.
Clearly, some affronts to dignity don't violate or entail violations
of human rights. For example, burning the corpses of Islamic soldiers
is, I think, an affront to dignity, but I'm not sure that there's
anybody whose rights are violated. The people in question are,
after all, dead. So their rights surely are not violated by violating
their corpses, and yet I think there's an affront to dignity
in the neighborhood.
I mean, there's another example of the case in which talk about
dignity can, I think, be morally illuminating or helpful even where
talk of rights fails to capture what's gone wrong.
There are goods of human life that the concept of dignity
seems especially apt to capture. The dignity of a good performance,
dignity in the face of death or infirmity. Perhaps in these cases talk
of dignity can be dispensed with in favor of talk of self-mastery or
self-command, self-mastery or self-command in the face of especially
But the talk of dignity calls our attention to the fact that self-possession
under such conditions merits our respect and admiration, and that
behavior of that kind is an ideal to be honored and perhaps promoted.
Yet none of this, I think, can be captured by talk about
rights and liberties. It is hard, for example, to make arguments for
promoting ideals of self-possession or the good performance I think
without some concepts in the perfectionist family.
And if one thinks as I do that society has an interest in
promoting good artistic performance or in safeguarding good athletic
performance, then one will find talk of dignity or may find talk of
dignity quite useful in saying what it is about such performance that
we want to promote.
There are some conditions into which people can be forced
by a conspiracy of circumstances and bad luck that are, I think,
affronts to their dignity as persons even if no violations of their
rights or liberties are involved: being homeless, living in squalor,
having to eat cat food, having to beg on the street with one's
children present, being unable to discharge the responsibilities of
parenthood by securing basic hearing for one's children. These, I
think, are all conditions in which one's dignity is violated, but
it's not clear that there's any rights violation in the
Finally, I am reluctant to ascribe rights to communities,
but I think communities, peoples and nations can have or aspire to
dignity among the people's of the earth and that it gives the lie
to a nation's pretensions to dignity if certain practices are
condoned within those nations or if some of its people are allowed to
live in degrading conditions.
Well, we may disagree about moral and political conclusions to
which talk of dignity points. Indeed, I've already suggested
that we do in many cases, but for now the point is that the concept
of human dignity stimulates moral reasoning and that the Council
has made a very interesting point in Reproduction and Responsibility
in suggesting that our legal, our moral, and especially our legal
and political thinking are impoverished by its absence.
Well, where does this leave us with respect to the questions I
said I'd take up? I surveyed the merits and demerits of talk
of dignity. Despite the demerits of talk of dignity, I think that
it's a very useful concept and for a number of reasons.
For one thing, I think dignity seems an appropriate concept
to describe us. It seems to be true of human beings that we have
dignity as, to vary an example from one of Krauthammer's personal
statements, it seems true that the Grand Canyon is awesome.
For another, the concept of human dignity has connotations which resonate
with many of the moral traditions that shape us. Those connotations
give the concept of dignity rhetorical power that commands a reader's
or a hearer's attention, and it signifies moral seriousness.
In that way talk of dignity differs from talk of
awesomeness, which while it may have had some power in the 17th
Century, as I believe it did, has been cheapened by careless adolescent
Third, talk about dignity is fruitful. The connotations or
resonances with our moral tradition suggest normative implications.
They suggest implications for how we ought to treat and respond to
human beings and human actions, at least those human actions in which
our human powers seem to be most engaged or which have the potential
for distinctive forms of human excellence.
Those connotations suggest implications for what our
attitudes, our doings, and our refrainings ought to be in virtue of the
fact that human beings and actions have dignity.
And finally, because the concept of dignity seems capable
of expressing judgments of adherence of many moral traditions, it seems
to be an apt concept in which to phrase documents which must be the
object of consensus, and I think it important as you reason through the
use you want to make of human dignity to remember just what an odd
genre of document you are producing, at least that you're producing
collectively. You're not producing philosophical treatises.
You're producing documents which have to gain the consensus of
people on the Council who have very different views and that one hopes
will command some consensus in the public at large.
For that reason, reliance on mid-level concepts like
dignity rather than more foundational concepts derived from Kantianism
or Aristotelianism, Utilitarianism, Catholicism or what have you, might
be most useful.
Well, how useful is the concept of dignity for the work to
which the Council is turning now? I understand that you're turning
now to various questions about health care ethics and children,
questions about guidelines for drug experimentation for treatment of
children, for children's access to care.
And here I confess uncertainty about the usefulness of the
notion of human dignity, and I'm uncertain because I think our
intuitions about the dignity of children are somewhat rubbery and
unsure. It is surely possible to treat children as mere means, to use
them, to abuse them, to exploit, degrade and demean them, to humiliate
It is easy to forget what a sense of themselves children,
even very young children, have and how easily they can be humiliated.
It's very easy, I think, to forget that, and unfortunately it's
possible to violate children.
There are many things it is possible to do to children that all
too often get done to children that seem in the neighborhood of
violations of dignity. It's also possible to say of conditions
in which children live that those conditions are subhuman.
But whether any of this should be discussed as violation of
the dignity of children is something about which, as I said, I'm a
bit unsure, and I'm unsure enough about this to suggest that some
other way of reasoning about children may be better. I don't
suggest any relaxing of strict prohibitions on the abuse, the
exploitation, the demeaning or the degradation of children, nor do I
mean to suggest anything that would license allowing them to live in
conditions that are subhuman.
Talk about dignity seems to me to suggest or to depend
perhaps upon what children will become when fully developed and
emancipated rather than what they are, and I wonder if talking about,
reasoning about what it's right and wrong to do to children might,
therefore, better proceed in some other terms.
I worry about talking of the dignity of children in part
because it seems to me it might distract from the real issues at stake,
but also because it threatens to cheapen talk about human dignity and,
therefore, to evacuate it of its force when it is, I have suggested, a
concept that has some force that can be quite useful to us.
All of us who were at dinner last night were privileged to see
the pictures of Dr. Hurlbut's baby son. How you reason about
how to treat a gift like that is very hard. It depends upon and
will draw upon many of the moral resources that we have available
to us. I am just not sure that in the end talk of human dignity
will be one of them.
Thank you very much.
CHAIRMAN PELLEGRINO: Thank you very much, Dr. Weithman.
Both you and Jim deserve our gratitude, especially mine for adhering
so rigorously and so well to the time restriction. It provides
ample opportunity for the members of the Council to explore your
And I'll open up the discussion now, and direct your
questions to either one or both of the presenters.
Sure — sorry, Gil.
DR. GÓMEZ-LOBO: Well, I want to thank both of you for
excellent presentations. This may be a little bit more rambling than
my usual interventions, but of course, there are many very, very
interesting suggestions in both expositions, and I'd like to
perhaps focus attention on the last remarks by Paul, if I may.
Of course, there are many different notions of human dignity,
but in my perception in American public life, it's the Kantian
tradition that seems to be preeminent. In other words, when in
public discussions or in discussions with other people you mention
slavery and you ask on what principles should we reject slavery,
invariably you go back to this idea that, of course, we should not
treat other human beings instrumentally, right?
So it seems to me that the sharp Kantian contrast between dignity
and, well, the symmetrical concept is price, if I recall correctly,
things that the value of different things is expressed in a different
way. The value of humanity or human beings is expressed in the
concept of dignity. The value of things is expressed in the notion
Now, in that regard, couldn't it be the case that, for
instance, the way we focus on children may be aided by that? In other
words, for instance, the case of research of Willowbrook and all of
those cases, it seems to me that there is a flawless conceptual
connection between making certain children, in this case disabled or
retarded children, instruments maybe for the sake of other children or
for the sake of future generations or whatever.
That seems to me to be a way of arguing for what went wrong
there. Now, if this is acceptable, then it seems to me rather
important to say, well, young children, Bill Hurlbut's son among
them, have dignity. It's hard for us perhaps visually to pinpoint
this because we think of a dignified person as an elderly gentleman of
But I think it's the extension of the concert of
dignity to all stages of life that is important, even to the unborn,
and there it seems to me there might be a useful application of the
concept of dignity
DR.Weithman: I certainly think that in thinking about how
children might be employed in medical studies, say, that it's
useful to think about whether or not we're treating them as mere
means. I certainly think that's so.
Whether if they are treated as mere means we have violated their
dignity, though it may follow given the way Kant sets things up,
it just doesn't strike me as the most useful way of expressing
it. Perhaps violating humanity within them or something like that
would be a good way of talking.
But I guess talking about the children's having dignity, of
which they are deprived by being treated as means strikes me as
a way of talking that might simply invite objections that we needn't
get into. Why isn't it enough to say that the children aren't
to be treated as mere means; that it is an exploitation of them
if we do so; and that it is for that reason wrong?
I just wonder why we need to take an extra step that simply
might invite controversy where no controversy is needed. When we say
that treating children as mere means is exploitative, it seems to me
that we have done enough.
DR. GÓMEZ-LOBO: Yeah, it seems to me that the two notions
are analytically tied to each other.
DR.CHILDRESS: I very much agree with Paul's point,
and as I was suggesting, when we talk about trying to specify a notion
of human dignity, a lot of these other conceptions do come up, avoiding
exploiting people, avoiding instrumentalizing them, avoiding
objectifying them in the various ways.
But then, again, they often function as free-floating concepts,
and you may well be right that, I guess, remnants of the Kantian
tradition may be most dominant in thinking in this area, but it
seems to me that they're rarely worked out in a clear way in
relation to the Kantian premises and much more likely to have infiltrated
the social, cultural, moral discourse in a way that people appeal
to them independently of that appeal to human dignity.
And I think as Paul has suggested, the big question is what
the appeal adds to or in some ways supports the concerns that might
well be expressed in other more specific and concrete ways.
DR.Weithman: Let me just try to loosen the connection
between treating something as a means and depriving it of dignity.
I'm not sure that I can do it, but let me just explore it for a
Suppose that the right way of thinking about our
relationship to our children is that of stewardship. Stewardship is
not something that I think in which the Kantian tradition is
particularly strong. I mean, its reflections on stewardship, I think,
are not as helpful as they might be, though I'm not a Kant
scholar. I could be wrong about that.
But clearly, we can be stewards of the earth, stewards of the
Grand Canyon or of the great sequoias, and we can fail at stewardship
by treating those things as mere means to our satisfaction so that
we can chop down sequoias and panel our billiard rooms with them,
for example, and it seems to me that in doing so we're failing
atstewardship. The ways in which we fail might appropriately be
described as using these grand creations of nature as mere means
when they shouldn't be that.
But I'm not sure that it's appropriate to describe what we've
done as violations of the dignity of the things in question. Now,
maybe we can think of our relationship with our children as that
of stewardship and that failing by treating children as mere means
is a failure of stewardship. Does it follow then that we're
violating their dignity? I'm not sure.
At least I'm trying to loosen the connection between
treating something as a mere means and violating its dignity. I'm
not sure whether the attempt succeeds or not.
CHAIRMAN PELLEGRINO: Dr. Lawler.
DR. LAWLER: Right. The problem with Kant in this context
is that Kant ain't American, but with respect to the right of
the children, you don't have to go into this instrumental objectification
sort of language. All you have to say is children have rights,
and they have Lockean rights, and Lockean rights based upon consent,
and children don't fully consent, of course, but you have to
understand children as full human beings, and this not using them
as means can be rephrased as simply you can't understand them
to be compelled to do anything they wouldn't consent to do as
free human beings.
But the problem though with the fact that Kant isn't
American, as both of you have pointed out in different ways, would be
something like this. We have rights, and that's a good thing.
I'm all for rights, but oftentimes we exercise our rights in
undignified ways. So it's our characteristically American tendency
in looking at our founding principles to go back prior to the founding
to the Christians and the Stoics and Leon to Genesis.
And you go forward to Kant and subsequent philosophers. So
we do have trouble talking about dignity, but I don't think we have
trouble talking about why we shouldn't treat children as
instruments because Locke by himself gives us enough there.
DR.Weithman: Locke isn't American either, and in fact,
my colleague Alasdair MacIntyre says that Locke's political
philosophy is so thoroughly suffused with religion that it probably
couldn't be taught in American public schools.
DR.Weithman: There is a regrettable tendency, I think, to
secularize Locke in an attempt to make him more American than I think
he is. I think that's very unfortunate both as a matter of Locke
scholarship and I think it's irresponsible to our own intellectual
heritage as Americans.
There are, I think, a number of difficulties with appealing to
Locke to ground the claim that children have rights. I mean Locke's
writings about children are, I think, quite interesting. The stuff
in the Treatise about why children in the state of nature aren't
free is, I think, particularly interesting in this connection.
It's not clear to me that Locke thought children, at least young
children, do have rights because they're not capable of exercising
reason and capable of apprehending the law of nature. That's
why they need to be entrusted to someone else until they reach the
age of maturity, at which point those to whom they're entrusted
lose their authority claims over them.
Even if we suppose the children have some kind of rights
based on consent and say that they shouldn't be treated in ways to
which they would not consent, trying to figure out to what children
would consent is a very difficult matter.
I have difficulty getting mine to decide what they like in
their lunch boxes. Getting them to decide or figuring out what they
would consent to on very complicated matters of treatment seems to me
very difficult, particularly if one thinks one has to ask oneself what
they would consent to as adults.
And what muddies the water still further, I think, is that
we, their parents, have a certain amount of control over what adults
they become and, therefore, what they would consent to when they reach
the age of adulthood.
Trying to figure out what children would consent to seems
to me extraordinarily difficult and not an idea that's going to
provide us a lot of guidance, I think.
CHAIRMAN PELLEGRINO: Lawler, Meilaender and George.
DR. LAWLER: Locke says the guardianship for parents over
children is temporary and nondespotic. So I don't think it's
so hard, and whatever Locke thought in some deep way, you know, this
would radically disagree, but that's not a big deal.
I would understand Locke the way the great author of the
Declaration of Independence understood Locke, which is not so
CHAIRMAN PELLEGRINO: Gil.
PROF. MEILAENDER: If each of these presentations had not
been as interesting to me as they were, I would have a question for
PROF. MEILAENDER: But because they were interesting,
I'd like to think out loud just a little bit and let you say
anything that occurs to you in response.
I'm interested less in Kant, the philosopher, and more
in Kant, the poet, that nice phrase "highest among the animals and
lowest among the hosts." And I wonder if that doesn't, in
fact, get at something rather important about what we mean when we make
these appeals to the concept of dignity.
Human being is not quite a beast and not quite a god, but
somewhere in between these two, and therefore, unlike the beasts, how
we come into being and go out of being has importance and
significance. We can give meaning and point to suffering, for
So that although we're animals, we're not quite
that. Not quite gods either. So that whatever exactly human
excellence means, it's excellence within certain kinds of limits,
limits of the body, for instance, and so forth, and I just wonder —
and if you've got nothing to say about it, that's okay, too .-
but I just wonder if maybe, in fact, a lot of the appeals to the
language of dignity aren't aimed at trying to think through what it
means to be this peculiar sort of in between creature who occupies this
very unusual status.
And I'd just be interested in anything you had to say
CHAIRMAN PELLEGRINO: Jim.
DR.CHILDRESS: Gil, I think your direction is both an
appropriate and an important one, and I think that for a variety of
moral discourse, spiritual discourse, et cetera, to think in terms of
the good or better ways of or less so for various ways of living,
patterns of life, confronting mortality, trying to figure out who we
are, et cetera; that that's very appropriate, and that is then a
place, I think, for a conception of human dignity as a standard of
virtue and excellence that one can develop that direction.
I guess I tend to think about a lot of these matters in the
context of the public policies and how we can defend various kinds of
public policies, and one of the points I was underlining in my
presentation is that when we then move to try to develop and defend the
public policy, for example, one that involves coercion, it seems to me
that we obviously have a stronger case if we're able to tie this
with some kinds of rights and duties, and I'm treating both of
those together because I'm not working here or thinking here as a
rights based philosopher,but rather one who can see these two as
And I think it's more difficult then to move from
whatever standard of excellence we come up with to defense of the
course of public policies. Clearly, it can be done in some settings,
but I'm much more inclined to think in terms whether we view as
Paul suggested human dignity as a mid-level concept. It certainly in
many forms of discourse will function parallel to a number of other
conceptions that I think may have as much weight.
So I guess in terms of the notion of human dignity you
point an important direction. Then when we try to spell this out, it
may go two different ways in terms of the kinds of standards that are
involved, and I think that either way can be appropriate for
development of public culture and the way we approach children and a
variety of other topics.
But as we move toward thinking of what kinds of public
policies are appropriate, then it seems to me we should end up trying
to specify this in ways that will pick up a variety of kinds of
interests and the like that won't quite be captured in the notion
of the Center of Excellence.
CHAIRMAN PELLEGRINO: Dr. George.
PROF. GEORGE: Thank you.
Jim and Paul, thanks for those fine presentations.
I want to just set out an argument that one sometimes hears
and ask you to — both of you — to respond to it. The argument goes
Science is about the business of rigorous, rational inquiry into
the facts of the natural order. Any ethics that appeals to dignity
or similar, difficult, perhaps somewhat slippery, difficult, hard
to define concepts. Indeed, any ethics other than a utilitarian
ethics, and especially an ethics that is derived from or associated
with religious traditions is simply insufficient to provide valid
reasons for limiting the freedom of scientists to conduct their
And this is especially true, the argument goes, where we
grant as we must today that scientists are people of goodwill and good
faith whose research objectives are to benefit humanity, especially by
finding treatments and cures for dreaded diseases and by improving the
conditions of life for vast numbers of people.
How would you respond? Perhaps, Jim, you could go first.
DR.CHILDRESS: It seems to me that, yes, we can think
along the lines that you have suggested as an approach to science that
we sometimes hear, but it seems to me that we also recognize a variety
of moral constraints that are appropriate.
And the question is: which of those moral constraints
relate to, in the context of this discussion today, to notions of human
dignity versus other kinds of moral conceptions?
And so I think that we can have rational discourse and not
some of your science as a rational enterprise, but we can have rational
discourse about a variety of moral directions and constraints that we
can appropriately bring to bear on science, and then appropriately use
in terms of directing and justifying public policies that constrain and
limit what scientists do.
However, the way I would be inclined to think about that would
be, again, to try to work out a conception even for connecting with
human dignity of the rights and duties that we find defensible,
some of which will connect with some conception of human dignity
and some may have quite different sources. But I would at least
see that as a possibility of rational discourse and argumentation
over and against those who would limit the rationality to the scientific
DR.Weithman: Three quick responses. The first, why carve out
an exception for utilitarianism? I mean, I'm not sure why utilitarianism
gets a free pass when other forms of ethics don't, from the
consequences to which any plausible version of utilitarianism appeals.
Well, themselves, it seems to me to be described in quite rich ethical
terms. So we want to look at what the consequences of human cloning
on a large scale are likely to be.
It seems to me very unlikely that the most plausible way to describe
the consequences for purposes of constraining or liberating science
is simply in terms of pleasure and pain. One simply needs to appeal
to a far richer description of the consequences to get any ethical
traction. Once you allow rich, ethical descriptions of the consequences,
I'm not sure why the utilitarian way of adding up the consequences
is the right way to go about deciding what to do.
So one reaction is: why carve out an exception for
The second reaction appeals to the claim that scientists
are people of goodwill. That is a claim that I have absolutely no
interest in denying. I also don't want to suppose that the
scientists are any better than the rest of us. The scientific
enterprise, like the enterprises, the professional enterprises in which
we all engage, is an enterprise that presumably sets up incentives
which tempt people to do what they can and make what progress they can
on their own watch and to their own credit.
That isn't to impugn the goodwill of scientists for a
moment. It's simply to note a fact about the human condition and
about professional life as we all know it, given that those incentives
are in place and that they are bound to be sorely tempting to
scientists, as they certainly would be to me and to many others.
I think it appropriate to talk about how to constrain the
pursuit of the incentives and what the incentives ought to be.
And finally, a third reaction is that it does seem science
and biotechnology, in particular, have the possibility so to impact
human life, basic human institutions, the way in which humans think of
themselves, that we have to be extraordinarily careful in pursuing
things that will change those dramatically.
I mean, we are, as Gil repeated, creatures of an
intermediate status, creatures whose way of thinking about ourselves is
profoundly tied to our natural condition, to the way in which we come
to be, to the way in which we go out of existence or have whatever
change in existence is brought about by death. Those are basic facts
of human life, and things that alter them by changing the ways in which
we come to be, by changing the relationship between generations, by
changing the conditions in which we go out of the world or prolonging
human life dramatically, all are bound to have profound consequences
for human beings, for the way we think of ourselves for how human life
That in itself, I think, is a reason to be very, very
careful and to think with all the tools we can about just what the
consequences of science are likely to be. In that way I think the
third reaction builds upon the first. We need the most sophisticated
description of the consequences of scientific progress that we can get,
and we need to evaluate them in the most sophisticated way.
CHAIRMAN PELLEGRINO: Lawler — oh, did you?
PROF. GEORGE: Could I have a second question?
CHAIRMAN PELLEGRINO: Please, go ahead.
PROF. GEORGE: Specifically for Paul, and it's not a
Paul, you really usefully contrasted talk of dignity and
the usefulness of the concept of dignity with an ethics of rights and
liberties and explained that there were some moral propositions that
couldn't be captured with the concept of dignity that can be with
the concept of rights and liberties, and vice versa.
What I'm wondering is could an ethics of duty — and I
mention it specifically in this question of whether there are some
things that an ethics of rights and liberties just can't capture
that the concept of dignity supplies — but could an ethics of duties
when attached to an ethics of rights and liberties, and Jim was talking
about a ethics of rights and duties, but could an ethics of duties,
especially if not a purely deontological, but rather one rooted in an
eudaimonistic understanding of our moral life, supply everything that
the concept of dignity supplies? So there wouldn't be anything
Now, even if the answer to that is yes, I'm not
supposing that that means we should ditch the concept of dignity at
all. That's not my question. I'm trying to understand the
concept of dignity by asking whether a eudaimonistic ethics that was
the grounds of an ethics of duty attached to an ethics of rights would
complete the picture.
DR.Weithman: I don't think so. I think the kind of
hybrid ethics in which duties and excellences or duties and virtues
work together is one that needs to be spelled out carefully and
investigated carefully. It seems to me there are better and worse ways
to build such an ethic, and the problems with some of the worst ways to
do it are, in fact, pointed out by virtue ethicists who don't want
to have much truck with duties at all.
But leave those problems aside. Are there moral intuitions
that we have or morally important considerations that we recognize that
couldn't be helpfully captured by such an ethic?
I guess I'm inclined to think so. I think moral
perfectionism plays an important role in our moral thinking, and so
there's an important niche in our moral thinking that is reserved
for people who excel in ways that go beyond what they are duty bound to
do and that part of ethical thinking and part of ethical training and
moral formation depends upon holding up such people at exemplars, and
so I think we need to talk about human excellence and human perfection
at least in certain areas in order to do that, and we need to be able
to talk in many of these cases about the dignity of the people we are
holding up as ideals.
I also think that we as a society have an interest in
promoting certain ideals of artistic perfection, say, or athletic
perfection or good athletic performance. I'm not sure that that
interest is a duty that we have, and so I think the talk about rights
and duties would leave us unable to capture that.
CHAIRMAN PELLEGRINO: Meilaender, Lawler. I'm sorry,
A point of information. Time is rapidly disappearing. So
conciseness would be helpful.
Thank you very much.
Go ahead, Dr. Meilaender. Jim, have you got a short one?
DR.CHILDRESS: Yes, very quickly.
CHAIRMAN PELLEGRINO: Sorry.
DR.CHILDRESS: It seems to me the direction you proposed
would be quite useful, but then notions that might be built into that
are duties to sell, for example, which are particularly contestable.
And back on the other point about utility for a moment and
giving it a free pass, I guess I would also add perhaps an application
that the controversy about the values related to the consequences is
one that persists, and those values for assessing consequences are ones
that are much up for grabs as the other issues, and that following
Paul, the notion of a precautionary approach or a principle might well
be an important addition, even within that framework.
So there are ways to enrich it as well, I suppose.
CHAIRMAN PELLEGRINO: Meilaender, Paul McHugh and Kass.
PROF. MEILAENDER: I think I'll pass because, I mean,
I've got plenty I'd like to say, but I'll give an
opportunity for people who haven't said anything.
CHAIRMAN PELLEGRINO: Lawler.
DR. LAWLER: Very quickly. So rights aren't enough;
duties aren't enough; dignity is not enough because it's an
ambiguous term. Got to stick excellence in there somewhere. So how
about this? We'll go back to the most old fashioned way imaginable
of looking at this, but still philosophic. Can we once again start to
talk about natural human goods and tie dignity as a mid-level concept
The bottom line is we are created in a good way by nature,
and the undignified modern project taken to an extreme would threaten
these goods we were given by nature.
CHAIRMAN PELLEGRINO: McHugh.
DR.McHUGH: Well, I too enjoyed both your presentations.
They were stimulating to me, and I'd like to comment what our
Council is about.
And our Council is a Council on Bioethics, and you've
presented to us material that makes me wonder the place of bioethics in
the analysis and the future of our world, particularly in the world
that I live in.
I live in a — I'm a teacher of medicine. My job is to
try to make the doctors of the future, and in order to do that, I have
to teach them various things. A lot of them are technical skills, and
we talked yesterday about the absence of technical skills in developing
a problem if we didn't have the technical skills and the problem
really wasn't what you thought it was.
But then there is this issue of developing the character of
people. The best doctors are those who have courage and temperance and
prudence and things of that sort, which, Dr. Childress, you made the
point that these are virtues in relationship to dignity that tie to the
practice, to the person, to the individual.
And of course, in our Council we have made this emphasis
not only in relationship to the way we have discussed things, but even
in our publications. We published a set of stories, plays, poems that
we thought were better descriptions of what we meant by human dignity
than the philosophical, analytical, and you might say bioethical
PARTICIPANT: You were right.
DR.McHUGH: Well, I think I'm on the right track
anyway to my question.
The question becomes to, again, return to Professor
Childress' point, that in these areas in a pluralistic society, we
can't get agreement. We certainly can't seem to get agreement
over laws derived from an analytic position, but we certainly in our
history as a country have moved ourselves ethically in a direction
primarily over products of art.
Harriet Beacher Stowe moved more people about what slavery did
not just for the slaves, but for the slave owners than anybody else
did. Solzhenitsyn in One Day in the Life of Ivan Denisovich
did more to disrupt the sophistic ideas about communism than all
of the analytic people.
We also know that this process can be deranged. I mean,
Ayn Rand can write stories that lead us in very wrong directions.
Now, all of this is to bring you around to the point about
I'm trying to make doctors, and I'm trying to be a citizen as
well. Does it mean that your role as analytical philosophers
fundamentally comes to be as critics, more as critics than creators,
more as analysis of what we are being driven for by the pictures,
everything from the Aristrean tragedies right till now, or do you
really think that bioethics is something that is more creative and
capable of doing something in a pluralistic society?
CHAIRMAN PELLEGRINO: Leon.
DR. KASS: Thank you.
And I want to thank you both for really very stimulating
presentations. If there were many hours, there would be many things to
Let me say just to Jim I probably as much as any of the
critics of our use of the term "dignity" feel the force of
those criticisms. I know that we have not done a careful thematic
analysis of it, and your very gentlemanly, gentle hortatory remarks at
the end are, at least speaking for myself, absolutely well taken.
A comment and then a question to try to engage the two of
you where you seem to have had probably more difference than, in fact,
A comment is that it does seem to me that Professor
Weithman and Gil's question and your response, Jim, suggest that
somehow the anthropological question even prior to the moral question
is somehow central here and needs a careful consideration, and it is, I
think, indispensable for thinking about some bioethical questions, by
no means all of them, when we are acquiring the power to alter the ways
in which human beings have hitherto entered life, left life, and
conduct their activities.
The notions of freedom and equality don't do the whole
work of thinking through those concerns that people have, and the
interest in human dignity might be one way of trying to flag an
interest in what are the human goods that we wish to defend and what
are the human goods that we feel are threatened.
But so I think that that's right, and I think we need
to do more work to try to spell that out, and "dignity" might
not be the right language, but there's something missing from the
way in which we've gone about talking about things for the most
part, and part of our effort here has been to call attention to those
things that have been missing.
The thing that interests me and the difference between your
presentations had to do with Jim's rightful caution that in a
pluralistic society certain kinds of efforts to promote virtue in the
community in ways that actually had coerced behaviors on others were
problematic, and that one would do far better if one talked about
violations of rights or duties.
Whereas Professor Weighman talked about communities have
virtues and there's a concern about what kind of a community we are
building for our children and for the future, and you know, we coerce
children to go to school. We started to coerce them to go to school
not because we wanted them to become computer experts, but because we
thought that it was good for them as human beings.
We have had blue laws, still I think defensible, laws about
prostitution, laws against voluntary servitude. We tolerate
discussions of banning the use of steroids in athletics not just
because they're unsafe or because their use is unfair.
There are ways in which both by the things that we
prohibit, but even by the things we, in fact, encourage through federal
funding and through public decision. We try to promote a society of
the sort we think is good, and I wonder whether or not the view of a
good society is exhausted by the rights and duties approach or whether
we don't need some kind of positive view of an ideal granting a
great deal of pluralism, but that the world of the future is in a way
our to shape. We shape it all the time with some tacit notion of what
a good community is, and I don't see how sensible public policy —
I guess my challenge is how could sensible policy do without such
conception however difficult it is to get an agreement and knowing that
we're going to fight about these things.
CHAIRMAN PELLEGRINO: Could I ask our two speakers to hold
for just a moment?
I am going to use the Chairman's privilege to extend
this discussion for a few moments. Dr. Meilaender wants to make a
statement, and then if you two would respond as you wish, and then
Thank you very much, Leon.
PROF. MEILAENDER: Well, this is just to raise the issue I
was going to raise before, but I'll chime in with it now because it
follows up on what Leon said, and it was really what I was thinking,
Jim, in response to what you had said earlier about pluralism, and
it's two basic things.
The first is that it's not clear to me how useful
rights talk always is. Talk about a conversation stopper. Rights talk
is very often a conversation stopper. Talk about a concept that's
hard to clarify on many occasions that it's difficult to know what
we mean by that language; it's very difficult to know what the
reason or basis for rights are. So exactly how much better off is
rights talk in a pluralistic society?
I'm just not sure about that. That's not exactly a
confidence statement, but it's a question.
And then the second point I was going to make, and this is
what chimes in with what Leon says, it's not clear to me how we —
if ultimately what we're talking about is who we are here, what
kind of creatures we are, if that's what the dignity language at
least in part is getting at, how could the public not care about that?
It doesn't mean we'd necessarily agree on it. It
doesn't mean that I could necessarily come up with something that
you'd find persuasive, but how could we not think it was important
for us to argue about even? It seems to me inevitable that it has a
CHAIRMAN PELLEGRINO: Jim, and then Dr. Weithman.
DR.CHILDRESS: Well, thanks very much.
And this always happens in meetings. Things really build
up to a crescendo at the end. So we'll probably need to have a
discussion afterwards, but thanks very much for the points.
First of all, I would distinguish public culture from
public policy, and I think the Council has done a wonderful job in this
regard of enriching public culture with attention to a variety of
At the point of justifying public policies, I didn't
say it was impossible to do from the other standpoint of, say, the
standard of virtue or excellence, just to use shorthand language now,
but there was more problematic, and I think that for many areas I agree
that we don't have agreement always on rights or duties, and I put
both of those together because I think about them together.
There will still be disputes there. However, within our
social, political, legal framework, there are presumptions in favor of
liberty, for example, that we have come over time to view as
presumptions that should be overridden only under certain kinds of
circumstances, and it is, I think, more problematic to override them on
the basis of a standard of virtue than it is on the other.
That's not to say it can't be done. It's more
problematic. Often, and we'll have some debate here in some of the
areas whether it's prostitution or selling organs or what. There
are issues that would relate to coercion or exploitation or the like
that could be seen in terms of a rights or duties framework without
necessarily going the other direction.
Again, I think the standard of virtue approach, absolutely
important for public culture, along with the other, and it's more
problematic at the point of justifying coercive laws, but not
impossible to do.
One quick comment in relation to Dr. McHugh's point
about whether bioethics ends up being always kind of a critical
perspective when one is thinking about this philosophically. I very
much agree that narrative, et cetera, in terms of character, individual
character for professionals in training, such as physicians, nurses,
teachers, but also for the society at large, that the narrative
approach is obviously going to be much more important for shaping
character, individual and social over time, and the work of being
human, my colleague Bill May, formerly on the Council, has used it last
year, using it again this year in an undergraduate course very
successfully, actually for the students who took it one of the
highlights of their undergraduate experience. So cudos.
Now, it seems to me though that there's still another
aspect to this, and that is processes of moral reasoning that need to
be thought about as well, and there it seems to me the philosopher,
theologian or whoever plays some role, but it probably is a subsidiary,
secondary role in trying to probe some of the assumptions and
implications of positions. So I would see it more in that way, and so
it looks like a critical perspective, but actually it's one that I
think can work in tandem with the other.
CHAIRMAN PELLEGRINO: thank you, Jim.
Dr. Weighman, closing statement?
DR.Weithman: Sure, and I will try to be brief. That will
not be easy because there were so many interesting things to respond to
in the Council's last set of remarks.
It's often assumed the disagreement, moral disagreement
even when public policy is concerned automatically means retreat to the
lowest common denominator of discussion, and I myself think that that
is a mistake. Disagreement in some areas is more important than
disagreement in others.
There may be disagreement about whether we should fund the
arts. There may be disagreement about what art is. I don't think
that that means we have to retreat to the lowest common denominator of
art or artistic expression or be afraid to fund the arts even in the
face of disagreement about whether we should do so. There are some
kinds of human perfection and human excellence that communities should
foster even if there's disagreement about the standards to be
employed in assessing it.
There are other areas in which disagreement may be much
more telling and in which we might think excellence is not something
that we need to seek publicly or to subsidize or encourage using public
power. I'm much more interested in fostering excellence of
artistic expression than I am in fostering excellence of sexual
expression in privacy between consenting adults. Some kinds of
excellences are worth pursuing; others aren't. Not all
disagreement forces us into silence. I think important to bear that in
There may be deep disagreement in society about the big
questions of what a good life is, perhaps deep disagreement about what
artistic expression is good, very deep disagreement about what forms of
sexual expression are good, excellent, tolerable, or ought to be legal.
I wonder whether — and this now goes to Dr. McHugh's
question — whether there is such profound disagreement about what
makes for a good doctor or what people want in their doctors. I would
be very surprised if people want to give up the traditional virtues and
excellences associated with the practice of medicine.
One of my worries about physician assisted suicide, for
example, is that it's advocates play on the traditional excellences
while promoting a practice that I fear will undermine them. People who
want physician assisted suicide want physician assisted suicide from
doctors who are caring and compassionate and have all the traditional
virtues and yet are willing to kill them.
I'm deeply worried about people trying to have it both
ways. That people want to have it both ways suggest that there is one
traditional way in which they do want to have it. If there is
widespread consensus on what virtues we want physicians to have, then
by all means encourage them, and I think the arts are a splendid way
to do it.
The report on human cloning that you all produced is
excellent. Is it going to persuade people? Perhaps. Far more
persuasive, I should think, would be a novel I've not read by the
author of The Remains of the Day and The Unconsoled on
the consequences of cloning people simply as repositories for organs to
be transplanted. I have not read the book. I read reviews of it. It
sounds absolutely chilling.
I would put that in the hands — in fact, if you can
overcome copyright problems, attach it as an appendix to the second
edition of your report on cloning.
DR.Weithman: Thank you all very much for having me.
It's been a wonderful experience. I appreciate your attention.
CHAIRMAN PELLEGRINO: Thank you very much to the speakers
and the commentators for a spirited discussion.
We will have to shorten our break just a little bit. We
will certainly have the public participation as promised with the time
(Whereupon, the foregoing matter went off
the record at 10:16 a.m. and went back on the record at 10:26 a.m.)
SESSION 6: DISCUSSION
OF STAFF WORKING PAPER ON "BIOETHICS AND HUMAN DISNITY"
CHAIRMAN PELLEGRINO: The next item on our agenda — this
technology is overwhelming. The ones I use you have to hold your
finger down. They're older.
The item on our agenda now is the consideration of a staff working
paper on the subject of dignity about which we've heard considerably
in the last few moments and we'll hear more.
Here there will be no presentation. The paper was prepared
by Dr. Adam Schulman with the participation of other members of the
staff. And so I think here we can start right in with questions and/or
comments about the paper, and I would entertain suggestions of anyone
who wants to begin to comment.
Anyone? Adam is not going to make — I asked him if he
wished to do so, and he preferred not to so you have more time on the
paper, on the substance of the paper itself.
However, if Adam wants to sit here and people may ask a
question about what a term means, I'd appreciate it very much.
Adam, I want to thank you on behalf of the Council for
doing this preliminary work.
Dr. George, you look like you're about to ask a
question. Have I interpreted you correctly?
PROF. GEORGE: Thank you, Dr. Pellegrino.
I did want to begin by first thanking Adam for his work on
the paper, which is very stimulating and interesting.
I want to ask Adam whether it might be possible for us to
say that there is, in fact, a national commitment that we as a people
have made to a certain understanding of dignity or at least to a
limited range of possible understandings, that is, excluding some
others. And if, therefore, given our own role as an agency or body of
the United States government, while it's interesting to explore
other concepts of dignity, whether we can say with some confidence that
we should as a matter of public policy be working within the
Now, of course, the term doesn't appear in any of the
founding documents of the nation, but my question is: is it possible
to glean from the Constitution and particularly from the Declaration of
Independence a certain understanding of the dignity of the human being,
one that excludes not only some possible alternative ethical
understandings, but also some alternative understandings of dignity
coming from other traditions which could reasonably be judged as just
alien to the one to which we've committed ourselves?
This is not to suggest that even if this is true that there is
an understanding embodied in our own national commitments, that
that understanding requires no defense. I would be all for defending
it, for sure, but is one there? Can we make some progress toward
understanding what concept of dignity, if any, American policy should
be made on the basis of by trying deeply to understand what is already
embedded in our founding documents?
DR. SCHULMAN: My feeling on that subject is that if you
take the Declaration of Independence and its trio of rights, life,
liberty, and the pursuit of happiness, it's not impossible, but
it's difficult to get from that a rich enough conception of the
positive content of the good life to address the bioethical
controversies that are upon us now and are coming in the future.
It seems to me it's certainly true that it would be
wrong to treat Lockean rights as simply negative or devoid of positive
content, and there are, I think, successful efforts to find a
conception of human virtue or excellence that goes along with
A teacher of mine at the University of Chicago, Nathan
Tarcov, wrote a book called Locke's Education for Liberty in
which he, I think, shows that the Lockean conception of rights leads to
a kind of notion of the sort of citizen that one would have to be in
order to exercise those rights.
But, again, it seems to me that I don't see how that
goes very far in the coming age of the power of science to modify human
nature. I'm not sure how far that would go toward spelling out
what aspects of our humanity are really essential and inviolable.
Maybe you have some ideas on that.
PROF. GEORGE: Well, I was wondering if in addition to the
invocation of rights to life, liberty and the pursuit of happiness
which in the declaration are explicitly a nonexhaustive list. If there
is anything to be gleaned from the idea that human beings are created
and that they are created equal.
Is there anything that is implicit; is there an
understanding of human dignity that might be implicit in the concept of
a creature who is endowed by his creator with unalienable rights, and
who is created equal.
So if we go beyond just the attention to the rights, to the
sort of deeper context in which that expressly nonexhaustive list is
set forth, whether we'd have a richer understanding.
DR. SCHULMAN: It seems possible. I guess I'd leave
that to you members of the Council to discuss.
CHAIRMAN PELLEGRINO: Is it on this point, Paul?
DR.McHUGH: Yes, it is on this point.
CHAIRMAN PELLEGRINO: Okay.
DR.McHUGH: If I can continue on that point because Robby
is speaking exactly in the same direction I am because if we are
created, and we are created equal, that truly makes — and
there is a creator who made us — not only do the rights and
duties and ultimate responsibilities come with that, but also a
kind of relationship amongst each other comes from that because
to some extent that is the definition of brotherhood or sisterhood,
that we come from a particular place.
It's that theme of brotherhood — you talk when you go to
the Biblical religion that the Judeo-Christian thing talks about
man being made in God's image, which you know I think that's
kind of interesting, and Augustine develops that, of course, in
his Trinity, but the thing that's more telling, it seems, for
Americans today is this brotherhood that we have, that we're
equal, but we have responsibilities to one another that comes from
being brothers, and even the responsibilities and duties we carry.
I was saying to several people yesterday there was this
picture of that statute outside of Boys Town: "he ain't
heavy, Father. He's my brother." And to some extent
that's a kind of thing that we in this society want to be able to
say for all of us. Yes, caring for the sick, caring for the child,
caring for everybody can be construed as heavy from outside, but the
person who is caring if they think of each other as brothers, he
ain't so heavy in that way.
CHAIRMAN PELLEGRINO: Thank you, Paul.
I have Hurlbut, Lawler, and Meilaender, in that order, and
DR. HURLBUT: Well, it seems to me that maybe your answer
to Robby contained a little bit of your answer in spite of the fact
that you didn't claim it.
The very notion that there might be some ways of living
which preserve freedom itself might have a meaning here. There might
be things that we could do to ourselves that would diminish our scope
of our freedom and, therefore, our capacities to operate for the good.
Of course, freedom finally doesn't mean much unless
it's attached to some notion of the good. It can't just be
So what I want to come back to somehow or another in this
conversation — I'm not quite sure how to do it — is what Leon was
saying at the end. Below the notion of dignity, there has to be some
notion of a natural good which we could mess up with our biotechnology,
and one dimension of that we might explore would be the concept of
But it does strike me that dignity intrinsically carries a
notion of moral valuation in it because human beings have some open
indeterminacy, and therefore, we can't just speak of a human nature
because human nature is full of all sorts of stuff, some very bad
So we've got to have some reference to where we're
getting the notion of what is good, and just to add a little to it, I
think we need to add to the notion of the Biblical description maybe
the term "love." Maybe that's a little too vague, but
God according to the Christian tradition — and I think this is very
resonant with all Biblical tradition — is God is love. Love seems to
me to be the notion that carries the coherent wholeness of the good,
and therefore, it is intrinsically preserving both the possibilities,
the freedom and the use of the possibilities in the positive and just
one last piece of that.
We in this current world, you hear it around universities a
lot, this flippant claim that you can't derive an "ought"
from an "is," the so-called naturalistic fallacy associated
with G.E. Moore, but I think it goes back to Hume, right?
And yet it strikes me that if you don't derive your
good somehow from what is, it's hard to know where you would get
it. Robby is usually a big authority on this, right? You can tell us,
Robby, but it seems to me that there must be some kind of a coherent
good that both preserves freedom and allows the manifestation of that
which is unquestionably good for human beings, that they would go hand
And that's a complicated thought.
CHAIRMAN PELLEGRINO: Lawler, if you want to comment.
DR. LAWLER: I agree with Bill, but I'm not going to
talk about that. Among the great contributions of this paper is the
criticism of Kant, which is radical and correct. Adam says on page 8,
"In locating human dignity entirely in rational autonomy, Kant was
forced to deny any moral significance to other aspects of our humanity,
including our family life, out loves, our loyalties, and other
emotions, as well as our way of coming into the world and all other
merely biological facts about the human organism."
And skipping a sentence, "if the rational will alone is the
seat of human dignity, why should it matter if we are born of cloned
embryos or if we enhance our muscles or control our moods with drugs
or if we sell our organs on the open market?"
And Footnote 11, "one will not, for example, find much
hint of human dignity in Kant's definition of marriage as the
association of two persons of different sex" — that's the
only controversial part nowadays — "two persons of different sex
for the lifelong reciprocal possession of their sexual faculties."
So if dignity has something to do with family, loyalty and
love, Kant provides no guidance whatsoever, zero, because for Kant the
idea, as Bill pointed out, of human nature is an oxymoron insofar as
we're natural. We're not human.
So the big question is in what respect does the Declaration
of Independence and our founders differ from Kant on this, and in
looking at the Declaration of Independence, you can say the list of
rights is nonexhaustive, and I'm sympathetic to that, although not
as a matter of judicial review, but the Declaration of Independence
itself was a product of legislative compromise, so often recommended by
Justice Scalia, and at the end, there were references added by the
whole body to the draft, to the act of the providential god, to the
judgmental god, and to sacred honor.
So in looking for an adequate conception of our dignity, wouldn't
we have to look to these fairly countercultural American traditions
mentioned by Adam? The Biblical tradition, and I'm glad you
brought this in because I really like it; our stoic tradition, most
recently talked up by Tom Wolfe not only in A Man in Full,
but also in I Am Charlotte Simmons with respect to college
athletes, Jo Jo, the college basketball player freeing himself from
the slavery of big time college athletics through the study of the
CHAIRMAN PELLEGRINO: Meilaender.
PROF. MEILAENDER: Well, I'm not sure what I have to
say relates to wherever we are. I think every undergraduate ought to
have to read some Kant before getting the Bachelor's degree
conferred upon them, but I want to just ask a question about the paper,
which I do not want to direct simply to Adam because I think a
question-answer sort of session isn't very helpful. Adam may want
to provide his own reply at some point.
But I'm interested to know what the rest of you think.
I mean, it's a very nice paper. It sorts out these different
conceptions which are in certain respects complementary, though also to
some degree in tension with each other.
And what I'm not sure about is the meaning, I guess I
want to say, the meaning of the conclusion to the paper, "dignity
understood as humanity."
What happens there in the conclusion? How did the rest of
you read it? Is that an alternative concept? That is to say we've
had four delineated and now we get a fifth.
Is this one that gathers up certain strands of the four
that have been delineated and somehow captures what is most essential
to them? What happens in the conclusion of the paper? What does
"dignity as humanity" mean sort of for its own sake in
relation to those four strands that have been delineated?
I wasn't quite sure, which I don't make that as a
criticism of the paper. I mean, you only gave yourself a couple pages
to conclude it, after all, and one can only do so much there, but I
wasn't quite sure.
I'd be interested to know what the rest of you made of
CHAIRMAN PELLEGRINO: Adam, would you like to comment?
DR. SCHULMAN: I'd rather hear what they made of it
DR. KASS: I'll bite because I very much welcome
Gil's question. The end sort of surprised me, and Gil's
generous way of putting it I would endorse completely. This is
something very useful here.
But if we tied this particular conclusion of this paper to some
of the discussion in the last session, it seems to me that various
of these attempts to articulate some teaching of human dignity are
a way of highlighting certain features of what it means to be human
and making them matters of regard, respect, encouragement and the
like, and that I took Adam not necessarily yet to be collecting
all of those things, but recognizing something of what they had
in common, still leaving open the question of which of those previous
accounts might be still in the conversation.
At least whatever criticisms he levels at them, I don't
think even in his own mind are fully damaging to them, as there's
some element there that commands our attention. And I took this to be
maybe an attempt to try our hand not at the language of dignity, but to
do the same thing sort of closer to the ground.
I mean, what are the human goods or what is good about our
humanity that we should be mindful of it, to do apologies for the
presumption of that substitution?
But, I mean, it means all the work is still to be done,
obviously, but I think it's the right work.
DR. HURLBUT: Leon, would our humanity then mean our
preservation of our capacity for evil, too?
DR. KASS: If you're a friend of freedom, then you are
a friend of the capacity for evil. If you don't like freedom, then
you say, "Do not eat of the Tree of Knowledge for good and
To be a free being is to live with those two alternatives,
and if you want something that's incapable of evil, be a chipmunk.
CHAIRMAN PELLEGRINO: Adam.
DR. SCHULMAN: It seems to me one could raise for
discussion the question would it be compatible with human dignity if
biomedical progress produced a drug or an operation on the brain that
simply removed our capacity for evil. Would that be something that
would be required for all human beings that reach a certain age? And
would that be something conducive to our humanity and dignity?
CHAIRMAN PELLEGRINO: Anyone want to respond to this utopian
question or dystopian?
PROF. GEORGE: Well, it would be, would it not, precisely
an abolition of human freedom? Is there any dissent from that? I
mean, is there a sense in which it would not be an abolition of human
PROF. MEILAENDER: Well, there are some slightly deeper
questions, too, that Leon has raised. We might want to think about
whether there would be a difference between producing a drug that
eliminated that capacity, and training a person or perhaps
"training" isn't even the right word; bringing about a
condition of a person who was so virtuous that he was no longer in any
way inclined or drawn to evil. I would not think of such a person as a
DR.McHUGH: Well, Durkheim did go so far as to say even
in the company of saints there would still be deviants. The saints
themselves would begin to find the deviants in places that we hadn't
thought of as deviant before.
PROF. MEILAENDER: But I take my depictions of heaven from
CHAIRMAN PELLEGRINO: Dr. Lawler.
DR. LAWLER: You worry too much, right? It's
absolutely beyond our power to create a world beyond good and bad or
good and evil. I'm absolutely sure of this even though you
can't prove the future, right?
For example, the operation you're talking about, those
who prescribe the operation will inevitably exempt themselves from it,
and say mood control, so that we can always be in good moods. Mood
management, we wouldn't want to be completely unconscious though.
We'd want to have moods that would allow some creativity, but not
too much. So we would be creative, but we wouldn't be that
miserable. We wouldn't get so moody that we wouldn't be late
for work or kind of like the contemporary professor or something, you
know, kind of the careerist creative type guy.
So mood management would require an absolutely perfect
understanding of human self-consciousness which I think will forever
elude us, and not only that, but lurking behind mood management will
always be this thought: life really stinks. I can't even get
through the day without managing my mood.
So lurking behind every attempt to create good moods will
be an ineradicable, really bad mood. So I just don't think we have
the capacity to abolish good and evil. We just have the capacity to
really screw ourselves up by not understanding the good to make life
So I actually think dignity is an intermediate concept and the foundational
concepts are the human goods we've been given by nature.
CHAIRMAN PELLEGRINO: Hurlbut.
DR. LAWLER: That dignity — for example, what's
wrong with dignity. I'm not against dignity. I'm pro dignity,
but that dignity is in a certain sense an intermediate concept.
The foundational concept is the appreciation, gratitude for those
goods that have been given by nature and our perverse capacity to
remove ourselves from them.
CHAIRMAN PELLEGRINO: Dr. Hurlbut.
DR. HURLBUT: When I asked Leon about human evil, I
didn't mean having just previously said something about freedom
that we would eliminate the freedom from humanity. I was just
questioning the equation, dignity equals humanity. That was what I was
after, and so dignity, if we're going to use this term
meaningfully, has to refer both to a capacity for the employment of our
freedom, but also some kind of reference to what's good in our
freedom within our capacities.
I mean, earlier when we were talking about children and dignity, it
struck me that I used the term dignity in a way that reflects onto
childhood, and yet I use it in a slightly different meaning. I
think children, for example, you watch children and people with
child-like mental capacities, very severely retarded people, for
example. You can sense right away in a hospital setting that you
can violate the dignity of any human being. It's an amazing
thing how everybody has the center to themselves that they know
when they're being violated, and that relates to the concept
of dignity in my mind, and it strikes me that this term is a beautiful
term because it subsumes the dimensions of human beings that our
only capacities are intrinsic natures and then goes on to be inclusive
of those manifestations of human freedom as we mature into our freedoms.
But if we're going to use this term, we can't just
make it an equation that dignity equals humanity somehow, can we?
We mean what's best in humanity, don't we, when we
DR. KASS: Well, I think that the term is equivocal in that
sense, I mean, the same way as you would talk about the nature of
something you could say that whatever happens to arise naturally is
natural or you might say what you really mean by the nature of the
thing is the thing in its perfection or in its peak.
There is that kind of ambiguity. You say that's a
wonderful specimen of humanity. You don't mean it's whatever
the world has tossed up, but there is a kind of idea or you would say
of the Black Stallion in a way in which you wouldn't say of Old
Dobbin, "That's a Horse," because that's somehow the
embodiment of what the thing is at its best.
I think that's partly what we mean. It's not just
anything that the human species, God help us, has somehow put into the
world, much of it regrettable, but sorry.
PROF. GEORGE: Yes, Bill. I just wanted to say that if we
look at Adam's final paragraph, I think he has captured the
essential idea you're after. Notice that it's not a simple
equation of humanity and dignity. What Adam says is or what he makes
reference to is human dignity understood as our essential and
I think what Adam must have in mind, and, Adam, you can
clarify this for us, is the human being understood as having inherent
worth, the human being as not reasonably or rightly reduced to
instrumental status, the human being who may have many nonessential
things about him, including emotions which may lead us to do inhumane,
even inhuman things, hatred, anger, and so forth, but those aren't
What would be essential is what I think, Bill, you're trying
to capture with the idea of the human good or the human goods or
the natural human goods, those things that, when considered as aspects
of the well-being flourishing of a creature who has inherent and
not just instrumental value, must be regarded as what — well,
Adam has given us, I think, a very apt term here — inviolable,
that which we cannot violate without violating something essential
to the human being, human being now considered as some entity, as
a creature of inherent worth, of profound .- well, what other word
can we choose but dignity?
CHAIRMAN PELLEGRINO: Alfonso.
DR. GÓMEZ-LOBO: This in a way tags onto what Robby was
saying, but I'm taking it a little bit further back. I personally
like the idea of cashing out some of the claims about dignity in terms
of human goods. I'm convinced that that can be worked out,
particularly given the steps that dignity invokes or requires respect,
and if one tries to figure out respect for what, it seems to me that
respect of the goods of a person is one of the most reasonable replies
one can give.
But I want to take it back to Kant, and I think Adam's criticisms
of Kant are very well taken. In fact, the definition of marriage
I always considered a terrible inconsistency within Kant's thought.
In fact, if I recall correctly, the German word for possession here
was a word that indicates rather use, not just possession, but Benutzen
or something like that, but I can't vouch for that.
But what I'm worried about is this. It's how can we give power
in a sense to the notion of dignity within the bioethical discussion,
and there it seems to me that the emphasis on the notion that to
consider that human beings have dignity is to consider them as ends
in themselves, and what follows from that is that it's instrumentalization
of human beings that constitute failurs in bioethical procedures.
For instance, in the question of the reasons why human
cloning might be wrong in principle, Adam lists because it violates
interpreting Kant, of course, and rightly so; it violates an
inalienable right or because of effects exactly, et cetera.
It seems to me that prior to that one could say, well, reproducing
or having children by cloning is a clear case of instrumentalization.
It's selecting a genome for reproductive purpose, and selecting
a genome would only be done with some kind of end and goal to reproduce
a great genius or whatever.
So it seems to me that there is this prior consideration of
instrumentalization of a human being that can be made fruitful for
bioethics, and it seems to me that when that is explained, it could
have much wider acceptance than it seems at first sight.
CHAIRMAN PELLEGRINO: Thank you.
PROF. MEILAENDER: I don't disagree, Alfonso, with what
you said, but I'm not sure instrumentalization gets everything that
we want to talk about. If you think about the cloning example, for
instance, I mean, there are some arguments that just seem to go on
forever about whether bringing a person into being in a certain way
instrumentalizes that person since, after all, only by bringing them
into being do they exist at all, and you have conferred the good of
existence upon them.
I mean, those arguments never seem to come to an end in the
bioethics literature, and I've never really known what exactly to
say about them, and so it seems to me that it might be that the issue
in that case, for instance, is not just instrumentalization of a
particular being, but the nature of the relation between the
generations or the fact that how we come into being is part of what we
mean by human dignity in some way.
And I'm not sure that that can all be captured in the
language of instrumentalization, though that language captures some
things that we mean. So it's in that sense that I think it's a
larger concept. It is what in the last session near the end Leon
referred to as sort of an anthropological concept before it gets to
some of these other issues. It just seems to me that it will get a
little too narrow and won't do all of the work it's supposed to
do if we reduce it to that, though I don't deny that that's an
important aspect of it.
DR. GÓMEZ-LOBO: Well, I agree with that, but it seemed to
me that this reduction or narrowing is what might be helpful in the
public domain, but incidentally, I would also interpret the way the two
generations would relate to each other in the case of cloning, again,
CHAIRMAN PELLEGRINO: Adam, I think you wanted to respond.
DR. SCHULMAN: I just wanted to amplify what Gil said. It
seems to me the prohibition against instrumentalization or
objectification can be helpful in certain biomedical, bioethical
contexts, but it's not clear to me that it can do all of the work
that you suggest.
And in particular, there are a couple of problems with it. One is that
in Kant's formulation it's not so much that instrumentalization
is forbidden. Kant doesn't ever say that it's wrong to
use someone as a means. He says it's wrong to use someone only
as a means and not at the same time as an end, and that's a
serious problem in interpreting that principle even in traditional
moral problems, let alone newfangled ones like cloning.
But it has also been suggested by some critics of the notion of
human dignity in the bioethical context that it's really not
adequate to say that cloning essentially amounts to instrumentalization
because it all depends on how the child is treated after it's
born, and it's certainly imaginable that someone could be the
product of cloning and never know about it and be adopted by a family
that never knows about it and treated as a human being with all
of the rights and freedoms.
So the argument is made that you can't prove that just
because someone is cloned he has been treated like an object and has
been essentially deprived of dignity, and so it seems to me that one
would have to find a broader account of what is troubling or
incompatible with human dignity about the technology of cloning.
CHAIRMAN PELLEGRINO: Thank you.
Leon. Oh, I'm sorry.
DR. KASS: I want to change directions, Peter. I want
to pick up on some things in the paper that have also been part
of our discussions in the past and led to some rather heated exchanges
in the work on the Taking Care document as to how we speak
about worth and dignity, and Robby has already weighed in with
a deep reading of the Declaration and the meaning of equality in
which equality means more than having equal rights.
And in the paper there are suggestions that at least
certain ancient notions of dignity are aristocratic and are unsuitable
therefore for the discussion of democratic times, and as a matter of
rhetoric I think there's something to be said for that, but people,
Peter, Bill, Gil, willing to talk about the human goods or what is a
good community, they don't seem to be shying away from — they
wouldn't necessarily put it always in terms of virtue.
Paul speaks about the virtues of the physician, and I'm
not sure whether it's fair to say that some notion of what's
humanly admirable is necessarily off the table just because we are
And it seems to me part of the difficulty of some of these presentations
is you've given us for the sake of clarity a certain polarization,
and the question is, I suppose, can one give an account, an anthropological
account of the human that would hold together both the higher and
the lower without having to drive a wedge between them. There will
be circumstances in which we'll be invited when you've got
someone who has lost all of their higher functions and they are
simply reduced to a largely vegetative state. The question is what
does their residual humanity or residual dignity, if they have it,
apply just to how we are obliged to honor and recognize that.
But I'm not sure that the people who hold only that
that should not be eliminated are denying — this is to refer to an old
conversation where Alfonso said any other kind of notion of dignity is
purely a social construct or matter of social convention.
I don't think he really would — I know I don't
want to hold you to that, but we all look up to and find admirable
certain kinds of displays of our humanity and not just among the
greats. I mean, there is human dignity in the embrace in the house of
mourning, and what we're honoring there is not an act of wilfulness
or of reason, but of some kind of expression of the understanding of
what our humanity calls for, and when we see it we appreciate it.
So I'm fumbling towards saying I think that the task
here is to try to give an account of the human that Kant, for his own
reasons was obliged not to be able to give, having surrendered so much
of the rest of the world to Newton, but which holds together the high
and the low in the account of human life that doesn't force us to
start with to drive the wedge between them. Circumstances may make
those questions hard.
Now, if I may be indulged, Mr. Chairman, just a little longer,
there is a Biblical passage whose truth, it seems to me doesn't
depend upon the place you find it. It's in the Noahide Code
where it says, "Whosoever sheds man's blood by man shall
his blood be shed, for in God's image was he created."
I may have the subject and the verb wrong in the last. It may not
have been passive. He created him. It might have been active.
There is an attempt to give an account as to why homicide
is wrong. It's not just fear of punishment. There's a reason
given. To shed human blood is the destruction of a creature made in
God's image. One amongst the animals, it's in the context of
the law about the eating of the animals, but not nearly on all fours
with the animals, and indeed, humanity takes responsibility for
defending human life against its violation precisely in that law.
But the funny thing about the injunction is although man is god-like,
what is somehow sacred is his blood or at least you shall not spill
the blood, and that the blood of the human, the mere circulation
is somehow also dignified by virtue of its being part of the being
that's an image, admittedly nearly an image, but a god-like
Now, there's a way in which there's an attempt to
hold together a unity of the being however hard it might be
theoretically finally to justify, which begins to give a picture of the
human person not only in terms of the higher things, but in the very
terms of the psychophysical unity, to use an anachronistic term that
would support the intuition that it would be a violation of being
itself to shed human blood.
And that, it seems to me, is a place to start where you
don't have to begin to pull all of these things apart, but to see
certain kinds of foundational things beginning with the good of human
life in which human dignity and the sanctity of life are not simply at
odds with each other, but are somehow friends.
CHAIRMAN PELLEGRINO: Thank you.
I think we have — oh, excuse me. Sorry.
DR. KASS: No.
CHAIRMAN PELLEGRINO: I think we have time for one more
comment, and I'm going to give that to Adam who was kind enough to
pull this together. Do you have any comment, Adam?
DR. SCHULMAN: Actually I'd rather hear from — I think
Robby George had something to say.
CHAIRMAN PELLEGRINO: Oh, I'm sorry. Did you have your
PROF. GEORGE: No, I don't want to take Adam's.
CHAIRMAN PELLEGRINO: No, please.
DR. SCHULMAN: Well, I thought what Leon just had to say
is very fine. I wanted to say that in the paper I think, though
I tried to present as vividly as possible some of the problems with
the sources of the modern notion of dignity, it seems to me that
none of those problems are simply decisive and that there may well
be wisdom in all of those sources, including the Bible and Kant's
moral philosophy and classical notions, including the Stoic and
also the Aristotelian notion of excellence, and that all of them
may serve as useful sources in seeking a concrete understanding
of dignity that would be sufficient to help us weather the storms
of modern biotechnology.
CHAIRMAN PELLEGRINO: Thank you, Adam.
Did you want to add?
PROF. GEORGE: Well, if we had just another second I would
say how valuable I think Leon's comment is. One of the points he
made, and it's certainly true, is that it's difficult to give a
satisfactory, intellectually satisfactory, account of the unity of the
human being, but the other side of that coin is that it's also
difficult, indeed, notoriously difficult to deny the unity of the human
being, to defend an account of the human being under which one's
true humanity is one's consciousness or conscious awareness and
one's bodily self is a subpersonal instrument of the consciousness
considered as the true self.
There are many different versions, many different efforts
to defend that kind of dualism, and they have as far as I can tell, at
least, come to naught. So it's a very difficult problem on both
sides, not just on the one.
CHAIRMAN PELLEGRINO: Thank you very much.
Adam, I want to thank you very much for undertaking the
heroic task of trying to address this very, very complicated issue, and
I think Adam's intent is to provide us with a tentative draft so
that we could look at it, and I want to thank all of you for your
input, and I know you're going to take this under advisement and
probably work on it and come back with something further, but I do want
to thank you.
It's a daunting task, as you know from the discussion
this morning, to deal with this concept of dignity, and I think we owe
him tremendous gratitude.
SESSION 7: PUBLIC COMMENTS
CHAIRMAN PELLEGRINO: I think we'd like to move now to
the final session, which is comments from the public, and I have one
person who has requested the privilege and that is Mr. Del Farris of
the Arkansas Children's Hospital, Little Rock, Arkansas.
MR. FARRIS: Yes, my comments basically come from
yesterday's session primarily with Dr. Nelson because his topic is
where I live. I'm the Director of Pastoral Care and the Director
of the Palliative Care Program at Arkansas Children's Hospital.
And some of the things he said, there were two things in particular
that were a little bit concerning for me that I wanted to give a
voice for you to hear, and as you go further in your deliberations
hopefully you can take some of this with you.
The first was when Dr. Nelson mentioned that he asked this
question. I can't remember the exact context, but he said do CAPTA
and EMTALA make any form of palliative care illegal, and I don't
know that he was throwing that out there as just a theoretical
possibility or is there some legitimacy to what he's saying if you
apply directly the language of those regulations?
If so, that's very concerning to those of us in the
palliative care movement, and any kind of difficulties to prevent
families from having access to and provision of palliative care would
be very alarming.
So I would like to ask you as you have influence in this
area going forward, if that does have any reality to it, any substance
to it, that you take to heart the needs for access and provision of
palliative care for patients and families.
Secondly, as a chaplain, he talked about right orthodoxy
and faith. I had to make a couple of comments on that, but in a way
I'm not really sure this was his intent. It may have been more of
how I was hearing it, but I got the impression that he was talking
about having the medical profession work with families to kind of
subdue somewhat their belief system, their right orthodoxy and to go
with their feelings. Parental love I think was one of the phrases that
was used there.
And, again, as a chaplain I would say that that's a very dangerous
thing to do because families and patients in these critical situations
probably at a core of who they are is their belief system, and so
I just couldn't let that go by without addressing that and saying
that we need to be careful in those arenas. Hopefully we can engage
chaplains and others who have some training and expertise in that
to allow the belief systems, even though they may be contrary to
what we think is right in the circumstances, allow the families
to draw strength and support from them and to facilitate that and
not use that as an opportunity to subdue those types of things,
but even in those situations where the families are greatly relying
upon God for healing, as we've worked with families like that,
often medical communities believe that they're in denial when
the reality is that that's not so. It's just their faith
system, and until they go through that process of exercising their
faith the way that they've been taught and brought up, they're
not able to accept the end result.
And so we have to support them and enable them and advocate
for them with the medical team, and so I would just caution going
forward in those regards.
There were just a couple of other things. One, the quality
of life discussion. It has been my experience in working with families
in the NICUs and the PICUs that it's not so much that they're
trying to make the child's life go away, which I think was a phrase
that was used around the table here.
My experience is it's because they have come to the
place where they are agonizing over the continued infliction of pain
and harm and discomfort and suffering that their child is undergoing.
So they're not thinking about we need to put an end to this life,
but they are thinking about that we want to end this ongoing suffering.
And just the agony that those families go through in those
circumstances, we theoretically can talk about quality of life, but
that's not really where families are. The parents are there in the
trenches just deeply moved that their baby is suffering, and they can
tolerate that for a certain extent if there is hope, but a lot of times
the hope comes essentially to an end, and then they want to put an end
to the ongoing aspects of suffering.
CHAIRMAN PELLEGRINO: Thank you very much.
MR. FARRIS: Okay.
CHAIRMAN PELLEGRINO: Oh, I'm sorry.
MR. FARRIS: Just had one more thing, which was on
CHAIRMAN PELLEGRINO: Right.
MR. FARRIS: That came up about talking, physicians
talking. I'm a preacher. I'm sorry. I may be taking more
time than I need to here.
But that is the bottom line issue I see with families and
ethical situations. I've been a member of our Ethics Committee for
ten years, and a lot of times what we've discovered is that if we
go and have an opportunity for a couple of Ethics Committee members to
get together with the family and then with the physicians, it's
simply a matter of family and physicians talking past each other, and
not being able to communicate.
Often we can avoid going through a full committee meeting
if we just sit down and have some good communication. So remember that
also, Dr. McHugh's point there about communicating and taking the
time. I really believe that is an essential part of what we need to do
in providing good care that's ethical and meets those needs.
Thank you for your time.
CHAIRMAN PELLEGRINO: Thank you very much.
I have one more request, which we did not have at the
beginning. Richard Doerflinger of the Untied States Conference of
MR. DOERFLINGER: Well, thank you, Doctor.
I didn't sign up yesterday because I wasn't sure
whether the snow would keep me from coming at all.
As someone who participated in the events of the 1980s on
Baby Doe and resulting legislation, I wonder if I could comment on that
because it has already been stated here yesterday that you need to
understand the context in which that legislation was framed.
The Baby Doe case in Indiana was one of the more egregious
cases, but it was by no means an isolated case. There was a survey
showing 77 percent of pediatricians at the time would have done the
same thing, refuse routine surgery for a child simply because the child
also had Down's Syndrome.
There were cases at Yale-New Haven, at Johns Hopkins,
University of Oklahoma, which is depriving handicapped children for
surgery for spina bifida based on the formula Q equals NE times H plus
S, quality of life equals natural endowment times contribution from
home and society.
Children were denied treatment not only because they were
expected to be mentally retarded, but simply because they were poor and
black. And that led to a court case that was settled out of court.
The response to that initially was by Surgeon General C.
Everett Koop, who of course himself was one of the great pediatric
surgeons of our time, and that was exactly the principle that has been
discussed here yesterday: equal treatment for equal cases based on the
equal dignity of every human life, and so you had a nondiscrimination
standard for giving children with other disabilities the same medically
indicated surgery you would give to others.
Now, that was fiercely opposed by the American Academy of
Pediatrics. Dr. Fost, who was here yesterday, wrote against it, said
it would be a much better standard to say that you can withdraw
treatment when the disabilities are such as to render the child
incapable of experiencing any benefit of the treatment. Severe
disabilities beyond Down's Syndrome should be, he argued a case for
removing otherwise routine life saving treatment.
Frankly, to disability rights groups this was a bit like
saying there will be no racism against the more light skinned racial
minorities, and the outrage about these cases continued.
It has been said also that Peter Singer has a chair in
ethics at Princeton University. Perhaps more relevant to this
discussion is that Peter Singer wrote the guest editorial in the
official journal of the American Academy of Pediatrics on this issue
opposing the Koop rule in which he famously said that a pig or a dog is
smarter than a handicapped newborn and perhaps has more rights.
The American Academy of Pediatrics sued successfully
against the Koop rule and decided it would prefer an actual standard of
care to be specifically written into policy and engaged in a
negotiation with right to life and disability rights groups, which they
all signed, including the AAP, and that is the language you have before
I think my organization was the only one engaged in the
negotiation not to sign the final language because we did have a
concern that burdensomeness of treatment and inhumaneness of treatment
can be a factor even in cases where it is not going to be virtually
futile in sustaining life, but understandably, the disability rights
groups did not want that burden standard because (a) it's
inherently subjective and (b) they feared, I think, with reason that
the medical profession would translate that through its prism in which
an unhappy or unproductive life can itself be a burden.
And so that is what produced the language you have before
you now, and I'm delighted to see pediatricians now discovering the
nuances of Catholic teaching on burdensome treatment. Even death bed
conversions are welcome, but in this case it may be 20 years late.
CHAIRMAN PELLEGRINO: Thank you very much.
PROF. GEORGE: Yes. If I could ask Richard Doerflinger a
question, one of our presenters yesterday said that she thought even if
the rules were loosened, as she suggested they be loosened, we would
not today have circumstances like the Baby Doe case. We wouldn't
have the outcome we got in the original Baby Doe case, and she gave
some reasons, including, she said, our understanding of Down's
Syndrome children, our appreciation of their abilities and their worth
has improved so that no one today, no responsible person today would
think it would be okay to deprive the child of an operation just
because he was handicapped.
Now, that did, I must say, I didn't have an opportunity
to get in on the discussion at that point, but it did strike me as
dubious, especially in view of the widespread practice of eugenic
abortion of Down's Syndrome children, something that Dr. Kass
called attention to in a profound talk that he gave at the Holocaust
Museum a few months ago.
But I wonder what your perspective is on the question of
whether the loosening of the rules might, in fact, result in more cases
like the actual Baby Doe case or do you think she's right that
we're past that now?
MR. DOERFLINGER: I'm not sure the situation has
changed that much. Frankly, at the time, in 1983 and so on, the groups
opposing Dr. Koop's regulation were perfectly willing to say using
Down's Syndrome was not the right way to go, and there were, you
know, recognitions that Down's Syndrome children can lead happy and
productive lives, but there are other disabilities that are more
serious in which a happy and productive life is not the case, and the
disability rights groups I think rightly said, "It's not your
job as a doctor to make me happy. It's your job to heal my
suffering body when it's in need and not to make your judgments
about what kinds of people ultimately are going to be happy and
productive and, therefore, have worthwhile lives."
So I don't think Down's Syndrome, though it was the
most egregious case that prompted the whole debate, it was the part of
the debate that people were sort of willing even then to agree on, at
least in principle, and they opposed the regulation because it would
also apply to other cases that in their view are more egregious.
I think the problem is with the standard itself. What is
the role of medicine in this case? Is it to make us happy or else?
And I think that issue remains.
CHAIRMAN PELLEGRINO: Thank you very much.
I'd like to thank the members of the Council, the
speakers, the staff, everyone who participated in this 22nd meeting of
We now stand adjourned. Thank you all very much.
(Whereupon, at 11:27 a.m., the meeting in the
above-entitled matter was concluded.)