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THURSDAY, February 2, 2006

Session 2: The Concept of Human Dignity (cont'd)

Daniel P. Sulmasy, O.F.M., M.D., Ph.D., Chair, John J. Conley Department of Ethics, Saint Vincent’s Hospital and Medical Center, New York, New York

CHAIRMAN PELLEGRINO:  We are about to move to our second speaker for the morning, Dr. Daniel Sulmasy, and again as with our other speaker, you have a complete or fairly complete, quasi-complete curriculum vitae in front of you for the details.  Dr. Sulmasy is a physician who is still seeing patients, the Director of the Center for Bioethics at St. Vincent's Hospital in New York and at New York Medical College as well.  He also is a Franciscan Friar.  We've asked Dan to reflect on the concept of dignity as seen from the classical point of view and religious point of view as well.

Dan, lest I take more of your time, I think you can take it away.  We have one or two Council Members who I'm sure will be here and will not miss anything too vital unless they stay out more than 30 seconds.


DR. SULMASY:  Well, I'm honored to be here, actually, among so many former teachers and esteemed colleagues, both in medicine and medical ethics.  And I'm going to try to do three things this morning that I hope will be useful to the Council, but given the brief time I'm allotted, I'm going to present them in a fairly compressed, abbreviated form and may wind up speaking too quickly here to do that.

The first thing I want to do is provide my own outline of a history of the philosophical uses of the word dignity, particularly as it relates to religious uses.  Second, sketch at least an argument about the meaning of dignity on the basis of consistency and its use.  And third, to sketch an argument about the meaning of dignity based on theory of value.

So dignity appears to be an important concept in ethics.  All of you are aware of this.  It occurs in documents like the Universal Declaration of Human Rights at the U.N., the European Convention on Human Rights and Biomedicine, and even somebody like Dworkin  has noted that the very idea of human rights seems to depend upon what he calls the "vague, but powerful idea of human dignity."

So the history part first.  The word dignity has an interested history in Western thought and I apologize for the very whirlwind tour I'll give and I could expound on these things, if you want at length later.

While it's often argued that the idea of dignity is essentially religious, and I know this argument has recently been made before you, the first place that I want to start is with scripture where it's very hard to make that argument at all.  The Hebrew translated as dignity, gedula, occurs rarely in the Hebrew scriptures and it means they are something more like nobility of character or personal standing in the community.

The Greek word, semnotes, occurs only three times in the whole Christian scriptures and it's best translated, most people would say, by the word seriousness. 

Aquinas uses dignita s and its cognate, 185 times in the Summa Theologiae, and I read them all, and it tends to mean the value that something has proper to its place in the great chain of being.  So plants have more dignity than rocks and angels have more dignity than human beings, sort of the way he uses it.

In a nutshell, while Christians may always have had some concept of human dignity, until very recently, it "had not been developed into either a clearly defined literary form or an internally consistent set of ideas."

Now Aristotle uses semnotes only three times and not at all in the Nichomachean Ethics.  In the Eudemian Ethics, he defines dignity as a virtue, the mean between servility and unaccommodatingness.  That's sort of hardly the way we tend to use the word today.

Roman stoics, particularly Cicero and Senecca made copious use of the word.  Recent translators would note that for the Romans, the Latin word literally meant worthiness.  And in its common political sense it meant a person's reputation or standing.

It's the Renaissance writer, Pico della Mirandola, who's credited with making the first connection between human freedom and dignity.  By contrast, Hobbes tied dignity to power.  He wrote that "the value or worth of a man is, as of all other things, his price; that is to say so much as he would be given for the use of his power."

In turn, Hobbes offered this definition of dignity:  "the public worth of a man which is the value set on him by the commonwealth is that which men commonly call dignity."

Now although he never cites him, Kant's notion of dignity seems to be a response to Hobbes.  Kant writes, "the respect I bear others or which another can claim from me, is the acknowledgement of the dignity of another man, that is, a worth which has no price, no equivalent for which the object of evaluation could be exchanged.  He insists elsewhere, "humanity itself is a dignity."

Now the Kantian notion probably has a more familiar ring in the 21st century, but it's another long story and if you want, I can go into more detail on that in the questions.  I can trace how the Kantian idea of dignity was married to the notion of human beings having been created in the image and the likeness of God by a Kantian theologian in the 19th century named Antonio Rosmini, and it subsequently made its word into Catholic theology and was first explicitly used in the encyclical Rerum Novarum in which Leo XIII defended the dignity of workers in the 19th century.

Before that, you have almost no Catholic Christian use of dignity the way it's used today.  And thus, it's actually by a retrospective baptism of a Kantian idea that dignity became the important word it is in, particularly Catholic, but other forms of Christian thought today.  Very late.

Now given the history I've just very sketchily outlined, it's clear and from Adam's paper as well, that many people have historically used the word dignity to mean different things.  And I want to suggest for you, and this may be helpful to the Council's work, a convenient way to classify those uses.  And the way I'll do it and it's a development from the paper I gave you, is to distinguish between attributed, intrinsic and derivative conceptions of dignity.

By attributed dignity, I mean the worth or value that human beings confer on others by acts of attribution.  The act of conferring this worth or value may be accomplished individually or communally, but it always involves some choice.  Attributed dignity is, in a sense, created.  It constitutes a conventional form of value and thus we attribute worth or value to those we consider "dignitaries," to those who carry themselves in a particular way or have certain talents, skills or powers.  We even attribute worth or value to ourselves, sometimes, using the word this way.  The Hobbesian notion, I will suggest to you, is an attributed notion of dignity. 

By intrinsic dignity, I mean the worth or value that people have simply because they are human.  Not by virtue of any social standing, ability to evoke admiration or any particular sets of talents, skills or powers.  Intrinsic value is the value something has by virtue of being the kind of thing that it is.  Intrinsic dignity is the value that humans have by virtue of the fact that they are human beings.  This value is thus not conferred or created by human choices, individual or collective, but prior to attribution.  So Kant's notion of dignity would be an intrinsic notion.

By derivative dignity, I mean the way some people use the word to describe how a process or state of affairs is congruent with the intrinsic dignity of a human being.  Thus, dignity is sometimes used to refer to a virtue, a state of affairs in which a human being habitually acts in a way that expresses the intrinsic value of the human.  This use of the word is not purely attributed, since it depends upon some conception of the human that's prior to it.  Nonetheless, the value itself to which this word refers is not intrinsic, since it's dependent upon this intrinsic value of the human.

Aristotle's use of the word is derivative and I think so are a lot of stoic uses of the word derivative.

Now these conceptions of dignity are by no means mutually exclusive.  Attributed, intrinsic and derivative conceptions of dignity are often at play in the same situation and yet each has been taken as the central focus for particular claims in bioethics.

So next I want to sketch out an argument that to be consistent in our use of moral words, to do the kind of moral work that somebody like Dworkin wants the word dignity to do, to make good use of the word in bioethics, that the notion of intrinsic dignity is the foundational notion.

And so the first argument is simple in its form.  It's to say that consistency is at least a necessary condition of an argument, even if we wouldn't — we would quickly add that it's not sufficient.  And in discussions about its fundamental moral meaning, then the word dignity can either be defined as the value or a worth or worth that a human being has either in terms of some property or in terms of simply being human.

I want to show that defining the fundamental moral meaning of dignity is the value that human beings have by virtue of their possession of some particular candidate property, leads us quickly to inconsistencies in our universally shared and settled moral positions.

Therefore, I think we'll be led to the alternative, that dignity is in its fundamental moral sense defined simply in terms of being human.  Now, of course, this kind of argument depends on the exhaustiveness of the list of candidate properties, but at least it puts the burden of proof on those who oppose assigning priority to the intrinsic sense to come up with the alternative property.  And if it's not one on my list, you may say well, age or size or IQ, whatever other property you want to give, to define the fundamental worth or value of a human being.

So what sorts of candidate properties have been proposed?  Well, some have argued that human dignity in its most fundamental moral sense depends upon the amount of pleasure or pain we have in our life.  And certainly, however, though I think again very quickly here, most of us can tell stories of extraordinary lessons in dignity that we've learned from persons whose lives have been racked by pain and most of us also know very undignified human beings who have spent their whole lives in pursuit of pleasure. 

Merely basing our moral stand squarely on a balance between pleasure and pain is seen, at least since the time of Aristotle, as a fairly anemic account of morality and human dignity and one that most persons would reject.

Second, some people might think that Hobbes was right, that human dignity depends upon one's social worth.  But there are problems with such a conception of dignity:  the unemployed, the severely handicapped, the mentally ill and all others who can't contribute to the economic well-being of society and are cared for by physicians would then have no dignity.  Yet, our society, I think, has gone to great lengths to recognize the dignity of such persons.             If we didn't believe that human dignity remains even if people are handicapped and have lost their economic value to society, we wouldn't be making handicapped access ramps for them.

Third, some people might think that dignity depends upon freedom, but again, I think this is a hard view to take consistently.  You'd have to hold that those who have lost control of certain human functions or have lost or who have never had the freedom to make choices have lost or never had dignity.  And this would mean that, for instance, infants, the retarded, the severely mentally ill, prisons, the comatose, perhaps even the sleeping, would have no dignity and I think that would be wrong.

Now some might suggest that what counts is the capacity for control and freedom, not the exercise, the active exercise of it.  One might suggest that some individuals without full control and freedom, nevertheless deserve to be treated with dignity, either because they have a potential for such a capacity so that, for instance, children come to be regarded as placeholders for actual bearers of dignity or they have a history of having exercised such a capacity, so that the demented come to be regarded as remnants of those who bear dignity.

But I think those arguments are quite tenuous too.  You might recognize where they come from.  But who would feel dignified and secure being named a placeholder or a remnant?

Further, these arguments still can't answer why those who never could or never will make free, rational choices, such as the severely mentally retarded, are worthy of our respect?  The fundamental meaning of human dignity, I think is not found simply in our freedom and control.

And the famous photograph of the Reverend Dr. Martin Luther King, sitting in the Alabama prison cell, I think is a portrait of what it means to have human dignity radiantly depicted, despite lost freedom and lost control.  Prison bars and the attitudes of others didn't erase his dignity.

Fourth, some people might suggest that human dignity is something that individuals are free to choose to define as they wish, according to their own inner lights, but of course, that's the ultimate conversation stopper.  You know, you can't impose your view of human dignity on me.  But this also leads to inconsistencies. 

First, I think the concept of a moral term implies that it has universal meaning.  That's a position acknowledged by both Kant and utilitarians like Hare.  Second, it means making it an objective argument that morality is subjective which is internally self-contradictory.  And third, to say that human dignity is subjective is to claim that one person can never reliably recognize the dignity of another person because I can never know exactly what any of you think human dignity means until you've told me what it means.  But I think we all recognize dignity or value in each other before any of us opens our mouths.  And so I think human dignity can't be a purely subjective notion.

Thus, all the argument from consistency would claim is that a fundamental human dignity must therefore be something that we have simply because we're human.  It's a notion that drove the civil rights movement in this country. It's the notion that Martin Luther King said he learned from his grandmother who told him this is what dignity means, Martin, don't let anybody ever tell you you're not a somebody, that being somebody, not the properties one has, not the color of one's skin or being free to do what you'd like, is what gives you dignity, because you are a somebody, a human being. 

And that's the foundation — and if that's the foundation of the notion of dignity in the civil rights movement, the argument from consistency says that's what it ought to mean in bioethics.

Now very briefly again, I'm conscious of the time here, I just want to outline another way that was more developed in the paper that we can arrive at a similar conclusion, an argument that depends on the theory of value or axiology.

Classically, people distinguish between intrinsic and instrumental values, but I think instrumental values are really a subclass of attributed values.  So the primary distinction I want to draw is between intrinsic values and attributed. Intrinsic value is the value something has of itself, the value it has by virtue of being the kind of thing that it is.   It's valuable, independent of any values, purposes, beliefs, interests or expectations.  Truly intrinsic values, according to the environmental ethicist, Holmes Rolston, are objectively there, discovered and not created by the valuer.

By contrast, attributed values are conveyed by a valuer.  Attributable values depend completely upon the purposes, beliefs, desires, interests or expectations of a valuer or group of valuers.  An instrumental value, for example, is one that is attributed to some entity because it serves a purpose for the valuer.  The instrumental value of the entity consists in its serving as a means by which the valuer achieves some purpose.  But there can also be noninstrumental attributed values as well, like the value of humor, which doesn't necessarily serve any clear instrumental purpose.

So the next step in my argument would be to say that if there are intrinsic values in the world, then the recognition of the intrinsic value depends upon one's ability to discern what kind of a thing it is.  And this brings me to the notion of natural kinds.  This is a relatively new concept in analytic philosophy, but I'll just say this, there's more of it in the paper.  But the fundamental idea behind natural kinds is that to pick something out from the rest of the universe, you have to pick it out as a something.  And this leads to what proponents have called a modest essentialism, that the essence of something is that by which one picks it out from the rest of reality as anything at all, as a member of a kind.

And the alternative seems inconceivable, that reality is really just completely undifferentiated, that human beings carve up the amorphous stuff of the universe for their own purposes.  It seems to me bizarre to suggest that there really are no actual kinds of things in the world independent of human classification, that there really aren't such things as stars or slugs or human beings.

And thus, the intrinsic value of a natural entity, the value it has by virtue of being the kind of thing that it is, depends upon one's ability to pick that individual out as a member of a natural kind.

And so I define intrinsic dignity with a capital D, as the intrinsic value of entities that are members of a natural kind that is as a kind capable of language, rationality, love, free will, moral agency, creativity and aesthetic sensibility.  This definition is actually decidedly anti-speciesist, because if there other kinds of entities in the universe besides human beings that have as a kind these capacities, they would also have dignity in an intrinsic sense.

Intrinsic dignity, as Dworkin suggests, is the foundation of our concepts of rights.  We respect rights because we first recognize intrinsic dignity.  We don't bestow dignity with a capital D in this intrinsic sense to the extent that we bestow rights.  Human beings have rights have must be respected because of the value they have by virtue of being the kinds of things that they are. 

Now importantly, the logic of natural kinds suggests that one picks out individuals as members of the kind, not because they express all the necessary and sufficient predicates to be classified as a member of the species, but by virtue of their inclusion under the extension of the natural kin, that as a kind has those properties.

The logic of natural kinds is not set theory.  For instance, very few bananas in the bin in the supermarket, right, express all the necessary and sufficient conditions for being classified as fruits of the species musa sapientum.  We define a banana, let's say, as a yellow fruit.  And you go to the bin and what do they look like?  Well, some are green, some are brown, some are spotted and some are yellow.  Nonetheless, they're all bananas and we pick them out as that. 

Well, healthcare depends profoundly upon this same kind of logic.  It's not, for instance, the expression of rationality that makes us human, but our belonging to a kind that is capable of rationality. 

When a human being is comatose, or mentally ill, we first pick the individual out as a human being.  Then diagnostically, right, we note the disparity between the characteristics of the afflicted individual and the paradigmatic features in typical development in the history of members of the human natural kind.  That's how we come to the judgment that the individual is sick.

And because that individual is a member of the human natural kind, we also recognize in that individual a value we call dignity.  In recognition of that worth, we have established the healing professions as our moral response to fellow humans suffering from injury and disease.  The plight of the sick will rarely serve the purposes, beliefs, desires, interests or expectations of any of us as individuals.  Rather, it's because of the intrinsic value of the sick, particularly those of us who are here who are healthcare professionals, have pledged that we will serve. 

And I would argue then that intrinsic human dignity is really in that sense the foundation of healthcare.  In a simple way, the bottom line is that every patient is a somebody and I think we lose our grip on that notion to our common peril.

That's the end of my brief, formal comments and I'll be happy to take questions.


CHAIRMAN PELLEGRINO:  Thank you very much, Dan.  Any indications of who would like to open the discussion?

DR. SCHAUB:  I've got a question about the intrinsic dignity you cited and also a question about the acquired dignities.

How do we know that something belongs to or is a member of a natural kind if it is not manifesting the species-typical capacities of that kind?  So human beings seem to be rather different from diamonds on this score, and in the paper you speak about diamonds, a stone that was soft and dull rather than hard and brilliant could not be a diamond.

But I take it that human beings may be human beings without speech and reason and still be human beings possessed of intrinsic dignity.  But it seems that we stray farther from the nature that is the ground of our dignity than other beings do and that raises some serious questions about particular classes of human beings.

The other question I had is about the attributed dignities and I'm not certain about this category.  As you explained it, these refer to non-intrinsic, but also non-instrumental values.  But if we say that somebody is behaving in an undignified manner, don't we mean that he's demeaning the highest aspects of his human nature, those very species' typical capacities that characterize our natural kind?  So we say it's undignified for an adult to behave like a child or like a dumb animal. 

Even a word like dignitary, it seems to me, which might seem to be more along the lines of a purely conventional usage, but even that word points to our nature as political beings and thus, to our capacities for speech and reason.

So these judgments are not egalitarian.  In fact, they're meritocratic or aristocratic.  Nonetheless, it seems to me that they are based on the same capacities that are said to be the source of humanity's intrinsic dignity.   So I wonder if these categories are somewhat closer together than you suggest and it seems to me it would be welcome to us if they were closer together because we've been struggling with these different understandings of dignity and the possible opposition between an egalitarian understanding and a more aristocratic understanding.

DR. SULMASY:  Terrific questions.  Thanks.  The first is sort of more the epistemology of how you tell a kind, right?  And it is, in some sense, a different kind of a logic than again saying sort of the necessary and sufficient conditions that one would have for membership within a class.

But we're pretty good at it as human beings.  I mean this question is put to me sort of what do I do?  Well, I walk out into the forest and I see a tree, right?  And I'm not stupid.  I walk another few feet and I see another tree.  And then I see a third tree and they all seem to have characteristics that put them together that are different from the other trees that I see around me.  And from those examples, those paradigmatic examples, I then am able to sort of say to what extent does this individual fall under that extension?

There are obviously going to be boundary categories within this, but another example would be, for instance, people have asked me well, is a hydatidiform mole not a human being, it's got the same genes, right?  But I would say that if you go to a standard textbook of medicine and go back to sort of Aristotelian sort of questions, there's been a substantial change.  That's another kind of — it's another substance.  It's another — it might have the same genes, but it's a different thing and not just a class, but a whole different thing.

Pediatricians will sometimes have this problem when they're looking at an individual, but I think they begin by saying this is an individual member of the human natural kind, not another species.  It depends on science, so we do a lot of scientific study that refines our understanding of the typical — of the natural history and typical features that are part of the kind.  But it is not in the end the immediate expression of all of those activities that allows us to make the judgment whether this is a member of the kind or not.

Second, your sets of questions about attributed and intrinsic dignity, I think, are very important.  And the paper you got, and I apologize for this.  I was hoping there would be proof pages of a chapter that's a later development of that in another book that's coming out and I gave it to Dan, at least the word draft of it, the manuscript draft.  So maybe the Council would want to see it.

I make — and I try to do this quickly here, because of these sorts of considerations which I think are real, a set of three distinctions between intrinsic, attributed and then what I've called derivative senses of dignity.  I think a lot of what you were talking about was in terms of derivative senses of the word, uses of the word dignity in which — and I think perhaps, for instance, going back reading the transcript, some of Jim Childress's talk last time was really talking about how, for instance, Dr. Kass, I think, often uses an attributed sense, the sort of derivative sense.  How well is this individual actually comporting, behaving in light of the kind of thing he or she is as a human being and the excellences that are part of what it means to be that kind of a thing?  And I think that in some sense is — may be a different class because it's not one hundred percent intrinsic in that ultimately the value goes back to what kind of a thing it is, but it's certainly not purely attributed either.

And then within the attributed class of values, remember that I'm talking about two classes of attributed values, instrumental and noninstrumental.  So I think there can be some non-instrumental, attributed values, sport, humor, things like that, and some that are purely instrumental and attributive.  And it's a long-winded answer and we could probably talk at greater length about it, but that's maybe at least for your benefit and I don't know if anybody else's, some further clarification.

CHAIRMAN PELLEGRINO:  I have Dresser, Kass, Lawler and Carson, in that order.

PROF. DRESSER:  So again, I am going to push some specifics.  I guess the first question is under your approach, all human beings have intrinsic dignity, but that doesn't mean that treating all human beings with dignity means exactly the same kind of treatment. So the next step for a physician or for us in bioethics thinking about what's right and wrong in terms of how we regard all these human beings with dignity, are there systematic ways of approaching that or is it just sort of casuistic?  How do you think about those issues?

DR. SULMASY:  Another good question.  I think that particularly in the setting of healthcare, I did a little of this in the paper, that there's no doubt that one of the things that illness and injury do is to assault our attributed sense of dignity.  There's no question about it.  People who are very sick and particularly the dying are robbed of their station in life.  They are — they lose control.  They appear differently to others and are valued differently by society.  All of these things happen to them and illness brings those things upon them.

But I think one of the fundamental questions is, is that all there is to their value?  Because I think medicine proceeds this way.  It says that because I recognize the intrinsic value of the person, then I have a duty to build up, to the extent that it's possible, the attributed values, the attributed dignity of that person to the extent I can.  That's largely what I do.

I think though that if that's the basis for it, then, in fact, a limit on what I can do is not do anything that would, in fact, eliminate or contradict the basis upon which I have decided I have a duty to do this.  And that would be anything that we would consider a violation of the intrinsic value of the person.  And so it's in my view that lots of our negative norms, don't sell yourself into slavery, do not kill, those kinds of negative norms, are associated with a recognition of the intrinsic value of the person and lots of our other kinds of duties of beneficence, if you will, are associated with the attributed dignities of the person and doing what we can when, particularly in health care, illness and injury raise questions, even for the person, about their value and certainly mount assaults that are palpable on their attributed sense of dignity.

PROF. DRESSER:  Would you have anything to say about so-called enhancement uses of medicine and how that relates to intrinsic dignity?

DR. SULMASY:  It is another interesting question.  I haven't fully developed that aspect of it yet, but I think that certainly this will have that kind of an impact.  Are there questions about what we're trying to do that change, if you will, the kind of thing that we are, what we're attempting to do and is that different from going after a beneficent duty to help the functioning, the flourishing of something as the kind of thing that it is?  But I haven't really fully developed that and I think it might be, though, a fruitful way of looking at some of those questions.

DR. KASS:  Thank you and thanks very much for the effort to try to clarify these things.

I'm going to try to follow where Diana Schaub went earlier.  I'm grateful that the new development of thought now has a category of things which are not simply attributed as, let us say, the human virtues might, in fact, be.  But it's not clear that the relation is best expressed in terms of intrinsic versus derivative.  Derivative, yes, in the sense that if there is no human life which is respected, the other things are not possible, but one might argue that — in fact, Alfonso gave us the text on this earlier, that in order of logic, it is actuality which precedes potentiality and if, as you say, the dignity of the human being has the species-typical capacity for language, rationality, love, free will, moral agency, creativity, etcetera, then it would seem that there would be greater dignity of an intrinsic sort once those capacities are, in fact, fully realized.  And that what we — and we might argue as to whether this particular instance is a realization or a perversion of those particular capacities, but I don't — I think that lots of human virtues, one could argue, are not stipulated, but in fact, discovered as is the awesomeness of the Grand Canyon and the like.

So I'm not sure that I'm — I think there is — I wouldn't sort of say intrinsic versus derivative, but I would say basic and full and then the question is what's the relation between these two things?  And that would be one point.

The second point is your argument is of a special value for the use to which you put it in the paper which is to say the assisted suicide and euthanasia question and whether one could ever act in the name of the intrinsic dignity of the human being by being the agent of its demise, no matter how merciful or worthy our intentions.

But there are lots of aspects of bioethics, certainly the Beyond Therapy Report which Rebecca was in a way alluding to, in which the question is not going into a business or out of business, but whether we are contributing to what Professor Churchland called earlier human flourishing or not, whether we are somehow adding to our worthiness as beings who realize those capacities or not.  And it seems to me that we need in bioethics, sort of both of these notions.

A third question then is how are they related?  And one would like to think that these are not simply the distinction between the preferences of aristocrats versus the preferences of egalitarians, but that there's some kind of deep relation between these two things and I wonder if — I'm winding up with an invitation for you to speculate on that particular point. 

And then second, to press you on the really hard thing at the end of the paper, to give the other concrete case, what happens at the end of a life when all of those capacities are lost?  And let's take the hard cases where it's hard to tell whether any of those capacities are still present.  This is certainly still the life that has lived such a life and still remains, at least bodily speaking, a member of that kind. 

You said it very nicely, I thought, in saying membership in a kind that has these.  And what happens when medicine, this great institution which is meant to — which rests finally, as you say, on the fundamental value of human dignity, seems in fact to be not only not doing any good, but continuing the abased condition, not merely socially abased, but the condition of a human being who is in all fundamental respects a kind of mockery of the human being that their life was.  I speak provocatively.

Couldn't one somehow say that medicine has produced a conundrum for which we don't — for which this insistence on the intrinsic dignity is — leads us to do great harm to the dignity which is the human being?


DR. SULMASY:  There are points at which the subparts of subparts of questions probably totalled up to about seven there, but let me try to answer some of them.


DR. KASS:  The paper is quite rich in that way.  It really spurs you on.

DR. SULMASY:  Well, thanks.  They are all great questions.

Yes, I think that the — I'm happy that I've developed the thought in advance of this and again, I've handed at least the manuscript version of the paper for you to take a look at.  I'm not sure that I want to quibble over the name, but I have recognized through the critiques — useful critiques of others, that attributed and intrinsic is simply too stark and that there had to be some other category that is, in fact, the instantiation, the development, the flourishing of the excellence of the kind of thing that it is, which depends, in part, on the intrinsic value.  If we wanted to come up with other names for that and derivative still sounds too small for you, I'd be open to that.  Because I think the important part is the question you're asking about what's the relationship between those.   

In terms of other uses of the work, I think I'm only beginning to look at some of those sorts of questions and I think you've spent yourself some more time looking at it in terms of therapy, enhancement, life extension and I think it will have a value there.  I just don't — at this point, know anything other than to say that attempts intentionally to change the kind of thing we are is probably a different category than enhancing or flourishing or abating or diminishment and that would have moral weight and we'd need to look more seriously at what that actually meant.

How are they related?  Well, once you, I think, accept the notion of the human being as a natural kind, then we have and there's a very good book on this by a man named Anthony Lisska who talks about dispositional predicates, the sense that we have, as a kind, dispositions.  Part of that is to grow and develop through certain stages of physical development, but they are also our capacities for moral choice, aesthetic experience, etcetera and that, in fact, our flourishing as those kinds, may in fact, in some schools be the point of ethics.  Right, that we sort of move to flourish as the kinds of things that we are.

And so I think that yes, it's the sort of sense that there's a bedrock grounding, if you will, in the intrinsic value that we have by being members of the kind, but being members of the kind means that there is the possibility of flourishing as a member of that kind.  Philippa Foot, for instance, talks about the word "good" being not a predicative kind of adjective, but one that makes us need to take into account in some way the kind of thing it is.

So if we talk about an example I sometimes use, a good bottle of wine, right, well, that can depend.  I say sometimes that's a good bottle of wine for wine from Long Island, right?


But there's a sense that to say the word "good" we have to have some notion of what kind of thing it is and what is excellence for that kind and what's the flourishing of that kind.

To go to your sort of example of the person who has lost all the capacities, one of the features of the human as a natural kind as any other biological natural kind is its finitude.  And I think that also human arts, like medicine, have to recognize their own finitude as well.  And so that when we come to the point where an individual has lost as many of those capacities as we would care to imagine, I think that in recognition of what kind of thing it is that we do not have an obligation, this is not a vitalist's view, I don't — we don't have an obligation to do everything that would be possible to sustain that life in that stage, but I do think that our recognition of the intrinsic value does put a negative norm in place that says we can't take an action in which we would snuff out that life because that would be again contradictory to the very basis that I think from which we start our whole ethical system.  

So yes, there's a lot more to be done here.  These are beginnings, these are a couple of papers where I'm moving in this direction, but I thank you for your questions because I think they're right in the same realm that I'm trying to think about.


DR. LAWLER:  Again, thanks so much for the great presentation.

This category of natural kind seems to mean something we can see with our own eyes that we didn't make ourselves.  Right?  But the word natural has a certain ambivalence to it because I want to think natural in the sense of human nature, biological nature.  But Kant identified this natural kind human being that we can see with our own eyes, but it's not natural in the sense that we have dignity and insofar as we transcend nature.

But that actually doesn't seem to be your view.  Your view seems to be we have intrinsic dignity because of capabilities we've been given by nature.  So you seem more of a Thomist than a Kantian.  That's good.


Now in light of our first presentation this morning, you might have to answer this sort of question, does your understanding of the intrinsic dignity of the human being require a natural science different from the natural science of the neuroscientists or the natural science of the evolutionary biologists or the sociobiologists. 

And one other comment that has nothing to do with that first one, I apologize for shifting.  I do think Leon and Diana are right that you probably should have intrinsic dignity one, and intrinsic dignity two or something.   You have this intrinsic dignity that comes from these natural capabilities we've been given, but it also has to be intrinsic dignity in the exercise of those capabilities in a virtuous way.

And I would add a little bit contrary to them, it's not just excellence, really, because I'm not sure there is — you don't say "he dunked the basketball in a dignified way." That's surely excellence, right.  Or "he buried three holes in a row in a dignified way" or something like that.

Dignity would be the exercise of virtue that's not necessarily even a human perfection, but living well with adversity, living well with finitude, living well with responsibilities given to members of our species and any other species like ours on some other planet, I don't care about that.

All right, so the connection of identification of dignity with excellence in terms of intrinsic dignity two seems to me to be wrong, but I can't correct it in exactly the right way.

I think you have to distinguish between excellence one and excellence two.


DR. SULMASY:  Let me take the first part.  Yes, I think this is not something that comes in opposition to evolution, for instance.  Natural kinds evolve.  Biological natural kinds evolve.  And so I have no objection to the incorporation of evolution into my conception of the human natural kind.

And human natural kinds have brains and all the science that we do and split brain experiments that I learned about as a Cornell medical student, I mean they're all wonderful things to do.  We are capable of doing those things as a kind; as a kind that can understand itself and other parts of nature well, so there's no sort of opposition to the science.  It's simply maybe a suggestion that the science itself doesn't give us our ethics.

And yes, I'll take the criticism that derivative, again, may not be as robust a term to capture the sort of sense of living well as I would have intended it.  It sounds probably a little more pejorative and I'll try to think of another word and I'm open to suggestions as well.


DR. CARSON: Dan, thank you for that.  That was wonderful and it's good to have you here.  And Leon already asked my difficult question, so I have an easy one for you.

Are value and dignity relative or absolute?  And let me put that in context.  If you have a diamond, let's say you have the Hope diamond on the one hand and you have an apple on the other hand, most people wouldn't have any trouble attributing the appropriate value.  However, if you were the only person in the world, which would then be most valuable, because the diamond really has no intrinsic value, but the apple at least you can eat. 

DR. SULMASY:  I think that there are, in fact, out of this sense of intrinsic value of things, particularly when we get to human interactions that we could generate some things that I think are moral absolutes.

I do think though that there's a sense in which other things in the world have value independent of me.  The existence of stars, that stars have value other than the fact that I give it to them or other people have given it to them or that we all together give it to them, but they have an intrinsic value as does a diamond or an apple. 

But there's also something of a hierarchy of these things and so for a human being I can use an apple for its instrumental value and in the condition of just being hungry, an apple has instrumental value for me and I can eat that without denying its intrinsic value.  I think when we get to the level of the human which has the intrinsic value that we call dignity, that that gives a norm which is qualitatively different in terms of how we respect the intrinsic value of the human. 

And again, I would add how I would treat the intrinsic value of an extraterrestrial that I met that had all these capabilities as a kind.  If there were — if we discover some day martians who have language and love and aesthetic sensibility and reason, I think it would be wrong ever to, for instance, end the life of such a creature.

DR. ROWLEY:  Dr. Rowley?

DR. ROWLEY:  This is an area in which I'm not even quite an amateur, but I was interested in your explanations in the beginning of the evolution of the context or the implications of the word dignity and how individuals through time and societies have viewed it differently.

So I assume that you would be accepting of the fact that we are still in the process of evolution, at least some aspects of our understanding of dignity, and that as we understand more about neuroscience, our notions of what may be either functions that allow dignity or enhance dignity are going to be far — have far greater understanding of the influence of these neurosystems on — at least some aspect of dignity and I don't want to get into whether it's going to be derivative dignity or intrinsic.

But so (a) it seems to me dignity is still an evolving concept.  Second, to the extent that you use the word flourishing, does society, and this is the same question I asked Pat, does society have a responsibility to see that every human being in the society is allowed to flourish and what are the political and social and legal implications and ethical implications if we do, as a society, have an obligation to see that every human being flourishes?

DR. SULMASY:  Again, all great questions.  I'm grateful for those as well.  Yes, the uses of the word have changed over time.  I'm not sure in reading it myself and I don't know if Professor Schulman would agree with this or not, but I'm not sure it's always simply been an evolution.  I think people have used it in different ways in different philosophical systems, and so all I was trying to do was to give an array of some of the ways in which that's been done and to try to classify some of those uses in a way that might be helpful to understanding different ways in which the word has been used that might particularly have use in bioethics.  Because I think all those different conceptions have occurred historically and all those different conceptions occur today.  For instance, in the assisted suicide debate, the bill that legalizes it in Oregon as the Death With Dignity Act, the reason people oppose it is they say it's an affront to human dignity.  My view is they're using it in intrinsic and attributed senses and that's part of how we can understand why there's a clash there.

And will increasing knowledge help us?  Yes.  I think, I'm less sanguine that our knowledge of neural networks will help us than I am with good, philosophical analysis, but I think that we can take the knowledge that we get from the sciences and the physical sciences, biological sciences and the human sciences and continue to work on our conceptions of this.

Second, in terms of human flourishing in society, we are as a kind social, inherently social. and the most — the deepest sort of sense of the common good we could have I think is one in which the flourishing of the whole, in part, instantiates my flourishing in a very rich, deep sense of our common good.  And yes, I think that these ideas feed very much into political philosophy and there are people who are doing serious work in this.  There's a guy named Rasmussen who's working on this in political philosophy.  Thomas Hurka's book on perfectionism, is a philosopher who is working on this conception of natural kinds and perfectionism in terms of political philosophy.  There's a guy named Steven Wall who is doing work on it in terms of political philosophy as well.

So yes, I think that for human beings, for us to flourish, as the kinds of things that we are, being as we are a social kind, that our flourishing has to be within a society.


PROF. MEILAENDER:  I also want to thank you very much for a very stimulating response to our invitation.

I want to return to the questions that Diana and Leon were raising, although maybe a tug in a slightly different direction which will not come completely as a surprise to everyone.  And whether I'm really going to make sense or not, I'm not sure, but let me just try.

Very nice, and I think on the whole it works very well, the argument worked out in which intrinsic dignity is really a characteristic of the kind of thing that human beings are.  You pick out that kind by pointing to certain kinds of capacities that are characteristic of the species, but the dignity is ascribed to members of the kind.  But then you've developed the derivative language to try to deal with the fact that it's sort of troubling and gets us into some hard questions that some individual members of the kind seem to display those typical characteristics much more fully than others.  I think I've got the problem right.

Interestingly, you turn to the word derivative to do that.  Leon, in kind of trying to think aloud about what didn't seem to work for him about that, floated basic versus full, which of course, turns — you begin with the kind and derive something from that.  He's got something different going and if we add the word humanity, we've got basic versus full humanity and I suspect maybe that's a formulation you're not quite happy with.

Now I want to try to just shove you in a certain direction that you might not want to go and that maybe you shouldn't go, actually.  I'm actually not sure in my own mind about this, but I just want to think about it because you want to sort this out as an entirely philosophical theory and if that could really work I'd be tickled to death.  But I'm not sure about it.

And Kierkegaard has a really nice little story at one point about two painters and the one painter says, he's a great artist and he's such a great practitioner of his art that he's traveled all over the world, but he's never found a human face so lovely that really seemed worthy of his art.  He's never painted it.  And the other painter says well, you know, I just stay right where I am and Kierkegaard says maybe because he brings a certain something with him, he's never found a face that wasn't worth painting because he carried a certain something along with him. 

Now what I'm wondering is whether the decision whether we should kind of start with intrinsic and then work out some kind of derivative language or whether it's basic and full, whether that's something that can be entirely settled on the basis of the kind of arguments that you're making, which are very nice.  Or whether, you know, you've got to bring a certain something with you.  You're either going to see that full dignity in every human being whether or not they display those species-typical characteristics, or you're going to think that although there's a certain kind of basic humanity there that we have to honor, nevertheless, it wouldn't be a face quite worth painting sort of.

And I'm not sure that that's settled by a set of arguments so much as it is by something you carry along with you and I've left it as vague as Kirkegaard leaves it.  I don't know, if that makes any sense at all to you, I'd be interested in hearing your comment on it.

DR. SULMASY:  No, I can see where you're going with it and I think it would be interesting to probe further.  I guess the derivative language and the — neither the derivative nor the basic and full is sort of satisfactory to me and partly the basic/full I think from some of the reasons you gave.  It may be that this sort of — it has to do with the sort of flowering, the flourishing of the individual as the kind of thing that it is, recognizing also though our — frankly within this that our finitude that I talked about further is tri-fold.  It's not simply physical finitude that characterizes individual members of the human natural kind, but we're also and we have to recognize this always, finite intellectually, we make mistakes, and we're finite morally.  We fail to see some of those things, like seeing the value that's there in the individual.

It becomes another question whether philosophy alone will be able to always get you to be able to see that or see it in a better light or whether one needs the something other that you're suggesting and I'll probably leave the question back there again where you left it.  But I think it's a different way of framing within my structure some of your questions which I think are important.


DR. HURLBUT:  I don't know quite where to go after that question.


I mean I actually would like to ask you this question, but I'm not going to.  I'd like to ask you to distinguish between dispositional predicates, character and properties which I think there's a sense in which they blend upwards into your — but I won't ask you that.

Instead, what I want to ask you about is I want to return to the comment that Mike Gazzaniga made at the end of the previous session where he said that there is —if I understood it right, Mike, you said basically that our moral sense or our personal dignity were irrelevant categories if you were the last and only person left on the earth.

Could you maybe rephrase that or did I get that okay?

I immediately feel uneasy about a statement like that and because I think to myself there are moral categories that relate to human dignity that are just somehow inside my being that even if I were the only person or even if I did something that no one every saw, that I could do acts of self degradation or I could do acts of degradation against the backdrop of the cosmos that would, in fact, both vitiate my nature and do violence against the larger order of things.

So I just wanted to in the larger context of your presentation, let me ask you to reflect on that a little bit and specifically, as I was reading your paper I was thinking this category of dignity with a capital D that you apply only to human beings, as far as I could sense, I was thinking about it.  Is there another category we could apply that to and it's a bit of a leap, but to the cosmic whole itself? 

It's funny because we all know that we are what we are within a relationship to the whole and there seems to be something about the whole that while it doesn't in any way erode the individual human being, not more than just the context of dignity, but as an intrinsic quality of goodness.  And in doing so, you might reflect a little bit on this category I mentioned of self-degradation and the relationship to suffering.

DR. SULMASY:  The last part came out, there's suffering too.  That's a third part.

DR. HURLBUT:  Yes, the internal.

DR. SULMASY:  But let me try to take some of these questions.   The first part, yes.  I would disagree with Dr. Gazzaniga's view that ethical terms and categories only arise intersubjectively and are intersubjective constructions and if there were only one person left on the earth, I still think that person would have moral responsibilities, duties and among those would be self-regarding acts.  So the question of suicide would arise.  The question of how I do treat the rest of the physical universe does arise and I think those are moral questions.

There's no doubt that such a person living alone would have by virtue of the physical conditions there flourishing as a human being impaired because there's no one else around.  But it doesn't mean that all morality would cease under that circumstance or that that person wouldn't have intrinsic dignity and have duties regarding that.

Regarding the value of the cosmos as a whole, that's actually where I got this idea to begin with.  I mean sometimes, I edit Theoretical Medicine and Bioethics and one of the problems I find with a lot of the discourse in bioethics is that a lot of it has become so political that people aren't reading any philosophy at all and that it's valuable to read fairly broadly.  So I got the idea from Holmes Rolston III who is an environmental ethicist who is trying to argue about why we do have duties towards things other than human beings and things do have value other than our uses for them.  And so yes, I do believe that other things have intrinsic value.

But I do think that that's not completely homogenous, that there's a scale to that value as well and that any kind that would be capable of the kinds of things that human beings are capable of as a kind, would have this kind of intrinsic value that I'm labeling dignity with a capital D.

As I've said, that would include extraterrestrials, if we found them, that had that.  Those kinds of things.

Now, the question of the relationship of these — this conception to suffering.  Yes, I think that's a very important part of this whole — of medical ethics, of philosophy of medicine and actually of natural kinds as well.  And I have a very — again, a pretty different take on what suffering means than has been in a lot of the literature as well, and related to the idea of natural kinds.  I was saying before, in response to Professor Meilaender, that  in fact, our finitude is at least tri-fold, right, that we are finite physically, finite intellectually, and finite morally.  And it's the apprehension of our finitude that I think is the substrate of our suffering.

So pain hurts, right, but the pain of arthritis does not really become suffering until the person can't open the jar, right?  It's the sort of sense of recognizing their limits.  And in its own little way, when I hit 45 and I had to get my reading glasses for the first time, that, in some ways, reminds me of my finitude.  There's a way in which every wave of nausea, every drop of blood that a patient experiences in some ways reminds them of their ultimate finitude, causes them, in fact, to come to grips with the fact that they can't do the things they used to be able to do as agents in the world and that that's an occasion of suffering for them.

But likewise, there are lots of other occasions of suffering that are caused by our moral finitude and our intellectual finitude.  So I think it relates to the idea of natural kinds as well.


DR. HURLBUT:  Holmes Rolston, his central theme, as far as I read him is that the cosmic whole that has an intrinsic dignity also has an in-built incompleteness or imperfection that calls forth from its higher order of beings a kind of willingness to enter into what he calls Kenosis, a self-emptying, a self-giving, a self-donation, a kind of willingness to participate in suffering for the sake of the whole.

Is that consistent with what —

DR. SULMASY:  Yes.  I think there might be a sense of stewardship, right, that we could say is part of our responsibility, being the kind of things that we are that can recognize the value of the cosmos.

CHAIRMAN PELLEGRINO:  George, McHugh and Alfonso.

PROF. GEORGE:  Dan, I really admired the rigor and precision that you brought to discussion of a difficult ethical concept.  You must have had a good teacher.


DR. SULMASY:  Several of them.


PROF. GEORGE:  Yes.  At the last meeting, when we were discussing Dr. Schulman's excellent introductory paper, I advanced the argument that whatever is to be said about the concept of human dignity, we have a national commitment in the United States to a certain conception of human dignity and that national commitment is expressed in the great self-evident truth as it labels itself of the Declaration of Independence.

I think that's really quite a radical, an amazing proposition, because among its implications, is the idea that as between magnificent exemplars of humanity, the brilliant Albert Einstein; the athletically magnificent Michael Jordan, on the one hand, and let's say a severely debilitated, retarded person on the other hand, there is a profound equality that despite the manifest inequalities of intelligence, strength, ability — there is at the most fundamental level an equality such that we would, if we're true to our national commitment, never entertain the thought that we would be justified in taking the life, even of a severely retarded person, severely debilitated person to harvest organs, heart or liver, to save the life of a magnificent human being like Albert Einstein or Michael Jordan, we just wouldn't go there, we just wouldn't do that.

And so I ask, is that commitment to that particular conception, that radical conception of human equality and dignity, with its implications, a noble myth, something we're committed to because of the social consequences of adopting any alternative view, living in a world where we would countenance such a thing as taking one life to spare others or save others?

Is it a noble myth or is it what it claims it is on its own terms, as expressed in the Declaration.  And that is a truth.  Is it really true that that severely retarded, debilitated person is the equal at the most fundamental level, in dignity, of Michael Jordan and Albert Einstein?

DR. SULMASY:  I think if you take the implications of my paper seriously, the answer is yes, that that is actually true.  Whether we behave in a manner consistent with that is obviously another matter.

The real ethics and that ends up with the sort of "as if" constructions of morality, you know — let's pretend this noble myth, as you say it was true, because that's the best way we can solve it, — in the end, I think, becomes a very dangerous way to construct a moral universe in a society.  Let's make believe this is true, even though, wink-wink, we all know actually what isn't, that we've just all made it up.

And so I believe that this is part of what Kant did, was to democratize this concept of dignity, to make it something that is inalienable, that doesn't admit of degrees, and that this is, in my theory, true.

Another quote that's appropriate here is Simone Weil says that what's most important in a human being is the impersonal in him, which, of course, comes as a shock to most Americans when we begin to think about a quote like that.

But I think it's to the point of what you're suggesting.  It's not what makes us unique and individualistic, but what we most fundamentally have in common, that we are members of the same natural kind, that is the fundamental basis of dignity and I believe the fundamental bedrock of a moral system.


DR. MCHUGH:  I too, Dan, enjoyed your talk very much.  I do feel that I'm scrambling to keep up with you in these abstract realms in this world.

And I want to follow along a little bit, I think, with what Gil Meilaender was asking you and you and me, back where we really belong.  We're in the process of trying to turn medical students into doctors.  A difficult task, but a wonderful one.  And it's a process in which we're trying to form their character, as well as enhance their knowledge.

This is a bit of a prologue to my question and in that process, I discovered — I was taught really, by a great surgeon, how to think about disorders and illnesses, the blemishes on those bananas.  And he taught me, and he changed surgery in that direction that we should be thinking of disorders differently than it seemed that was being taught in medical schools before, that diseases weren't entities, but they were human life under altered circumstances, altered physical circumstances, altered social circumstances, altered environmental circumstances and our job was to try to fit that — those circumstances better so that their life could flourish.

The reason this was such a telling idea that I got from Francis Moore was that it then made it clear to me, one, why I should be very, very interested in studying the sciences that were emerging around — I mean work like Janet Rowley's work comes to life when gee, I've got to understand what Janet is doing because she's showing us in what way life changes with these interesting genetic and molecular changes that make sense of the disease now, as a process; and makes sense also about our growing capacity to control it.

It did that on the one hand, and on the other hand, it also told me, gee, you know, I was supposed to be going to try to benefit that life by putting those circumstances back together.  But that's the background to it.  So it had a very practical function in developing this idea, again, which Pat Churchland talked about, namely demonstrating processes and thinking that would make us more effective, having the more power of character and relating to what doctors relate to, namely, the individual in that situation.    

So, with all of that, I want to know whether you see similar practical advantages, in the character formation of the young doctors that you're teaching and try to bring along, by asking them to think of this idea of natural kinds, rather than individuals living a life in which disease and disorder has altered their process and the like.

Does it have — you mentioned there were negative things that it got you to do.  Are there positive things that you'd say now doctors should really learn how to do this and think about this so that they will encounter their patient in the way the patient really believes benefit is built which is, you know, which is a linkage between two people, people who are themselves expecting things from each other?

This is a Council on Bioethics.  This is a test as to whether bioethics does us any damn good or not and hence my question ultimately, do we have more practical things to think because of what you're telling us rather than what Francis Moore said, think of disorder as life under altered circumstances?

DR. SULMASY:  I don't think those are incompatible notions at all.  I mean I may be approaching it from a philosophical point of view.  I haven't mentioned natural kinds once in a lecture I give to the medical students,


But well — it's because, no, no, because it obviously isn't going to work very well in that setting.     

I will, since you like stories, tell you from my own days as a Cornell medical student, of a time I was asked, as a sub-intern, to transfer a demented patient from the room the patient was in, to another room that had other demented patients in it.  And this was the third time within a week the patient had been transferred rooms because the resident wanted, under those circumstances, to just keep the demented people all hoarded together and keep them away from the other patients.

And when I objected, at this point, that this was an affront to, I thought, to that person's dignity, I was told that, one, what are you worried about?  She's got two neurons held together by a treponeme for a brain.  And I refused to do it, under those circumstances.  And doing that as a medical student, getting your letters of recommendation is not an easy thing to do.  It was on the belief which I already had at that point, that that person, as a human being had dignity and that my job, even as a student as I recognized it, was to care for the dignity of that individual.

And fortunately, in my stand, it had an effect.  The person actually thanked me later, said you're right.  I'm getting too cynical. I'm sorry about this, and I need to be aware of the dignity of patients.

So I think the concept of dignity is extraordinarily important and I define vulnerability (and people who are demented, for instance, are among the most vulnerable) as those whose dignity is at risk that it will not be recognized.

And I think students can understand that, and they have to be brought typically by example to understand that that individual that they're treating, whether they're demented, whether they're homeless, has dignity and that that's why they're serving them.  And if they need to be convinced by natural kinds, most of them are convinced more by the stories.


DR. GÓMEZ-LOBO:  I don't think I need to be convinced by natural kinds, but I do have a question about natural kinds and it's this, that when the whole idea was introduced and defended by someone like Kripke, etcetera,that there was his concentration on the molecular level, for instance, the quantification of water as a natural kind has to do with the fact that if something has a molecular structure of water then it is water.

Now the question is this, do you think there's any hope that we're going to be able to identify let's say a necessary and sufficient set of genes, genetic material for human beings?  Of course, this is terribly important for Bill Hurlbut and for all of us because of the altered nuclear transfer issue.

DR. SULMASY:  Yes.  First, I think that the development of natural kinds has gone a lot since Kripke, whereas somebody like Wiggins is the person that I think is, in Sameness and Substance, has really got the best sort of hold on this.  And even people in the area of bioethics, Baruch Brody had an early book on natural kinds as well before he started doing ethics.

And so I think it is something that's gone way past simply molecules at this point.

The question of whether or not there will be a necessary and sufficient set of genetic properties that will define the human genome, I say no.  And I think actually, you and I may have had a little bit of a conversation about this a few years ago, but I think that one of the best books on this topic of sort of genetic reductionism is Lenny Moss's What Genes Can't Do.  So if people haven't read it, it's a great book. It sort of says, as one person has put it, DNA didn't invent life.  Life invented DNA.  That it's probably better thought of as a part of an animal, as it is as the  — if you will — physical correlate of the soul.

I'll leave it there.  There's a much longer discussion.

CHAIRMAN PELLEGRINO:  Thank you very much, Dan, and thank you all for your comments.

We've stolen about 15 minutes.  Let's return at 2:15 for this afternoon's session, so lunch won't be curtailed.

(Whereupon, at 12:33 p.m., the meeting was recessed, to reconvene at 2:15 p.m.)


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