The Stupidity of Dignity

The report does not, the editors admit, settle the question of what dignity is or how it should guide our policies. It does, however, reveal a great deal about the approach to bioethics represented by the Council. And what it reveals should alarm anyone concerned with American biomedicine and its promise to improve human welfare. For this government-sponsored bioethics does not want medical practice to maximize health and flourishing; it considers that quest to be a bad thing, not a good thing.

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How did the United States, the world's scientific powerhouse, reach a point at which it grapples with the ethical challenges of twenty-first-century biomedicine using Bible stories, Catholic doctrine, and woolly rabbinical allegory?

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The bioethicist Ruth Macklin, who had been fed up with loose talk about dignity intended to squelch research and therapy, threw down the gauntlet in a 2003 editorial, "Dignity Is a Useless Concept." Macklin argued that bioethics has done just fine with the principle of personal autonomy--the idea that, because all humans have the same minimum capacity to suffer, prosper, reason, and choose, no human has the right to impinge on the life, body, or freedom of another. This is why informed consent serves as the bedrock of ethical research and practice, and it clearly rules out the kinds of abuses that led to the birth of bioethics in the first place, such as Mengele's sadistic pseudoexperiments in Nazi Germany and the withholding of treatment to indigent black patients in the infamous Tuskegee syphilis study. Once you recognize the principle of autonomy, Macklin argued, "dignity" adds nothing.

Highlighted by lampertina

The report does not, the editors admit, settle the question of what dignity is or how it should guide our policies. It does, however, reveal a great deal about the approach to bioethics represented by the Council. And what it reveals should alarm anyone concerned with American biomedicine and its promise to improve human welfare. For this government-sponsored bioethics does not want medical practice to maximize health and flourishing; it considers that quest to be a bad thing, not a good thing.

Highlighted by lampertina

The general feeling is that, even if a new technology would improve life and health and decrease suffering and waste, it might have to be rejected, or even outlawed, if it affronted human dignity.

Whatever that is. The problem is that "dignity" is a squishy, subjective notion, hardly up to the heavyweight moral demands assigned to it. The bioethicist Ruth Macklin, who had been fed up with loose talk about dignity intended to squelch research and therapy, threw down the gauntlet in a 2003 editorial, "Dignity Is a Useless Concept." Macklin argued that bioethics has done just fine with the principle of personal autonomy--the idea that, because all humans have the same minimum capacity to suffer, prosper, reason, and choose, no human has the right to impinge on the life, body, or freedom of another. This is why informed consent serves as the bedrock of ethical research and practice, and it clearly rules out the kinds of abuses that led to the birth of bioethics in the first place, such as Mengele's sadistic pseudoexperiments in Nazi Germany and the withholding of treatment to indigent black patients in the infamous Tuskegee syphilis study. Once you recognize the principle of autonomy, Macklin argued, "dignity" adds nothing.

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To understand the source of this topsy-turvy value system, one has to look more deeply at the currents that underlie the Council. Although the Dignity report presents itself as a scholarly deliberation of universal moral concerns, it springs from a movement to impose a radical political agenda, fed by fervent religious impulses, onto American biomedicine.

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Conspicuous by their absence are several fields of expertise that one might have thought would have something to offer any discussion of dignity and biomedicine. None of the contributors is a life scientist--or a psychologist, an anthropologist, a sociologist, or a historian. According to one of the introductory chapters, the Council takes a "critical view of contemporary academic bioethics and of the way bioethical questions are debated in the public square"--so critical, it seems, that Macklin (the villain of almost every piece) was not invited to expand on her argument, nor were mainstream bioethicists (who tend to be sympathetic to Macklin's viewpoint) given an opportunity to defend it.

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Despite these exclusions, the volume finds room for seven essays that align their arguments with Judeo-Christian doctrine. We read passages that assume the divine authorship of the Bible, that accept the literal truth of the miracles narrated in Genesis (such as the notion that the biblical patriarchs lived up to 900 years), that claim that divine revelation is a source of truth, that argue for the existence of an immaterial soul separate from the physiology of the brain, and that assert that the Old Testament is the only grounds for morality (for example, the article by Kass claims that respect for human life is rooted in Genesis 9:6, in which God instructs the survivors of his Flood in the code of vendetta: "Whoso sheddeth man's blood, by man shall his blood be shed, for in the image of God was man made").

The Judeo-Christian--in some cases, explicitly biblical--arguments found in essay after essay in this volume are quite extraordinary. Yet, aside from two paragraphs in a commentary by Daniel Dennett, the volume contains no critical examination of any of its religious claims.

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on 2008-05-18 by lampertina

OM(non-existant)G...

How did the United States, the world's scientific powerhouse, reach a point at which it grapples with the ethical challenges of twenty-first-century biomedicine using Bible stories, Catholic doctrine, and woolly rabbinical allegory?

Highlighted by lampertina

Kass has a problem not just with longevity and health but with the modern conception of freedom. There is a "mortal danger," he writes, in the notion "that a person has a right over his body, a right that allows him to do whatever he wants to do with it." He is troubled by cosmetic surgery, by gender reassignment, and by women who postpone motherhood or choose to remain single in their twenties.

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And, in 2001, this man, whose pro-death, anti-freedom views put him well outside the American mainstream, became the President's adviser on bioethics--a position from which he convinced the president to outlaw federally funded research that used new stem-cell lines.

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After several members opposed Kass on embryonic stem-cell research, on therapeutic cloning (which Kass was in favor of criminalizing), and on the distortions of science that kept finding their way into Council reports, Kass fired two of them (biologist Elizabeth Blackburn and philosopher William May) and replaced them with Christian-affiliated scholars.

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on 2008-05-18 by lampertina

Yikes...

For two decades, a group of intellectual activists, many of whom had jumped from the radical left to the radical right, has urged that we rethink the Enlightenment roots of the American social order. The recognition of a right to life, liberty, and the pursuit of happiness and the mandate of government to secure these rights are too tepid, they argue, for a morally worthy society. This impoverished vision has only led to anomie, hedonism, and rampant immoral behavior such as illegitimacy, pornography, and abortion. Society should aim higher than this bare-bones individualism and promote conformity to more rigorous moral standards, ones that could be applied to our behavior by an authority larger than ourselves.

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Most of today's denominations are not up to the task: Evangelical Protestantism is too anti-intellectual, and mainstream Protestantism and Judaism too humanistic. The Catholic Church, with its long tradition of scholarship and its rock-solid moral precepts, became the natural home for this movement, and the journal First Things, under the leadership of Father Richard John Neuhaus, its mouthpiece. Catholicism now provides the intellectual muscle behind a movement that embraces socially conservative Jewish and Protestant intellectuals as well.

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The Judeo-Christian--in some cases, explicitly biblical--arguments found in essay after essay in this volume are quite extraordinary. Yet, aside from two paragraphs in a commentary by Daniel Dennett, the volume contains no critical examination of any of its religious claims.

Highlighted by david_voelker

The concept of dignity is natural ground on which to build an obstructionist bioethics. An alleged breach of dignity provides a way for third parties to pass judgment on actions that are knowingly and willingly chosen by the affected individuals. It thus offers a moralistic justification for expanded government regulation of science, medicine, and private life.

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How did the United States, the world's scientific powerhouse, reach a point at which it grapples with the ethical challenges of twenty-first-century biomedicine using Bible stories, Catholic doctrine, and woolly rabbinical allegory?

Highlighted by david_voelker

spawns outright contradictions at every turn. We read that slavery and degradation are morally wrong because they take someone's dignity away. But we also read that nothing you can do to a person, including enslaving or degrading him, can take his dignity away. We read that dignity reflects excellence, striving, and conscience, so that only some people achieve it by dint of effort and character. We also read that everyone, no matter how lazy, evil, or mentally impaired, has dignity in full measure.

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But one hardly needs the notion of "dignity" to say why it's wrong to gas six million Jews or to send Russian dissidents to the gulag.

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on 2008-05-18 by lampertina

No bloody kidding.

the concept of dignity remains a mess

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First, dignity is relative.

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Second, dignity is fungible.

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every one of us voluntarily and repeatedly relinquishes dignity for other goods in life

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Kass has a problem not just with longevity and health but with the modern conception of freedom. There is a "mortal danger," he writes, in the notion "that a person has a right over his body, a right that allows him to do whatever he wants to do with it." He is troubled by cosmetic surgery, by gender reassignment, and by women who postpone motherhood or choose to remain single in their twenties. Sometimes his fixation on dignity takes him right off the deep end:

Worst of all from this point of view are those more uncivilized forms of eating, like licking an ice cream cone--a catlike activity that has been made acceptable in informal America but that still offends those who know eating in public is offensive. ... Eating on the street--even when undertaken, say, because one is between appointments and has no other time to eat--displays [a] lack of self-control: It beckons enslavement to the belly. ... Lacking utensils for cutting and lifting to mouth, he will often be seen using his teeth for tearing off chewable portions, just like any animal. ... This doglike feeding, if one must engage in it, ought to be kept from public view, where, even if we feel no shame, others are compelled to witness our shameful behavior.

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Third, dignity can be harmful.

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"Has anything good ever come from denying or constricting human dignity?" The answer is an emphatic "yes."

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A free society disempowers the state from enforcing a conception of dignity on its citizens.

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on 2008-05-18 by lampertina

Yes!

my country 'tis of thee, sweet land of liberty.

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So is dignity a useless concept? Almost. The word does have an identifiable sense, which gives it a claim, though a limited one, on our moral consideration.

Dignity is a phenomenon of human perception.

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certain features in another human being trigger ascriptions of worth. These features include signs of composure, cleanliness, maturity, attractiveness, and control of the body. The perception of dignity in turn elicits a response in the perceiver. Just as the smell of baking bread triggers a desire to eat it, and the sight of a baby's face triggers a desire to protect it, the appearance of dignity triggers a desire to esteem and respect the dignified person.

This explains why dignity is morally significant: We should not ignore a phenomenon that causes one person to respect the rights and interests of another. But it also explains why dignity is relative, fungible, and often harmful. Dignity is skin-deep: it's the sizzle, not the steak; the cover, not the book. What ultimately matters is respect for the person, not the perceptual signals that typically trigger it. Indeed, the gap between perception and reality makes us vulnerable to dignity illusions. We may be impressed by signs of dignity without underlying merit, as in the tin-pot dictator, and fail to recognize merit in a person who has been stripped of the signs of dignity, such as a pauper or refugee.

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When the concept of dignity is precisely specified, it becomes a mundane matter of thoughtfulness pushing against callousness and bureaucratic inertia, not a contentious moral conundrum. And, because it amounts to treating people in the way that they wish to be treated, ultimately it's just another application of the principle of autonomy.

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Reductions in dignity may harden the perceiver's heart and loosen his inhibitions against mistreating the person. When people are degraded and humiliated, such as Jews in Nazi Germany being forced to wear yellow armbands or dissidents in the Cultural Revolution being forced to wear grotesque haircuts and costumes, onlookers find it easier to despise them.

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these cases involve coercion, so once again they are ruled out by autonomy and respect for persons. So, even when breaches of dignity lead to an identifiable harm, it's ultimately autonomy and respect for persons that gives us the grounds for condemning it.

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for such hypotheses to justify restrictive laws, they need empirical support. In one's imagination, anything can lead to anything else: Allowing people to skip church can lead to indolence; letting women drive can lead to sexual licentiousness. In a free society, one cannot empower the government to outlaw any behavior that offends someone just because the offendee can pull a hypothetical future injury out of the air. No doubt Mao, Savonarola, and Cotton Mather could provide plenty of reasons why letting people do what they wanted would lead to the breakdown of society.

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The sickness in theocon bioethics goes beyond imposing a Catholic agenda on a secular democracy and using "dignity" to condemn anything that gives someone the creeps. Ever since the cloning of Dolly the sheep a decade ago, the panic sown by conservative bioethicists, amplified by a sensationalist press, has turned the public discussion of bioethics into a miasma of scientific illiteracy. Brave New World, a work of fiction, is treated as inerrant prophesy. Cloning is confused with resurrecting the dead or mass-producing babies. Longevity becomes "immortality," improvement becomes "perfection," the screening for disease genes becomes "designer babies" or even "reshaping the species." The reality is that biomedical research is a Sisyphean struggle to eke small increments in health from a staggeringly complex, entropy-beset human body. It is not, and probably never will be, a runaway train.

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on 2008-05-18 by lampertina

What a great paragraph -- and the last 2 sentences are literature. Just wonderful!

A major sin of theocon bioethics is exactly the one that it sees in biomedical research: overweening hubris. In every age, prophets foresee dystopias that never materialize, while failing to anticipate the real revolutions. Had there been a President's Council on Cyberethics in the 1960s, no doubt it would have decried the threat of the Internet, since it would inexorably lead to 1984, or to computers "taking over" like HAL in 2001. Conservative bioethicists presume to soothsay the outcome of the quintessentially unpredictable endeavor called scientific research. And they would stage-manage the kinds of social change that, in a free society, only emerge as hundreds of millions of people weigh the costs and benefits of new developments for themselves, adjusting their mores and dealing with specific harms as they arise, as they did with in vitro fertilization and the Internet.

Worst of all, theocon bioethics flaunts a callousness toward the billions of non-geriatric people, born and unborn, whose lives or health could be saved by biomedical advances. Even if progress were delayed a mere decade by moratoria, red tape, and funding taboos (to say nothing of the threat of criminal prosecution), millions of people with degenerative diseases and failing organs would needlessly suffer and die. And that would be the biggest affront to human dignity of all.

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And the Church's franchise to guide people in the most profound events of their lives--birth, death, and reproduction--is in danger of being undermined when biomedicine scrambles the rules. It's not surprising, then, that "dignity" is a recurring theme in Catholic doctrine: The word appears more than 100 times in the 1997 edition of the Catechism and is a leitmotif in the Vatican's recent pronouncements on biomedicine.

Highlighted by david_voelker

First, dignity is relative. One doesn't have to be a scientific or moral relativist to notice that ascriptions of dignity vary radically with the time, place, and beholder. In olden days, a glimpse of stocking was looked on as something shocking. We chuckle at the photographs of Victorians in starched collars and wool suits hiking in the woods on a sweltering day, or at the Brahmins and patriarchs of countless societies who consider it beneath their dignity to pick up a dish or play with a child. Thorstein Veblen wrote of a French king who considered it beneath his dignity to move his throne back from the fireplace, and one night roasted to death when his attendant failed to show up. Kass finds other people licking an ice-cream cone to be shamefully undignified; I have no problem with it.

Second, dignity is fungible. The Council and Vatican treat dignity as a sacred value, never to be compromised. In fact, every one of us voluntarily and repeatedly relinquishes dignity for other goods in life. Getting out of a small car is undignified. Having sex is undignified. Doffing your belt and spread- eagling to allow a security guard to slide a wand up your crotch is undignified. Most pointedly, modern medicine is a gantlet of indignities. Most readers of this article have undergone a pelvic or rectal examination, and many have had the pleasure of a colonoscopy as well. We repeatedly vote with our feet (and other body parts) that dignity is a trivial value, well worth trading off for life, health, and safety.

Third, dignity can be harmful. In her comments on the Dignity volume, Jean Bethke Elshtain rhetorically asked, "Has anything good ever come from denying or constricting human dignity?" The answer is an emphatic "yes." Every sashed and be-medaled despot reviewing his troops from a lofty platform seeks to command respect through ostentatious displays of dignity. Political and religious repressions are often rationalized as a defense of the dignity of a state, leader, or creed: Just think of the Salman Rushdie fatwa, the Danish cartoon riots, or the British schoolteacher in Sudan who faced flogging and a lynch mob because her class named a teddy bear Mohammed. Indeed, totalitarianism is often the imposition of a leader's conception of dignity on a population, such as the identical uniforms in Maoist China or the burqas of the Taliban.

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The perception of dignity in turn elicits a response in the perceiver. Just as the smell of baking bread triggers a desire to eat it, and the sight of a baby's face triggers a desire to protect it, the appearance of dignity triggers a desire to esteem and respect the dignified person.

This explains why dignity is morally significant: We should not ignore a phenomenon that causes one person to respect the rights and interests of another. But it also explains why dignity is relative, fungible, and often harmful. Dignity is skin-deep: it's the sizzle, not the steak; the cover, not the book. What ultimately matters is respect for the person, not the perceptual signals that typically trigger it. Indeed, the gap between perception and reality makes us vulnerable to dignity illusions. We may be impressed by signs of dignity without underlying merit, as in the tin-pot dictator, and fail to recognize merit in a person who has been stripped of the signs of dignity, such as a pauper or refugee.

Highlighted by david_voelker

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