The Search for Human Dignity

The pursuit of external goods has become so dominant in our society that the practices which act to distinguish the internal goods of human being have come to be not only systemically disregarded but also increasingly under attack as vilified objects. Dignity is one such distinction. This essay looks at some of the skepticism that surrounds the notion of dignity. It tracks some of the varied notions that have been used to substantiate the value of dignity. The method by which intelligent persons arrive at very divergent but none-the-less rational positions authorized by specific ends will also be considered on the way toward fulfilling the ultimate aim of this essay, which is to provide an objective value for dignity. Dignity, especially in the integral sense, is indispensable to ordering our human lives in such a way to further normalize the ends of common goodness, maximizing the reach of human well-being and the nature of human excellence.

Many arguments questioning the worth of dignity, target it’s functional value in rights frameworks such as the Universal Declaration of Human Rights (UDHR) and where it is used in responding to questions in the area of bioethical approaches to medical care, treatment, and research. More recently the question of dignity has been raised with regards to how humans might extend the notion to animals and the integrity of earth’s ecosystem. The predominant contention with dignity is that it is vacuous. That the concept offers no real substance to the existing framework for human rights, no clear reason to obligation, and at the very best dignity is viewed by its critics as a redundancy to the bona fides of autonomy.

In 2003, Ruth Macklin put forward a now famous address on the notion of human dignity as an editorial in the influential publication, The BMJ (British Medical Journal). Brief and powerful, this text titled ‘Dignity is a useless concept’ argues that dignity is not a useful concept for the ethical analysis of medical activities. Focused primarily on the question of application in medical treatment and research, Macklin laid the claim that dignity is simply meaningless. Macklin writes, “dignity seems to have no meaning beyond what is implied by the principle of medical ethics, respect for persons: the need to obtain voluntary, informed consent; the requirement to protect confidentiality; and the need to avoid discrimination and abusive practices.” Macklin describes how dignity in one document after another always appears vague and doing nothing beyond ‘respect for persons.’ Autonomy, for Macklin along with many in the medical community, is a clear guiding principle in medical ethics. It stands as one of the ‘four pillars’ in medical ethics along with beneficence, non-maleficence, and justice. Where autonomy covers respect for persons’ agency and maintains a distinct position in the field largely based on its instrumental durability dignity is said to be vague in human rights documents and as a notion perhaps borrowed from religious sources, out of place in medical ethics.

Autonomy does provide valuable content to the field of medical ethics, especially in relation to interpretive and deliberative models of physician to patient relationships that emerged out of a critical response to the many abuses suffered mostly by women, children, minority groups, and the poor due to the excesses of paternalism in medical ethics. The principle of autonomy aims to preserve the equivalent agency of the thinking self and the acting self of each person as a patient with respect to the natural liberties of choice, preference, and self-determination. Autonomy goes a long way to helping many physicians and patients avoid abusive direct and indirect abuses. The key problem with autonomy is the challenge of truly arriving at a universal understanding of the regulating precept of “voluntary, informed consent.” If we are to believe that autonomy in concordance with the pillars is principle enough to safeguard respect for persons, we must resign ourselves to a narrow view on the expansive territory of the medical complex, and an efficiently calculated materialist view on the human body. In this last sense with respect to conceptions of the human body, that dignity emerges as being quite distinct to autonomy.

The fact is that the are scores of examples where we can see the protection of autonomy break down, I will offer two: Sheila Pouliot, a never competent patient in New York whose state enforced right to autonomy, overriding the wishes of her family, attending chaplains, and care-providers, ordered life preserving treatment that ultimately tortured her body for weeks until the presiding judge visited Sheila’s bedside and called an end to the treatment, saying “there’s the law and then there’s what’s right”; Ajuda Ismaila Adamu v. Pfizer, Inc, where two hundred Nigerian nationals, all of them sick children, as a result of consenting to a pharmaceutical experiment where potential side effects were either not fully disclosed or not fully understood, eleven children died, while many others were left blind, deaf, paralyzed, and others brain-damaged.

In his essay ‘Human Dignity and Bioethics (2008),’ Daniel Sulmasy offers three ways that dignity has been shown to function in moral philosophy, medical ethics and bioethics discourse. The three senses of dignity that Sulmasy describes are the kind attributed, the intrinsic kind, and the inflorescent – or value as bestowed based on character traits, worth based on simply being human, and worth indicated by the flourishing of individual members of human kind indicative of human excellence. For designating value in an axiological (ethical value) sense, Sulmasy reduces those three senses into two categories, the intrinsic and the attributed. Sulmasy describes intrinsic human dignity as the “worth that all human beings have simply by being human,” and attributed human dignity as that worth or value that human beings confer upon others. He writes, “Attributed values depend completely on the purposes, beliefs, desires, interests, or expectations of a valuer or group of valuers.”

Standards of attributed dignity do not stop at the way that persons choose to acknowledge the value of any specific others say by bestowing distinguished titles on distinct practical identities such as General of the US Army. In the far-reaching sense that informs the way it functions as a precept to approaching human rights, in human dignity we find a view on normativity that is unique to humans as moral agents, the grounds for a form of constancy that recognizes the value of one’s own existence as reflected in the existence of each other. Describing the Janus-faced shape of dignity, Michael Rosen writes, “our duty to respect the dignity of humanity is–on this I agree with Kant– fundamentally a duty toward ourselves,” in the sense that our ‘self’ is socially inseparable from the selves of others, thereby “in failing to respect the humanity of others we actually undermine the humanity in ourselves.”

The material cause for intrinsic human dignity arises from humans as they are: interdependent and capable of choosing to order our lives in such a way that promotes specific living values over others, such as flourishing, caring, and inclusion over suffering, neglect, and alienation. If we cannot endorse our own nature as moral agents embodying a reasoning kind, then nothing can be universally normative at all (Korsgaard; 107). Intrinsic dignity entails self-regarding and other-regarding moral duties on the grounds that as members of an interdependent natural kind we possess certain human excellences as a form of latent potential that can only be maximized through morally guided relationships with each other. Suzy Killmister describes dignity as an “upholding of one’s own standards and norms” while acting in such a way that will uphold each other’s ability to live according to their own standards. The interdependent nature of the human capacity to flourish demonstrates the objective value of intrinsic human dignity.

Alasdair MacIntyre observes, “Aquinas takes notice of the facts of fundamental practical disagreement as arising from disagreements about the nature of the ultimate human good.” The kinds of goods that we seek governs the way in which we order our lives, to the extent we have authority over our selves, our bodies (more on this later). For seeking the goods of excellence in any kind of endeavor, from palliative care to engineering the human genome, a practice is required. Here, practice is used in the way that MacIntyre defines it in chapter 14 of his work After Virtue; practice involves a set of activities that are difficult, requiring skills and effort to acquire paired with a disciplined approach toward respecting established standards of excellence for those practitioners of the practice. “To enter into a practice is,” he writes:

…to accept the authority of those standards and the inadequacy of my own performance as judged by them. It is to subject my own attitudes, choices, preferences and tastes to the standards which currently and partially define the practice.

There are two types of internal goods to such practices. One good is in the goal or end that defines the practice, which is the common good that can be produced in no other way. The second good is understood as the consequent benefits of engaging in the practice and pursuing its end. Through history and the continuation of practice traditions masters of practices develop upon conceptions of those standards of excellences, transmuting the secondary goods while sustaining the first internal goods.

In this sense Ruth Macklin and Steven Pinker are right to say that there are religious foundations to notions of human dignity, even where human dignity claims no religious authority. Pinker explicitly refers to dignity as an instrument of a theocon conspiracy, while Macklin argues from a position of pragmatic materialism not uncommon to the theoretical structure of the medical complex, patterned after what Michel Foucault characterizes as a “gaze of the concrete sensibility, a gaze that travels from body to body.”

The religious foundations to the notion of dignity cannot and should not be ignored. After all, as Charles Camosy observes, it is in the church that we find two thousand years of systematic investigation into what a set of intuitive rules for maximizing human flourishing consists of. Skeptics ignore the fact that this practice by the church has never actually resembled anything like a closed-circuit or insular project. In fact, the church has extended this investigation to draw on the internal goods of nearly every conceivable practice across the arts, sciences, philosophy, medicine, and to this day remains a practice that only the whole church – as constituted by all members of the faith – can do.

The practice of ordering person and community around the notions of good, right, service, and love are especially evolved in the church. The latter most becomes evident when we consider the profound conception of agapic ethics, or ordering our lives around God’s grace as a model for human love. On the conception of agape, or God’s love, Robert Merrihew Adams cites Socrates with regard to love’s particularity, writing that there is a “first object of love, for whose sake, we say, all other objects are loved… this is the good.” This is used to close the distance between the finite infinite and infinite goods available to humans. This is a love that we first become aware of in recognizing the human place in nature, capable of joy, wonder, sorrow, mystery, and happiness. How is that we have such latent capacities? This first object of love is no thing at all except that it is infinitely present throughout all true internal and external goods. Where persons become filled with this love they turn it toward the finitude of their own life, existing in relation to others.

Charles Foster argues that dignity is objective human flourishing. Flourishing is about being and doing. Flourishing in the sense being used here is available to all human beings by their very nature, but through the practice and cultivation of virtues seeking a common good. Often when human dignity is described in this way, as being intrinsic to our very nature as ‘latent potential,’ the understanding that follows is that somehow dignity is inalienable. So that even where a person is submitted to waterboarding their dignity somehow goes untouched, because torture cannot take that away from any person. To an extent I am sympathetic with this notion but I strongly disagree with this deduction.

This view of dignity rests on a Homeric sense of virtues revolving around human excellence as exemplified by the warrior hero then translated into our modern invention, the autonomous individual. Dignity, like humans themselves, can certainly be violated. Violence, exploitation, displacement, alienation, so many of the demands of the global economy and liberal market threaten, corrupt, and gut dignity from human experience in the world. Yes, human dignity is rooted in what Suzy Killmister describes as ‘potential’ – but its fruits are drawn from the fact that without it, humans are absolutely bare. As church social doctrine declares, “The human person cannot find fulfillment in himself, that is, apart from the fact that he exists ‘with’ others and ‘for’ others.” The grounds for human dignity is in the interdependent nature of tending to human well- being.

Human dignity is also integral “by virtue of bodily requirements.” After referring to violence, vulnerability, and mourning Judith Butler writes “…we are, from the start, given over to the other, one in which we are, from the start, even prior to individuation itself and, by virtue of bodily requirements.” MacIntyre takes the direction that having been raised from a state of utter vulnerability as a entirely dependent life, then cultivated through a complex of relations that educate a persons, providing for needs and instills an indebtedness in us, toward those who may have provided the care and to for providing care to further generation. Butler warns though, that it is this vulnerability that follows us all of our lives that leaves us available to violence and remorselessness of interests that disregards our being.

Luke Gormally writes, “We live our lives with dignity–with what one might call an existential dignity–in so far as our choices are consistent with an objective order of values.” Like Mette Lebech and the framers of the UDHR, I am of the mind that dignity can function as a basis for law and ethics. We can see how autonomy does work both legally and ethically, and we also see where it has come in conflict with others notions such as justice and beneficence. The legal account of human dignity, as Hoffman LJ points out, argues for rights and protections for “the preservation of mental stability and…the right to die with dignity and the right to be protected from treatment, or from a lack of treatment, which will result in one dying in avoidably distressing circumstances.”

Justice in the greatest sense of what it is worth, in Onora O’Neill’s view, imparts protections from injury in the face of the ubiquitous vulnerabilities of the human condition. But the reach of justice, rights and institutional protections fail to reach all persons. And where the instruments of justice touch certain lives, especially the lives of the categorically “supernumerous” poor, defenseless, without representative personhood, they often become dangerous. So we must still turn toward one another with one another, holding constancy on the dial of our collective instincts to guide moral action in the most directly lived sense.

Leon Kass offers an argument for human dignity that goes right to the heart of where we must move our conceptions in order to locate it’s worth and strength: the body. Western assumptions about the mind and body, the individual and society, affect theoretical points of view and ethical paradigms in ways that obscure certain realities of our concrete embodied lives. Kass writes that such dualistic notions of personhood, as infused into the culture by Descartes and by Kant, “denies the importance of life’s concrete particularity, lived always locally, corporeally, and in a unique trajectory from zygote in the womb to body in the coffin… not all dignity consists in reason and freedom.” The answer to threats on human dignity must not ignore what is urgent, or deny “dignity to the human bodily life as lived.”

There are many complications the arise out of rapidly developing technologies and socio-political orders that seem to operate at a pace that for surpasses our ability to morally ‘keep up.’ We see whole catalogues of ethicists taking on one procedure and one technology after another with a kind of certainty that seems authoritative, at least as an informed viewpoint. For the practice of understanding the worth of human dignity we must try to embrace what it requires of us as we are ordering our lives and our loves toward specific ends. We must consider what human dignity requires of us that no other notions about human nature ask. Human dignity asks that we embody a form of mutual reverence for one another, with the understanding that the goods or excellences of our embodied lives are achieved in direct proportion to how we order ourselves with regard to one another. This excellence in our nature heartens social inclusion, which reasonably extends beyond our natural kind.

Robert Schmaltz is a graduate student at Fordham University.

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