Another Look at Dignity

Cambridge Quarterly of Healthcare Ethics

Volumn 13, Issue 1, 2004, Pages 7-14

  Häyry, Matti ^a  

^a NONE

Author keywords

[No Author keywords available]

Indexed keywords

BENEFICENCE; BIRTH CONTROL; CONCEPT FORMATION; EMBRYOLOGY; ETHICS; FAMILY; GENE; GENOME; HEALTH CARE POLICY; HUMAN; HUMAN RIGHTS; JUSTICE; LEGAL ASPECT; LIFE; MOLECULAR CLONING; MORALITY; RELIGIOUS GROUP; REVIEW; STEM CELL;

EID: 18844474793     PISSN: 09631801     EISSN: None     Source Type: Journal    
DOI: 10.1017/s0963180104131034     Document Type: Review

References (42)

1. Adopted by the General Conference of UNESCO at its twenty-ninth session, 1997 Nov 11. On the significance given to the document, see, for example: Dennis C, Gallagher R, Campbell P. Everyone's genome. Nature 2001;409:813.
2. See, for example: Broberg M, Bresson Ladegaard Knox J, eds. Dignity, Ethics, and Law: Bibliography. Copenhagen: Centre for Ethics and Law; 1999.
3. These principles were first formulated in 1979 by: Beauchamp TL, Childress JL. Principles of Biomedical Ethics, 4th ed. New York: Oxford University Press, 1994; and extensively explained and defended in, for example: Gillon R, ed. Principles of Health Care Ethics. New York: Wiley; 1994. For critical European comments, see, for example: Holm S. Not just autonomy: the principles of American biomedical ethics. Journal of Medical Ethics 1995;21:332-8; Häyry M. Ethics committees, principles, and consequences. Journal of Medical Ethics 1998;24:81-5 ; Takala T. What is wrong with global bioethics? on the limitations of the four principles approach. Cambridge Quarterly of Healthcare Ethics 2001;10:72-7. Close competitors to "dignity" in European bioethics include "solidarity" and "precaution." These three form a unity that could be called the "European Catechism," as opposed to the "American Mantra" of the Georgetown philosophers. Whereas dignity is usually brought up to challenge autonomy as the paramount ethical ideal, solidarity is set against (the "American concept of") justice and precaution with the utilitarian or free-market determination of benefits and harms. See, for example, the special issue on "Solidarity in Health Care": Houtepen R, ter Meulen R, eds. Health Care Analysis 2000;8:329-411; and the special issue on "The Precautionary Principle and Its Implications for Science": Kaiser M, ed. Foundations of Science 1997;2.
4. These principles were first formulated in 1979 by: Beauchamp TL, Childress JL. Principles of Biomedical Ethics, 4th ed. New York: Oxford University Press, 1994; and extensively explained and defended in, for example: Gillon R, ed. Principles of Health Care Ethics. New York: Wiley; 1994. For critical European comments, see, for example: Holm S. Not just autonomy: the principles of American biomedical ethics. Journal of Medical Ethics 1995;21:332-8; Häyry M. Ethics committees, principles, and consequences. Journal of Medical Ethics 1998;24:81-5 ; Takala T. What is wrong with global bioethics? on the limitations of the four principles approach. Cambridge Quarterly of Healthcare Ethics 2001;10:72-7. Close competitors to "dignity" in European bioethics include "solidarity" and "precaution." These three form a unity that could be called the "European Catechism," as opposed to the "American Mantra" of the Georgetown philosophers. Whereas dignity is usually brought up to challenge autonomy as the paramount ethical ideal, solidarity is set against (the "American concept of") justice and precaution with the utilitarian or free-market determination of benefits and harms. See, for example, the special issue on "Solidarity in Health Care": Houtepen R, ter Meulen R, eds. Health Care Analysis 2000;8:329-411; and the special issue on "The Precautionary Principle and Its Implications for Science": Kaiser M, ed. Foundations of Science 1997;2.
5. These principles were first formulated in 1979 by: Beauchamp TL, Childress JL. Principles of Biomedical Ethics, 4th ed. New York: Oxford University Press, 1994; and extensively explained and defended in, for example: Gillon R, ed. Principles of Health Care Ethics. New York: Wiley; 1994. For critical European comments, see, for example: Holm S. Not just autonomy: the principles of American biomedical ethics. Journal of Medical Ethics 1995;21:332-8; Häyry M. Ethics committees, principles, and consequences. Journal of Medical Ethics 1998;24:81-5 ; Takala T. What is wrong with global bioethics? on the limitations of the four principles approach. Cambridge Quarterly of Healthcare Ethics 2001;10:72-7. Close competitors to "dignity" in European bioethics include "solidarity" and "precaution." These three form a unity that could be called the "European Catechism," as opposed to the "American Mantra" of the Georgetown philosophers. Whereas dignity is usually brought up to challenge autonomy as the paramount ethical ideal, solidarity is set against (the "American concept of") justice and precaution with the utilitarian or free-market determination of benefits and harms. See, for example, the special issue on "Solidarity in Health Care": Houtepen R, ter Meulen R, eds. Health Care Analysis 2000;8:329-411; and the special issue on "The Precautionary Principle and Its Implications for Science": Kaiser M, ed. Foundations of Science 1997;2.
6. These principles were first formulated in 1979 by: Beauchamp TL, Childress JL. Principles of Biomedical Ethics, 4th ed. New York: Oxford University Press, 1994; and extensively explained and defended in, for example: Gillon R, ed. Principles of Health Care Ethics. New York: Wiley; 1994. For critical European comments, see, for example: Holm S. Not just autonomy: the principles of American biomedical ethics. Journal of Medical Ethics 1995;21:332-8; Häyry M. Ethics committees, principles, and consequences. Journal of Medical Ethics 1998;24:81-5 ; Takala T. What is wrong with global bioethics? on the limitations of the four principles approach. Cambridge Quarterly of Healthcare Ethics 2001;10:72-7. Close competitors to "dignity" in European bioethics include "solidarity" and "precaution." These three form a unity that could be called the "European Catechism," as opposed to the "American Mantra" of the Georgetown philosophers. Whereas dignity is usually brought up to challenge autonomy as the paramount ethical ideal, solidarity is set against (the "American concept of") justice and precaution with the utilitarian or free-market determination of benefits and harms. See, for example, the special issue on "Solidarity in Health Care": Houtepen R, ter Meulen R, eds. Health Care Analysis 2000;8:329-411; and the special issue on "The Precautionary Principle and Its Implications for Science": Kaiser M, ed. Foundations of Science 1997;2.
7. These principles were first formulated in 1979 by: Beauchamp TL, Childress JL. Principles of Biomedical Ethics, 4th ed. New York: Oxford University Press, 1994; and extensively explained and defended in, for example: Gillon R, ed. Principles of Health Care Ethics. New York: Wiley; 1994. For critical European comments, see, for example: Holm S. Not just autonomy: the principles of American biomedical ethics. Journal of Medical Ethics 1995;21:332-8; Häyry M. Ethics committees, principles, and consequences. Journal of Medical Ethics 1998;24:81-5 ; Takala T. What is wrong with global bioethics? on the limitations of the four principles approach. Cambridge Quarterly of Healthcare Ethics 2001;10:72-7. Close competitors to "dignity" in European bioethics include "solidarity" and "precaution." These three form a unity that could be called the "European Catechism," as opposed to the "American Mantra" of the Georgetown philosophers. Whereas dignity is usually brought up to challenge autonomy as the paramount ethical ideal, solidarity is set against (the "American concept of") justice and precaution with the utilitarian or free-market determination of benefits and harms. See, for example, the special issue on "Solidarity in Health Care": Houtepen R, ter Meulen R, eds. Health Care Analysis 2000;8:329-411; and the special issue on "The Precautionary Principle and Its Implications for Science": Kaiser M, ed. Foundations of Science 1997;2.
8. These principles were first formulated in 1979 by: Beauchamp TL, Childress JL. Principles of Biomedical Ethics, 4th ed. New York: Oxford University Press, 1994; and extensively explained and defended in, for example: Gillon R, ed. Principles of Health Care Ethics. New York: Wiley; 1994. For critical European comments, see, for example: Holm S. Not just autonomy: the principles of American biomedical ethics. Journal of Medical Ethics 1995;21:332-8; Häyry M. Ethics committees, principles, and consequences. Journal of Medical Ethics 1998;24:81-5 ; Takala T. What is wrong with global bioethics? on the limitations of the four principles approach. Cambridge Quarterly of Healthcare Ethics 2001;10:72-7. Close competitors to "dignity" in European bioethics include "solidarity" and "precaution." These three form a unity that could be called the "European Catechism," as opposed to the "American Mantra" of the Georgetown philosophers. Whereas dignity is usually brought up to challenge autonomy as the paramount ethical ideal, solidarity is set against (the "American concept of") justice and precaution with the utilitarian or free-market determination of benefits and harms. See, for example, the special issue on "Solidarity in Health Care": Houtepen R, ter Meulen R, eds. Health Care Analysis 2000;8:329-411; and the special issue on "The Precautionary Principle and Its Implications for Science": Kaiser M, ed. Foundations of Science 1997;2.
9. These principles were first formulated in 1979 by: Beauchamp TL, Childress JL. Principles of Biomedical Ethics, 4th ed. New York: Oxford University Press, 1994; and extensively explained and defended in, for example: Gillon R, ed. Principles of Health Care Ethics. New York: Wiley; 1994. For critical European comments, see, for example: Holm S. Not just autonomy: the principles of American biomedical ethics. Journal of Medical Ethics 1995;21:332-8; Häyry M. Ethics committees, principles, and consequences. Journal of Medical Ethics 1998;24:81-5 ; Takala T. What is wrong with global bioethics? on the limitations of the four principles approach. Cambridge Quarterly of Healthcare Ethics 2001;10:72-7. Close competitors to "dignity" in European bioethics include "solidarity" and "precaution." These three form a unity that could be called the "European Catechism," as opposed to the "American Mantra" of the Georgetown philosophers. Whereas dignity is usually brought up to challenge autonomy as the paramount ethical ideal, solidarity is set against (the "American concept of") justice and precaution with the utilitarian or free-market determination of benefits and harms. See, for example, the special issue on "Solidarity in Health Care": Houtepen R, ter Meulen R, eds. Health Care Analysis 2000;8:329-411; and the special issue on "The Precautionary Principle and Its Implications for Science": Kaiser M, ed. Foundations of Science 1997;2.
10. There are two traditional "European" readings, and presumably countless others, of which I sketch here only three. A full analysis of the uses and meanings of "dignity" would be an enormous undertaking. The word in its Latin and Latin-derived forms has been around for almost as long as the European culture, and equivalent concepts can be found in other languages and other cultures. For some of the "European" uses, see, for example, note 2, Broberg, Bresson Ladegaard Knox 1999; Becker GK. In search of humanity: human dignity as a basic moral attitude. In: Häyry M, Takala T, eds. The Future of Value Inquiry. Amsterdam: Rodopi; 2001:53-64.
11. One thing to be noted is that dignity is not a very old concept in modern philosophy. For instance, Frederick Copleston's comprehensive nine-volume History of Philosophy. (Tunbridge Wells, UK: Burns and Oates; 1946-1975) makes no reference to it. And given that this work explains reliably almost everything in philosophy, I can only conclude that in the 1940s, 1950s, 1960s, and 1970s, when the book was originally written and published, "dignity" was not a proper word in the philosopher's vocabulary.
12. See note 2, Broberg, Bresson Ladegaard Knox 1999:109-10, 113, 116.
13. Adopted by the United Nations General Assembly, resolution 217 A (III), 1948 Dec 10.
14. Some have suggested that there is a continuum from documents like The Declaration of the Rights of Man and of the Citizen, issued in France in 1789. But this is probably not the right place to begin this particular story because in that document the term was used in another sense altogether. The word "dignity" is there, but the meaning is "honors," or "positions of honor." Others have made an ideological link to the United States Declaration of Independence, with its emphasis on individual rights. But the word "dignity" does not appear in this document at all.
15. Tonti-Filippini N. The concept of human dignity in the international human rights instruments. In: de Dios Valdo Correa J, Sgreccia E, eds. Identity and Statute of Human Embryo. Vatican City: Libreria Editrice Vaticana; 1998:381-404, at 389.
16. See note 2, Broberg and Bresson Ladegaard Knox 1999.
17. Pope Leo XIII, Rerum Novarum, 1891 May 15, n. 32, quoted from: see note 9, Tonti-Filippini 1998:388. The deleted passage marked by the ellipsis is: "To consent to any treatment which is calculated to defeat the end and purpose of his being is beyond his right; he cannot give up his soul to servitude. . . ."
18. This is not explicitly stated in the quoted passage, but it is an essential part of the Catholic approach to modern bioethics.
19. A useful summary of this view in the ethics of medicine and healthcare is provided by: Quinn KP. Method in Catholic bioethics. Kennedy Institute of Ethics Journal 2000;10:353-63.
20. Kant I. The metaphysical principles of virtue [Metaphysische Anfangsgründe der Tugendlehre; 1797:434-5]. In: Kant I. Ethical Philosophy, 2nd ed. Ellington JW, trans. Indianapolis, Ind.: Hackett; 1994:97. This volume also includes an introduction by W. A. Wick. The deleted passage marked by the ellipsis is: "can measure himself against each member of his species. " Kant's original German word is Würde ("worth" or "value"), but he also drags, from time to time, along the Latin term "dignitas" in brackets.
21. Kant I. The metaphysical principles of virtue [Metaphysische Anfangsgründe der Tugendlehre; 1797:434-5]. In: Kant I. Ethical Philosophy, 2nd ed. Ellington JW, trans. Indianapolis, Ind.: Hackett; 1994:97. This volume also includes an introduction by W. A. Wick. The deleted passage marked by the ellipsis is: "can measure himself against each member of his species. " Kant's original German word is Würde ("worth" or "value"), but he also drags, from time to time, along the Latin term "dignitas" in brackets.
22. See, for example: Hakker H. Ethical responsibility in prenatal genetic diagnosis. Biomedical Ethics 1997;2:78-85; Seifert J. What Is Life? The Originality, Irreducibility, and Value of Life. Amsterdam: Rodopi; 1997; Delkeskamp-Hayes C. Respecting, protecting, persons, humans, and conceptual muddles in the bioethics convention. Journal of Medicine and Philosophy 2000;25:147-80; Reuter L. Human is what is born of a human: personhood, rationality, and an European convention. Journal of Medicine and Philosophy 2000;25:181-94; Hołówka J. Permissibility of embryonic research. In: Friele MB, ed. Embryo Experimentation in Europe: Bio-Medical, Legal, and Philosophical Aspects. Bad Neuenahr-Ahrweiler, Germany: Europäische Akademie; 2001:75-97; also see note 4, Becker 2001 .
23. See, for example: Hakker H. Ethical responsibility in prenatal genetic diagnosis. Biomedical Ethics 1997;2:78-85; Seifert J. What Is Life? The Originality, Irreducibility, and Value of Life. Amsterdam: Rodopi; 1997; Delkeskamp-Hayes C. Respecting, protecting, persons, humans, and conceptual muddles in the bioethics convention. Journal of Medicine and Philosophy 2000;25:147-80; Reuter L. Human is what is born of a human: personhood, rationality, and an European convention. Journal of Medicine and Philosophy 2000;25:181-94; Hołówka J. Permissibility of embryonic research. In: Friele MB, ed. Embryo Experimentation in Europe: Bio-Medical, Legal, and Philosophical Aspects. Bad Neuenahr-Ahrweiler, Germany: Europäische Akademie; 2001:75-97; also see note 4, Becker 2001 .
24. See, for example: Hakker H. Ethical responsibility in prenatal genetic diagnosis. Biomedical Ethics 1997;2:78-85; Seifert J. What Is Life? The Originality, Irreducibility, and Value of Life. Amsterdam: Rodopi; 1997; Delkeskamp-Hayes C. Respecting, protecting, persons, humans, and conceptual muddles in the bioethics convention. Journal of Medicine and Philosophy 2000;25:147-80; Reuter L. Human is what is born of a human: personhood, rationality, and an European convention. Journal of Medicine and Philosophy 2000;25:181-94; Hołówka J. Permissibility of embryonic research. In: Friele MB, ed. Embryo Experimentation in Europe: Bio-Medical, Legal, and Philosophical Aspects. Bad Neuenahr-Ahrweiler, Germany: Europäische Akademie; 2001:75-97; also see note 4, Becker 2001 .
25. See, for example: Hakker H. Ethical responsibility in prenatal genetic diagnosis. Biomedical Ethics 1997;2:78-85; Seifert J. What Is Life? The Originality, Irreducibility, and Value of Life. Amsterdam: Rodopi; 1997; Delkeskamp-Hayes C. Respecting, protecting, persons, humans, and conceptual muddles in the bioethics convention. Journal of Medicine and Philosophy 2000;25:147-80; Reuter L. Human is what is born of a human: personhood, rationality, and an European convention. Journal of Medicine and Philosophy 2000;25:181-94; Hołówka J. Permissibility of embryonic research. In: Friele MB, ed. Embryo Experimentation in Europe: Bio-Medical, Legal, and Philosophical Aspects. Bad Neuenahr-Ahrweiler, Germany: Europäische Akademie; 2001:75-97; also see note 4, Becker 2001 .
26. See, for example: Hakker H. Ethical responsibility in prenatal genetic diagnosis. Biomedical Ethics 1997;2:78-85; Seifert J. What Is Life? The Originality, Irreducibility, and Value of Life. Amsterdam: Rodopi; 1997; Delkeskamp-Hayes C. Respecting, protecting, persons, humans, and conceptual muddles in the bioethics convention. Journal of Medicine and Philosophy 2000;25:147-80; Reuter L. Human is what is born of a human: personhood, rationality, and an European convention. Journal of Medicine and Philosophy 2000;25:181-94; Hołówka J. Permissibility of embryonic research. In: Friele MB, ed. Embryo Experimentation in Europe: Bio-Medical, Legal, and Philosophical Aspects. Bad Neuenahr-Ahrweiler, Germany: Europäische Akademie; 2001:75-97; also see note 4, Becker 2001 .
27. See, for example: Hakker H. Ethical responsibility in prenatal genetic diagnosis. Biomedical Ethics 1997;2:78-85; Seifert J. What Is Life? The Originality, Irreducibility, and Value of Life. Amsterdam: Rodopi; 1997; Delkeskamp-Hayes C. Respecting, protecting, persons, humans, and conceptual muddles in the bioethics convention. Journal of Medicine and Philosophy 2000;25:147-80; Reuter L. Human is what is born of a human: personhood, rationality, and an European convention. Journal of Medicine and Philosophy 2000;25:181-94; Hołówka J. Permissibility of embryonic research. In: Friele MB, ed. Embryo Experimentation in Europe: Bio-Medical, Legal, and Philosophical Aspects. Bad Neuenahr-Ahrweiler, Germany: Europäische Akademie; 2001:75-97; also see note 4, Becker 2001 .
28. See, for example: Wessels U. Genetic engineering and ethics in Germany. In: Dyson A, Harris J, eds. Ethics and Biotechnology. London: Routledge; 1994:230-58, 237-8, 241-3.
29. Articles 1, 2, 11.
30. See, for example: Harris J. Is cloning an attack on human dignity? Nature 1997;387:754; Labib K. Don't leave dignity out of the cloning debate. Nature 1997;388:15; Kahn A. Cloning, dignity, and ethical revisionism. Nature 1997;388:320; Shapiro D. Cloning, dignity, and ethical reasoning. Nature 1997;388:511; Harris J. Cloning and bioethical thinking. Nature 1997;389:433.
31. See, for example: Harris J. Is cloning an attack on human dignity? Nature 1997;387:754; Labib K. Don't leave dignity out of the cloning debate. Nature 1997;388:15; Kahn A. Cloning, dignity, and ethical revisionism. Nature 1997;388:320; Shapiro D. Cloning, dignity, and ethical reasoning. Nature 1997;388:511; Harris J. Cloning and bioethical thinking. Nature 1997;389:433.
32. See, for example: Harris J. Is cloning an attack on human dignity? Nature 1997;387:754; Labib K. Don't leave dignity out of the cloning debate. Nature 1997;388:15; Kahn A. Cloning, dignity, and ethical revisionism. Nature 1997;388:320; Shapiro D. Cloning, dignity, and ethical reasoning. Nature 1997;388:511; Harris J. Cloning and bioethical thinking. Nature 1997;389:433.
33. See, for example: Harris J. Is cloning an attack on human dignity? Nature 1997;387:754; Labib K. Don't leave dignity out of the cloning debate. Nature 1997;388:15; Kahn A. Cloning, dignity, and ethical revisionism. Nature 1997;388:320; Shapiro D. Cloning, dignity, and ethical reasoning. Nature 1997;388:511; Harris J. Cloning and bioethical thinking. Nature 1997;389:433.
34. See, for example: Harris J. Is cloning an attack on human dignity? Nature 1997;387:754; Labib K. Don't leave dignity out of the cloning debate. Nature 1997;388:15; Kahn A. Cloning, dignity, and ethical revisionism. Nature 1997;388:320; Shapiro D. Cloning, dignity, and ethical reasoning. Nature 1997;388:511; Harris J. Cloning and bioethical thinking. Nature 1997;389:433.
35. Labib has replied to this that there "really is a fundamental difference between a naturally occurring identical twin, and a child that would be the clone of the person it would look to as its father or mother" (see note 18, Labib 1997:15), but it is not clear what he means by this. Is he predicting that the clone's life would be miserable? Then by all means ban cloning, but leave "dignity" and "uniqueness" out of it, and also ban other instances of reproduction where the future child's life could be unhappy. Or is he saying that the naturalness of twinning can be contrasted with the unnaturalness of cloning? If so, then see, for example: Häyry M. Categorical objections to genetic engineering: a critique. In: Dyson A, Harris J, eds. Ethics and Biotechnology. London: Routledge; 1994:202-15.
36. The argument from dignity is probably used in this context for political reasons. In the preface of the declaration, Federico Mayor praises the text for striking a balance "between safeguarding respect for human rights . . . and the need to ensure the freedom of research." In other words, people's feelings are soothed by a ban on cloning, and scientists can continue their work on other aspects of the human genome, whatever the implications on the lives of human beings at the early stages of their development.
37. Bentham J. An Introduction to the Principles of Morals and Legislation [orig. 1789]. Burns JH, Hart HLA, eds. London: Methuen; 1982; Mill JS. On Liberty [orig. 1859]. O'Grady J, ed. Ware, UK: Wordsworth; 1996; Mill JS. Utilitarianism [orig. 1861]. Sher G, ed. Indianapolis, Ind.: Hackett; 1979.
38. Bentham J. An Introduction to the Principles of Morals and Legislation [orig. 1789]. Burns JH, Hart HLA, eds. London: Methuen; 1982; Mill JS. On Liberty [orig. 1859]. O'Grady J, ed. Ware, UK: Wordsworth; 1996; Mill JS. Utilitarianism [orig. 1861]. Sher G, ed. Indianapolis, Ind.: Hackett; 1979.
39. Bentham J. An Introduction to the Principles of Morals and Legislation [orig. 1789]. Burns JH, Hart HLA, eds. London: Methuen; 1982; Mill JS. On Liberty [orig. 1859]. O'Grady J, ed. Ware, UK: Wordsworth; 1996; Mill JS. Utilitarianism [orig. 1861]. Sher G, ed. Indianapolis, Ind.: Hackett; 1979.
40. See, for example: Fraser SI, Walters JW. Death - whose decision? euthanasia and the terminally ill. Journal of Medical Ethics 2000;26:121-5.
41. See, for example: Karjalainen J-M. Justice, dignity, autonomy: a letter to an old friend on the quality of life. In: Mortensen V, ed. Life and Death: Moral Implications of Biotechnology. Geneva: Lutheran World Federation and WWC Publications; 1995:69-85, at 80-1.
42. Bentham extended the requirement of equality even wider than Kant, Pope Leo XIII, or Eleanor Roosevelt, when he wrote about cruelty to animals (see note 21, Bentham 1982:283, n. b): The day may come, when the rest of the animal creation may acquire those rights which never could have been withholden from them but by the hand of tyranny. The French have already discovered that the blackness of skin is no reason why a human being should be abandoned without redress to the caprice of a tormentor. It may come one day to be recognized, that the number of legs, villosity of the skin, or the termination of the os sacrum, are reasons equally insufficient for abandoning a sensitive being to the same fate. What else is it that should trace the insuperable line? Is it the faculty of reason, or, perhaps, the faculty of discourse? But a full-grown horse or dog, is beyond comparison a more rational, as well as a more conversible animal, than an infant of a day, or a week, or even a month, old. But suppose the case were otherwise, what would it avail? the question is not, Can they reason? nor, Can they talk? but, Can they suffer?