instruere...inlustrare...delectare Disputations

Friday, January 09, 2009

Who's adding nothing?

This is last year's news, but Ad Saeculum recently commented on a piece of commentary by Steven Pinker which disparages references to human dignity in bioethics. According to Pinker:
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.
There are many problems with preferring "autonomy" to "dignity" as the basis for bioethics, and Br. Robert mentions some of them in his blog post. Here, I'll limit myself to pointing out one of them:

Pinker's above-quoted conclusion -- that dignity adds nothing to autonomy -- is objectively, demonstrably, you could even say trivially, false.

Personal autonomy, according to Pinker, is "the idea that ... no human has the right to impinge on the life, body, or freedom of another." It is, therefore, a negative characteristic. I don't have the right to do certain things to you.

Dignity, on the other hand, is a positive characteristic. Personal dignity imposes positive obligations on other persons. Your autonomy prevents me from doing things to you, but your dignity compels me to do things for you.

In the most straightforward and literal sense, dignity does add something to autonomy. It adds a duty of commission.

It adds something else, too, if I may step a little past my pledge above to limit myself to one problem with Pinker's position. It adds bounds on informed consent.

According to Pinker, the utility of the principle of personal autonomy "is why informed consent serves as the bedrock of ethical research and practice." But the principle of personal dignity also produces a concept of informed consent -- a different concept, in fact, which again demonstrates the falsehood of the "dignity adds nothing" claim.*

The difference is this: If humans have personal dignity, then informed consent is not in itself sufficient to make research and practice ethical. My reason and choice are how I exercise my autonomy, so any choice I reason my way to cannot compromise my autonomy.

Personal dignity, on the other hand, may be a quality I have because of my reason and will, but it's not exercised through them. (It's not really exercised at all.) So I can reason my way to a choice that is contrary to my personal dignity. If ethics are based on personal dignity, then, I can give informed consent to unethical research and practice, something I can't do if ethics are based on personal autonomy.

* If the intent is to develop a myth which explains why things are the way they are in bioethics, then I suppose Pinker's argument against dignity holds. If humans have dignity, then an autonomy-based bioethics is insufficient, so if an autonomy-based bioethics has to be held to be sufficient, then humans have to be held without dignity.