Book Review
Human Dignity and Bioethics: Essays Commissioned by the President's Council on Bioethics
N Engl J Med 2008; 359:660-661August 7, 2008
- Article
Human Dignity and Bioethics: Essays Commissioned by the President's Council on Bioethics
By Adam Schulman, F. Daniel Davis, and Daniel C. Dennett, with 20 others. 555 pp. Washington, DC, The President's Council on Bioethics, 2008. $49. ISBN: 978-0-16-080071-9 ; Government Printing Office Stock Number 017-023-00218-0.In 2001, President George W. Bush established the President's Council on Bioethics and appointed Leon Kass as its chair. Under Kass's direction, the council issued reports on caregiving, stem-cell research, cloning, assisted reproduction, and biomedical enhancement. The reports frequently invoked, but never defined, the notion of human dignity. Bioethicist Ruth Macklin famously took the council to task for this omission, arguing that the concept of dignity added nothing to bioethical inquiry that was not already captured by the principle of autonomy. Other critics went further, charging that the council employed the language of human dignity so loosely that it was nothing more than a rhetorical trump card used to reject policies that were at odds with the Bush administration's perspective.
Human Dignity and Bioethics, the first report issued under the council's new chair, Edmund Pellegrino, aims to respond to critics of this use of the word “dignity” and to clarify its meaning. Pellegrino suggests that “by putting the question [of dignity's meaning] to a diverse group of scholars,” the report provides “a sense of the breadth of opinions” on this subject. Diversity and breadth come in many forms — political, religious, professional — but none are well represented in this volume.
Of the anthology's 20 essays, more than half are penned by authors who either work for Christian institutions or identify themselves as members of the Catholic church. More than a third of the authors have published pieces in neoconservative journals or are members of neoconservative think tanks. And they are even less diverse professionally: the contributors are overwhelmingly philosophers and political scientists, with a nod to lawyers and physicians but not even a wink at bench scientists.
Though one's credentials need not predict one's viewpoint, in this volume there are few substantive surprises. Human dignity is largely proffered as a touchstone — if not the touchstone — for bioethical reflection. For most of the authors, the source of human dignity is theological or metaphysical: human beings have dignity because they are made in God's image or because they possess certain features intrinsic to humanity, such as rationality. Insofar as dignity is at the core of humanity, assaults on dignity are seen as threats to human life.
This perspective leads to predictable policy positions. With few exceptions, the authors deploy human dignity as a moral stop sign to constrain activities that have long troubled neoconservatives and adherents of traditional Judeo-Christian views: abortion, embryo research, cloning, stem-cell research, assisted suicide, and human enhancement.
One could imagine these authors — who believe that dignity is an attribute of all human beings — logically concluding that dignity also requires society to provide famine relief, education, and universal access to health care. Failure to make these resources available arguably violates the dignity of millions of people who face the dehumanizing consequences of hunger, illiteracy, and a lack of health care. That just one author, Martha Nussbaum, appeals to dignity to advocate for social entitlements underscores the degree to which this report wraps political and religious agendas in the guise of dignity.
To serve as such a blunt instrument, dignity need not be given much texture or depth. On the whole, for example, the volume neglects to explore whether one's dignity can be violated without being diminished or destroyed; whether one can choose to be treated in ways others might consider undignified; whether dignity marks a floor of decency below which treatment of humans should not fall; or whether dignity signifies a degree of excellence toward which all humans should strive. Council member Gilbert Meilaender's essay skillfully sorts through some of these nuances, but the book is otherwise disappointingly weak on such crucial distinctions.
So much of the volume is devoted to theological and metaphysical expositions of dignity that important discussions of dignity's role in medical practice are marginalized to the last two chapters. These essays, one written by Pellegrino and the other by council member Rebecca Dresser, thoughtfully describe dignity as it is experienced by patients. Insofar as they assume no previous theoretical knowledge, they provide a welcome counterpoint to the less accessible “boutique bioethics” that characterizes most of the report.
Those defending the report's diversity may point to these essays and the few others that deviate from its central message. But authors who do not hew to the party line are subjected to withering criticism in commentaries that follow their essays. Consider Meilaender's response to atheist philosopher Patricia Churchland's essay. He closes by telling Churchland, who rejects theological grounds for dignity, that if she cannot understand Catholic objections to certain biomedical practices, “the most dignified thing [for her] to do would be to remain silent.”
Diana Schaub's commentary on Nussbaum's essay is similarly disparaging. Nussbaum, who views dignity as a vehicle for expanding freedom, favors decriminalizing drug use, prostitution, and assisted suicide. She also advocates expanding access to resources that improve health, such as recreation. Rather than criticize Nussbaum on the merits, Schaub responds that Nussbaum's proposal would create “repellant results” in which “heroin-addled `sex workers' . . . have a political entitlement to bicycle paths” and people who are “brain-injured, or persistently vegetative from all those legal drugs,” could be “ease[d] off” by caregivers. This mischaracterization of Nussbaum's position leaves the reader with the impression that the council is not willing to entertain opposing viewpoints.
The most glaring example of this tendency is the council's decision to silence its loudest critic. Despite the central role that Macklin continues to play in this debate, and the invective leveled against her (Pellegrino chastises her for making “rash assertions” in her “diatribe against the idea of human dignity”), she was not invited to contribute to the report. Her absence from the dialogue undermines the council's promise to produce the honest, even-handed, and productive exploration that the concept of human dignity deserves.
Leslie A. Meltzer, J.D., M.Sc.
Johns Hopkins Berman Institute of Bioethics, Baltimore, MD 21205- Citing Articles (2)
