Human Dignity and Bioethics
Edited by Edmund D. Pellegrino, Adam Schulman, and Thomas W. Merrill
University of Notre Dame Press Notre Dame, Indiana
Preface copyright © 2009 by University of Notre Dame Notre Dame, Indiana 46556 www.undpress.nd.edu All Rights Reserved Published in the United States of America
The essays in this volume were commissioned by the President’s Council on Bioethics and are in the public domain. They are published here by special arrangement with the President’s Council on Bioethics.
Library of Congress Cataloging-in-Publication Data Human dignity and bioethics / edited by Edmund D. Pellegrino. p. cm. — (Notre Dame studies in medical ethics) Includes bibliographical references and index. ISBN-13: 978-0-268-03892-2 (pbk. : alk. paper) ISBN-10: 0-268-03892-9 (pbk. : alk. paper) 1. Bioethics. 2. Dignity. I. Pellegrino, Edmund D., 1920– II. President's Council on Bioethics (U.S.) QH332.H842 2008 174'.957—dc22 2009005511
∞ The paper in this book meets the guidelines for permanence and durability of the Committee on Production Guidelines for Book Longevity of the Council on Library Resources.
Contents Preface: The Persisting Relevance of Dignity Edmund D. Pellegrino, with Adam Schulman and Thomas W. Merrill . . . . . . . . . . . . . . .ix Introduction 1 Bioethics and the Question of Human Dignity Adam Schulman . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 2 Human Dignity and Respect for Persons: A Historical Perspective on Public Bioethics F. Daniel Davis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Part I. Dignity and Modern Science 3 How to Protect Human Dignity from Science Daniel C. Dennett . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 4 Human Dignity and the Mystery of the Human Soul Robert P. Kraynak . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 Commentary on Kraynak Daniel C. Dennett . . . . . . . . . . . . . . . . . . . . . . . . . . 83 Commentary on Dennett Robert P. Kraynak . . . . . . . . . . . . . . . . . . . . . . . . . . 89
v
vi | Table of Contents Commentary on Dennett Alfonso Gómez-Lobo . . . . . . . . . . . . . . . . . . . . . . . . 95 5 Human Dignity from a Neurophilosophical Perspective Patricia S. Churchland . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99 Commentary on Churchland Gilbert Meilaender . . . . . . . . . . . . . . . . . . . . . . . . . 122 Part II. Human Nature and the Future of Man 6 Human Uniqueness and Human Dignity: Persons in Nature and the Nature of Persons Holmes Rolston III . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129 7 Human Dignity and the Future of Man Charles Rubin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155 8 Dignity and Enhancement Nick Bostrom . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173 Commentary on Bostrom Charles Rubin . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207 Part III. Dignity and Modern Culture 9 Human Dignity and Public Discourse Richard John Neuhaus . . . . . . . . . . . . . . . . . . . . . . . . . . . . 215 10 Modern and American Dignity Peter Augustine Lawler . . . . . . . . . . . . . . . . . . . . . . . . . . . . 229 11 Human Dignity: Exploring and Explicating the Council’s Vision Gilbert Meilaender . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 253 Commentary on Meilaender and Dennett Peter Augustine Lawler . . . . . . . . . . . . . . . . . . . . . . 278 Commentary on Meilaender and Lawler Diana Schaub . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 284
Table of Contents | vii Part IV. The Sources and Meaning of Dignity 12 Defending Human Dignity Leon R. Kass . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 297 13 Kant’s Concept of Human Dignity as a Resource for Bioethics Susan M. Shell . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 333 14 Human Dignity and Political Entitlements Martha Nussbaum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 351 Commentary on Nussbaum, Shell, and Kass Diana Schaub . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 381 15 The Irreducibly Religious Character of Human Dignity David Gelernter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 387 Part V. Theories of Human Dignity 16 The Nature and Basis of Human Dignity Patrick Lee and Robert P. George . . . . . . . . . . . . . . . . . . . . 409 17 Two Arguments from Human Dignity Paul Weithman . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 435 18 Dignity and Bioethics: History, Theory, and Selected Applications Daniel P. Sulmasy, O.F.M. . . . . . . . . . . . . . . . . . . . . . . . . . 469 Part VI. Human Dignity and the Practice of Medicine 19 Human Dignity and the Seriously Ill Patient Rebecca Dresser . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 505 20 The Lived Experience of Human Dignity Edmund D. Pellegrino . . . . . . . . . . . . . . . . . . . . . . . . . . . 513 Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 541 Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 545
Preface: The Persisting Relevance of Dignity Edmund D. Pellegrino, with Adam Schulman and Thomas W. Merrill Human Dignity and Bioethics was originally published by the President’s Council on Bioethics in response to questions about the Council’s use of the term human dignity. We invited thinkers and scholars from a variety of disciplines and points of view to help us reflect on this controversial yet still compelling idea. Now we are happy to see their work and this volume find a new home and new audiences through the University of Notre Dame Press. In its published reports, the President’s Council on Bioethics has made direct and indirect references to the ethical implications of the concept of human dignity. The Council has not agreed upon, nor recommended, an all-purpose definition of that concept. The reason for this is clear as one peruses this anthology of essays by authorities in fields ranging from theology to philosophy, medicine, and the biological sciences. Each of the essays in this volume examines the concept of human dignity from the perspective of the author’s expertise and moral commitments. Each is, therefore, an exposition of some facet of the reality its author perceives as fundamental. The fact that there is no agreement on the definition of dignity does not mean that there is no truth of the matter, nor does it mean that any definition is as good as any other. ix
x | Preface The Council believes that this collection of essays achieves its original intention—to stimulate reflection and discussion by placing before the public these variegated perspectives on this complex issue. In that way, the public can better understand a concept on which many bioethicists and others ground their arguments about rights, obligations, and even the meaning of what it is to be human. In this sense, this volume complements the earlier Council anthology Being Human: Readings from the President’s Council on Bioethics.* Although neither volume focuses on one particular ethical or bioethical policy or principle, both converge on the question of the meaning of being human, that is, on philosophical or theological anthropology. Ultimately, the most fundamental questions in law and ethics are shaped by what we think it means to be human and what we think are the obligations owed to the human person. It is one thing if man is a unique being in the biosphere, as some think; it is another if, as others insist, he is simply the biosphere’s most complex animal to date. This volume, together with the prior volume Being Human, provides the public and policymakers with the materials for a deeper comprehension of our shared humanity, upon which we all build our answers to life’s most challenging questions. To ignore or belittle the relevance of human dignity for bioethics because there is no agreement on its definition, to assume that one definition is as good as another, or to dispose of the question as “just semantics” is to forget that the central purpose of bioethics is to protect human dignity in the age of biotechnology. * * * * I have asked my colleagues Adam Schulman and Thomas W. Merrill to provide the following topographical outline for the convenience and assistance of the reader. The two essays comprising the introduction to the volume provide a thematic and historical prologue to the eighteen essays and eight commentaries that follow. In “Bioethics * Now available as Being Human: Core Readings in the Humanities, ed. Leon Kass (New York: Norton, 2004).
Preface | xi and the Question of Human Dignity,” Adam Schulman, senior research consultant at the President’s Council and tutor at St. John’s College, introduces the question of human dignity and illustrates how difficult it can be to apply the concept in bioethical controversies. To shed light on why its application to bioethics is so problematic, Schulman examines the complex roots of the modern notion of human dignity—in classical antiquity, Biblical religion, Kantian moral philosophy, and twentieth-century constitutions and inter national declarations. In “Human Dignity and Respect for Persons: A Historical Perspective on Public Bioethics,” F. Daniel Davis, executive director of the President’s Council, situates the Council’s appeals to the notion of human dignity within the context of the history of public bioethics in the United States. Davis compares the work of the President’s Council to that of the earlier National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, the first major national forum for bioethics in the United States. In its landmark 1979 Belmont Report, the National Commission had argued that “respect for persons” or “autonomy” should be the foundational principle of public bioethics. Yet many observers find a bioethics based solely on autonomy to be impoverished and incapable of fully meeting the challenges posed by biomedical advances. According to Davis, the turn to dignity notable in the work of the President’s Council reflects, in part, the Council’s search for a richer and more comprehensive bioethics. A fundamental question about “human dignity” is whether it is compatible with what modern science teaches us about human beings. Furthermore, if modern science proves to be inhospitable to human dignity, can religion or theology provide an alternative foundation? These issues involving human dignity, science, and religion are thematic in the essays of Part I, “Dignity and Modern Science.” In “How to Protect Human Dignity from Science,” Daniel C. Dennett of Tufts University argues that our belief in human dignity is indeed threatened by the discoveries of modern science, but we cannot hope to protect it by recourse to unscientific notions such as a separable or immortal soul. Rather, Dennett suggests, we should accept the results of modern science while paying more attention to the phenomenon of “belief in belief,” i.e., moral opinions ungrounded in science but favorable to the healthy functioning of political societies. In “Human
xii | Preface Dignity and the Mystery of the Human Soul,” Robert P. Kraynak of Colgate University suggests that human dignity is real, but that neither modern science nor Aristotelian philosophy can provide us with a defensible account of it. In contrast, Kraynak argues, Biblical religion is able to do justice to human dignity in part because it acknowledges the genuine mystery of the human soul, which eludes rational analysis. Dennett’s and Kraynak’s views come squarely into conflict, as their lively and stimulating exchange of commentaries reveals. In his comment, Alfonso Gómez-Lobo, a Council member, engages Dennett’s arguments about the moral status of the embryo. In “Human Dignity from a Neurophilosophical Perspective,” Patricia S. Churchland of the University of California at San Diego argues that evolutionary biology and neuroscience can explain how and why dignity became a powerful and useful concept in human society. Churchland suggests that ideas of dignity and morality originally arose as helpful responses to the need for group survival. Yet, she argues, dignity and morality have a tendency to reach beyond their original function and to make absolute claims, claims that often stand in the way of scientific progress—as seen in traditional religious resistance to vaccines, anaesthesia, and, more recently, embryonic stem cell research. In his commentary, Council member Gilbert Meilaender questions whether Churchland’s account of dignity—entirely in terms of utility to the group—can really explain why we human beings care so deeply about dignity and its inviolability. Does human nature as revealed by modern science provide a foundation for belief in human dignity? Furthermore, would human dignity be enhanced or undermined by radical modifications of human nature, such as are envisioned in science fiction and championed by “transhumanists”? Such questions are addressed in the essays of Part II, “Human Nature and the Future of Man.” In “Human Uniqueness and Human Dignity: Persons in Nature and the Nature of Persons,” Holmes Rolston III of Colorado State University argues that, far from undermining human dignity, modern science—including biology, anthropology, and neuropsychology—helps us appreciate the extraordinary features of the human animal that are the grounds for human uniqueness and human dignity. Above all, Rolston suggests, what these sciences reveal is that human beings and only human beings have the capacity to be ethical animals in the full sense. In
Preface | xiii “Human Dignity and the Future of Man,” Charles Rubin of Duquesne University examines the teachings of prominent transhumanists, who foretell and advocate radical biotechnological enhancements to human nature. Rubin finds that, in their enthusiasm for a radically new and transformed human nature, the transhumanists fail to reflect adequately on the goals of such a transformation and on the dangers that may be encountered along the way. In “Dignity and Enhancement,” Nick Bostrom of Oxford University—himself a noted transhumanist—suggests that we cannot judge in the abstract whether a given enhancement will be a boon or a burden, and that it would a mistake to dismiss all enhancements out of hand. Bostrom argues that, rather than undermining human dignity, certain enhancements to human nature are likely to make our dignity more secure and more widely appreciated. The issues dividing Rubin and Bostrom are explored in a commentary by Rubin on Bostrom’s essay. The essays of Part III, “Dignity and Modern Culture,” explore aspects of human dignity in the contemporary American context. In “Human Dignity and Public Discourse,” the late Father Richard John Neuhaus of the journal First Things notes that Americans usually refrain from appealing to comprehensive accounts of morality and religion in order to resolve their political disputes. While on the whole such restraint is commendable, controversies of bioethics— most famously over abortion—make it all but impossible to avoid such appeals, and Neuhaus concludes that, in order to deal with such ethical challenges, we need some notion of the human person as worthy of moral respect at every moment of his or her development. The dignity of the human person, Neuhaus concludes, is indispensable to our political deliberations on how we should live together. In “Modern and American Dignity,” Peter Augustine Lawler of Berry College (and a Council member) reflects on our ambiguous and ambivalent experience of individuality and individualism. As modern individualists, Lawler argues, we refuse to be treated merely as means for the ends of anyone or anything other than ourselves. Yet when we try to give an account of what grounds that individuality, we find it very hard to answer, as we are satisfied neither with the Christian God, nor with Nature’s God as envisioned by early modern scientific and political thought, nor with the various forms of existentialism. Lawler suggests that this American ambivalence about the ground of
xiv | Preface transcendence is both anxiety-producing and a truthful reflection of the human condition. In “Human Dignity: Exploring and Explicating the Council’s Vision,” Gilbert Meilaender examines previous reports of the Council with a view to clarifying the sense of human dignity invoked in them. He finds a tension within the Council’s writings between a comparative sense of dignity, rooted in unequally shared distinctions of excellence, and an egalitarian sense of dignity that recognizes our common humanity throughout all stages and conditions of human life. Meilaender suggests that this tension—which echoes the difference between classical and Christian accounts of human dignity—also reflects a serious division of opinion on the question of human dignity within the Council itself. That issue is in turn taken up and examined from different points of view in commentaries by Peter Lawler and fellow Council member Diana Schaub. Part IV, “The Sources and Meaning of Dignity,” turns away from the contemporary scene to look more deeply at the roots of the notion of human dignity. In “Defending Human Dignity,” Leon R. Kass, the first chairman of the President’s Council on Bioethics, begins by articulating two senses of dignity, the basic dignity shared by all human beings and the full dignity actualized in human flourishing. These two senses of dignity, Kass finds, appear to point in different directions but can be shown to be mutually dependent: together they reveal the uniquely human aspiration for transcendence. In “Kant’s Concept of Human Dignity as a Resource for Bioethics,” Susan M. Shell of Boston College shows how the thought of the German idealist philosopher Immanuel Kant can be brought to bear on matters bioethical. Unlike many interpreters of Kant who see in his thought only a rigid mind-body dualism, Shell discovers a Kant who is far more nuanced and attuned to the embodied character of human rationality. In Shell’s presentation, Kant’s “anthropology” combines a recognition of the importance of protecting individual autonomy with an awareness that mere autonomy cannot help us solve the most problematic issues in bioethics. In “Human Dignity and Political Entitlements,” Martha Nussbaum of the University of Chicago argues that human dignity is of crucial importance in grounding and elaborating an account of political rights and obligations. Nussbaum suggests that a sensible politics of human dignity would focus on preserving the conditions (and fostering the human
Preface | xv capabilities) that are necessary for human flourishing, and she offers some reflections on how her “capabilities approach” would help us deal with some well-known questions in bioethics. Diana Schaub’s commentary addresses issues raise by Nussbaum as well as by Shell and Kass. In “The Irreducibly Religious Character of Human Dignity,” David Gelernter of Yale University argues that Biblical religion is an indispensable source for our notion of human dignity. Reprising some of the themes of the exchange between Dennett and Kraynak, Gelernter suggests that dignity cannot be separated from its religious origins without doing great violence to its meaning and undermining our belief in it. The essays in Part V, “Theories of Human Dignity,” analyze the concept of human dignity and unfold its implications for practice. In “The Nature and Basis of Human Dignity,” Patrick Lee of the Franciscan University of Steubenville and Robert P. George, a Council member and professor at Princeton University, reject claims that dignity or moral status can be defined in terms of interests, sentience, or pleasure, and draw instead on the Thomistic view that human dignity consists in having a nature capable of reason and free choice. They also argue that, in a human being, such a nature should be regarded as worthy of moral respect at all stages of development and decline. In “Two Arguments From Human Dignity,” Paul Weithman of the University of Notre Dame examines two prominent arguments that appeal to human dignity in order to justify political entitlements: the argument that some things (including conditions of gross material deprivation) are simply not fitting for human beings and therefore violate human dignity; and the argument that there are certain threshold capacities without which human beings cannot live lives worthy of a human being, and that human beings are therefore entitled to develop those capacities. Weithman argues that both of these arguments, while initially plausible, ultimately fail to make their case and must be supplemented with arguments more characteristic of the social contract tradition. In “Dignity and Bioethics: History, Theory, and Selected Applications,” Daniel P. Sulmasy, O.F.M., of the New York Medical College and St. Vincent’s Hospital, provides a thorough conceptual analysis of the ways in which the word “dignity” has been used in bioethics and concludes that intrinsic dignity, the dignity we possess simply by virtue of being human, is the most
xvi | Preface fundamental sense of the term. Intrinsic dignity, he argues, provides the foundation for a robust set of moral norms and gives practical guidance on bioethical issues, including access to health care, care of the disabled, embryonic stem cell research, cloning, and others. The essays of Part VI, “Human Dignity and the Practice of Medicine,” turn away from conceptual analysis to focus on the lived experience of human dignity in the encounter between physician and patient. In “Human Dignity and the Seriously Ill Patient,” Rebecca Dresser of Washington University reminds us of the many ways in which the dignity of patients may be threatened, especially in the context of severe illness. Such experiences, Dresser argues, show us that dignity is not the same as autonomy and that it needs to be protected. In “The Lived Experience of Human Dignity,” Dr. Edmund D. Pellegrino, current chairman of the President’s Council on Bioethics, argues that, for a full understanding of human dignity, abstract analysis of the concept is not sufficient; we must also attend to the lived experience of dignity. The meaning of human dignity becomes particularly vivid, Pellegrino argues, in the human predicament of illness, when that dignity is threatened. Such experiences, both Pellegrino and Dresser conclude, illustrate the enduring indispensability of the notion of human dignity for medical practice and human affairs generally.