Human Dignity and Bioethics

Human Dignity and the Seriously Ill Patient | 507
of-life context, she contends that appeals to dignity are actually appeals
to promote patient autonomy in decisions about life-sustaining
treatment. Appeals to dignity may also stand in for other principles,
such as respect for persons, confidentiality in the doctor-patient relationship,
or bans on “discriminatory and abusive practices.” Macklin
concludes that dignity “is a useless concept in medical ethics and can
be eliminated without any loss of content.” 4
Macklin’s provocative challenge has generated many responses
and in that sense has served as a useful trigger to further examination
of the dignity concept. Although some writers share Macklin’s disdain
for the concept, others see human dignity as a distinct ideal, one
that is both morally and practically significant. I am part of the second
group. Like any other moral arguments, appeals to dignity may
be inappropriate or superficial, or they may mask inadequately supported
claims. But it does not follow from this that bioethics should
abandon appeals to dignity.
Macklin’s argument that we should eliminate dignity from bioethics
analysis is unpersuasive for at least three reasons. First, the
claim that the concept of dignity is too vague to be useful implies
that other bioethics concepts are free of this problem. 5 Yet many bioethics
concepts are imprecise. Examples are the concepts of justice,
fairness, and rights. 6 All of these concepts are defined and applied
in a variety of ways by different groups and individuals. Indeed, the
proper meaning of the concepts Macklin prefers, such as autonomy,
respect for persons, discrimination, and abuse, are sufficiently imprecise
to generate extensive scholarly debate over how they should be
defined and applied. Macklin sets up a double standard in demanding
a clear and widely accepted definition of dignity.
Second, Macklin’s critique is premature. It is true that individuals
and groups invoking dignity in bioethics do not always supply a
clear account of its meaning. And bioethics scholars have not devoted
much effort to discussing the concept. 7 Yet these are not reasons
to abandon dignity. Rather, they are reasons to pay more attention
to it. The shortcomings of the existing literature should attract more
scholarly work and policy debates over the proper meaning and applications
of human dignity.
Other writers make similar arguments. While acknowledging that
dignity can mean different things to different people, Ann Gallagher