TheStupidity of Dignity

By

This spring, the President's Council on Bioethics released a
555-page report, titled Human Dignity and Bioethics. The Council,
created in 2001 by George W. Bush, is a panel of scholars charged
with advising the president and exploring policy issues related to
the ethics of biomedical innovation, including drugs that would
enhance cognition, genetic manipulation of animals or humans,
therapies that could extend the lifespan, and embryonic stem cells
and so-called "therapeutic cloning" that could furnish replacements
for diseased tissue and organs. Advances like these, if translated
into freely undertaken treatments, could make millions of people
better off and no one worse off. So what's not to like? The
advances do not raise the traditional concerns of bioethics, which
focuses on potential harm and coercion of patients or research
subjects. What, then, are the ethical concerns that call for a
presidential council?Many people are vaguely disquieted by developments (real or
imagined) that could alter minds and bodies in novel ways.
Romantics and Greens tend to idealize the natural and demonize
technology. Traditionalists and conservatives by temperament
distrust radical change. Egalitarians worry about an arms race in
enhancement techniques. And anyone is likely to have a "yuck"
response when contemplating unprecedented manipulations of our
biology. The President's Council has become a forum for the airing
of this disquiet, and the concept of "dignity" a rubric for
expounding on it. This collection of essays is the culmination of a
long effort by the Council to place dignity at the center of
bioethics. The general feeling is that, even if a new technology
would improve life and health and decrease suffering and waste, it
might have to be rejected, or even outlawed, if it affronted human
dignity.

Whatever that is. 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.

Goaded by Macklin's essay, the Council acknowledged the need to put
dignity on a firmer conceptual foundation. This volume of 28 essays
and commentaries by Council members and invited contributors is
their deliverable, addressed directly to President Bush. The report
does not, the editors admit, settle the question of what dignity is
or how it should guide our policies. It does, however, reveal a
great deal about the approach to bioethics represented by the
Council. And what it reveals should alarm anyone concerned with
American biomedicine and its promise to improve human welfare. For
this government- sponsored bioethics does not want medical practice
to maximize health and flourishing; it considers that quest to be a
bad thing, not a good thing.

To understand the source of this topsy-turvy value system, one has
to look more deeply at the currents that underlie the Council.
Although the Dignity report presents itself as a scholarly
deliberation of universal moral concerns, it springs from a
movement to impose a radical political agenda, fed by fervent
religious impulses, onto American biomedicine.

The report's oddness begins with its list of contributors. Two (Adam
Schulman and Daniel Davis) are Council staffers, and wrote superb
introductory pieces. Of the remaining 21, four (Leon R. Kass, David
Gelernter, Robert George, and Robert Kraynak) are vociferous
advocates of a central role for religion in morality and public
life, and another eleven work for Christian institutions (all but
two of the institutions Catholic). Of course, institutional
affiliation does not entail partiality, but, with three-quarters of
the invited contributors having religious entanglements, one gets a
sense that the fix is in. A deeper look confirms it.

Conspicuous by their absence are several fields of expertise that
one might have thought would have something to offer any discussion
of dignity and biomedicine. None of the contributors is a life
scientist--or a psychologist, an anthropologist, a sociologist, or
a historian. According to one of the introductory chapters, the
Council takes a "critical view of contemporary academic bioethics
and of the way bioethical questions are debated in the public
square"--so critical, it seems, that Macklin (the villain of almost
every piece) was not invited to expand on her argument, nor were
mainstream bioethicists (who tend to be sympathetic to Macklin's
viewpoint) given an opportunity to defend it.

Despite these exclusions, the volume finds room for seven essays
that align their arguments with Judeo-Christian doctrine. We read
passages that assume the divine authorship of the Bible, that
accept the literal truth of the miracles narrated in Genesis (such
as the notion that the biblical patriarchs lived up to 900 years),
that claim that divine revelation is a source of truth, that argue
for the existence of an immaterial soul separate from the physiology
of the brain, and that assert that the Old Testament is the only
grounds for morality (for example, the article by Kass claims that
respect for human life is rooted in Genesis 9:6, in which God
instructs the survivors of his Flood in the code of vendetta:
"Whoso sheddeth man's blood, by man shall his blood be shed, for in
the image of God was man made").

The Judeo-Christian--in some cases, explicitly biblical-- arguments
found in essay after essay in this volume are quite extraordinary.
Yet, aside from two paragraphs in a commentary by Daniel Dennett,
the volume contains no critical examination of any of its religious
claims.

How did the United States, the world's scientific powerhouse, reach
a point at which it grapples with the ethical challenges of
twenty-first-century biomedicine using Bible stories, Catholic
doctrine, and woolly rabbinical allegory? Part of the answer lies
with the outsize influence of Kass, the Council's founding director
(and an occasional contributor to tnr), who came to prominence in
the 1970s with his moralistic condemnation of in vitro
fertilization, then popularly known as "test-tube babies." As soon
as the procedure became feasible, the country swiftly left Kass
behind, and, for most people today, it is an ethical no-brainer.
That did not stop Kass from subsequently assailing a broad swath of
other medical practices as ethically troubling, including organ
transplants, autopsies, contraception, antidepressants, even the
dissection of cadavers.

Kass frequently makes his case using appeals to "human dignity" (and
related expressions like "fundamental aspects of human existence"
and "the central core of our humanity"). In an essay with the
revealing title "L'Chaim and Its Limits, " Kass voiced his
frustration that the rabbis he spoke with just couldn't see what
was so terrible about technologies that would extend life, health,
and fertility. "The desire to prolong youthfulness," he wrote in
reply, is "an expression of a childish and narcissistic wish
incompatible with devotion to posterity." The years that would be
added to other people's lives, he judged, were not worth living:
"Would professional tennis players really enjoy playing 25 percent
more games of tennis?" And, as empirical evidence that "mortality
makes life matter," he notes that the Greek gods lived "shallow and
frivolous lives"--an example of his disconcerting habit of treating
fiction as fact. (Kass cites Brave New World five times in his
Dignity essay.)

Kass has a problem not just with longevity and health but with the
modern conception of freedom. There is a "mortal danger," he
writes, in the notion "that a person has a right over his body, a
right that allows him to do whatever he wants to do with it." He is
troubled by cosmetic surgery, by gender reassignment, and by women
who postpone motherhood or choose to remain single in their
twenties. Sometimes his fixation on dignity takes him right off the
deep end:

Worst of all from this point of view are those more uncivilized
forms of eating, like licking an ice cream cone--a catlike activity
that has been made acceptable in informal America but that still
offends those who know eating in public is offensive. ... Eating on
the street--even when undertaken, say, because one is between
appointments and has no other time to eat--displays [a] lack of
self-control: It beckons enslavement to the belly. ... Lacking
utensils for cutting and lifting to mouth, he will often be seen
using his teeth for tearing off chewable portions, just like any
animal. ... This doglike feeding, if one must engage in it, ought
to be kept from public view, where, even if we feel no shame,
others are compelled to witness our shameful behavior.

And, in 2001, this man, whose pro-death, anti-freedom views put him
well outside the American mainstream, became the President's
adviser on bioethics-- a position from which he convinced the
president to outlaw federally funded research that used new
stem-cell lines. In his speech announcing the stem-cell policy,
Bush invited Kass to form the Council. Kass packed it with
conservative scholars and pundits, advocates of religious
(particularly Catholic) principles in the public sphere, and
writers with a paper trail of skittishness toward biomedical
advances, together with a smattering of scientists (mostly with a
reputation for being religious or politically conservative). After
several members opposed Kass on embryonic stem-cell research, on
therapeutic cloning (which Kass was in favor of criminalizing), and
on the distortions of science that kept finding their way into
Council reports, Kass fired two of them (biologist Elizabeth
Blackburn and philosopher William May) and replaced them with
Christian-affiliated scholars.

Though Kass has jawboned his version of bioethics into governmental
deliberation and policy, it is not just a personal obsession of his
but part of a larger movement, one that is increasingly associated
with Catholic institutions. (In 2005, Kass relinquished the Council
chairmanship to Edmund Pellegrino, an 85-year-old medical ethicist
and former president of the Catholic University of America.)
Everyone knows about the Bush administration's alliance with
evangelical Protestantism. But the pervasive Catholic flavoring of
the Council, particularly its Dignity report, is at first glance
puzzling. In fact, it is part of a powerful but little-known
development in American politics, recently documented by Damon
Linker in his book The Theocons.

For two decades, a group of intellectual activists, many of whom had
jumped from the radical left to the radical right, has urged that
we rethink the Enlightenment roots of the American social order.
The recognition of a right to life, liberty, and the pursuit of
happiness and the mandate of government to secure these rights are
too tepid, they argue, for a morally worthy society. This
impoverished vision has only led to anomie, hedonism, and rampant
immoral behavior such as illegitimacy, pornography, and abortion.
Society should aim higher than this bare-bones individualism and
promote conformity to more rigorous moral standards, ones that
could be applied to our behavior by an authority larger than
ourselves.

Since episodes of divine revelation seem to have decreased in recent
millennia, the problem becomes who will formulate and interpret
these standards. Most of today's denominations are not up to the
task: Evangelical Protestantism is too anti-intellectual, and
mainstream Protestantism and Judaism too humanistic. The Catholic
Church, with its long tradition of scholarship and its rock-solid
moral precepts, became the natural home for this movement, and the
journal First Things, under the leadership of Father Richard John
Neuhaus, its mouthpiece. Catholicism now provides the intellectual
muscle behind a movement that embraces socially conservative Jewish
and Protestant intellectuals as well. When Neuhaus met with Bush in
1998 as he was planning his run for the presidency, they
immediately hit it off.

Three of the original Council members (including Kass) are board
members of First Things, and Neuhaus himself contributed an essay
to the Dignity volume. In addition, five other members have
contributed articles to First Things over the years. The concept of
dignity is natural ground on which to build an obstructionist
bioethics. An alleged breach of dignity provides a way for third
parties to pass judgment on actions that are knowingly and willingly
chosen by the affected individuals. It thus offers a moralistic
justification for expanded government regulation of science,
medicine, and private life. And the Church's franchise to guide
people in the most profound events of their lives-- birth, death,
and reproduction--is in danger of being undermined when biomedicine
scrambles the rules. It's not surprising, then, that "dignity" is a
recurring theme in Catholic doctrine: The word appears more than 100
times in the 1997 edition of the Catechism and is a leitmotif in
the Vatican's recent pronouncements on biomedicine.

To be fair, most of the chapters in the Dignity volume don't appeal
directly to Catholic doctrine, and of course the validity of an
argument cannot be judged from the motives or affiliations of its
champions. Judged solely on the merits of their arguments, how well
do the essayists clarify the concept of dignity?

By their own admission, not very well. Almost every essayist
concedes that the concept remains slippery and ambiguous. In fact,
it spawns outright contradictions at every turn. We read that
slavery and degradation are morally wrong because they take
someone's dignity away. But we also read that nothing you can do to
a person, including enslaving or degrading him, can take his
dignity away. We read that dignity reflects excellence, striving,
and conscience, so that only some people achieve it by dint of
effort and character. We also read that everyone, no matter how
lazy, evil, or mentally impaired, has dignity in full measure.
Several essayists play the genocide card and claim that the horrors
of the twentieth century are what you get when you fail to hold
dignity sacrosanct. But one hardly needs the notion of "dignity" to
say why it's wrong to gas six million Jews or to send Russian
dissidents to the gulag.

So, despite the best efforts of the contributors, the concept of
dignity remains a mess. The reason, I think, is that dignity has
three features that undermine any possibility of using it as a
foundation for bioethics.

First, dignity is relative. One doesn't have to be a scientific or
moral relativist to notice that ascriptions of dignity vary
radically with the time, place, and beholder. In olden days, a
glimpse of stocking was looked on as something shocking. We chuckle
at the photographs of Victorians in starched collars and wool suits
hiking in the woods on a sweltering day, or at the Brahmins and
patriarchs of countless societies who consider it beneath their
dignity to pick up a dish or play with a child. Thorstein Veblen
wrote of a French king who considered it beneath his dignity to
move his throne back from the fireplace, and one night roasted to
death when his attendant failed to show up. Kass finds other people
licking an ice-cream cone to be shamefully undignified; I have no
problem with it.

Second, dignity is fungible. The Council and Vatican treat dignity
as a sacred value, never to be compromised. In fact, every one of
us voluntarily and repeatedly relinquishes dignity for other goods
in life. Getting out of a small car is undignified. Having sex is
undignified. Doffing your belt and spread- eagling to allow a
security guard to slide a wand up your crotch is undignified. Most
pointedly, modern medicine is a gantlet of indignities. Most readers
of this article have undergone a pelvic or rectal examination, and
many have had the pleasure of a colonoscopy as well. We repeatedly
vote with our feet (and other body parts) that dignity is a trivial
value, well worth trading off for life, health, and safety.

Third, dignity can be harmful. In her comments on the Dignity
volume, Jean Bethke Elshtain rhetorically asked, "Has anything good
ever come from denying or constricting human dignity?" The answer
is an emphatic "yes." Every sashed and bemedaled despot reviewing
his troops from a lofty platform seeks to command respect through
ostentatious displays of dignity. Political and religious
repressions are often rationalized as a defense of the dignity of a
state, leader, or creed: Just think of the Salman Rushdie fatwa, the
Danish cartoon riots, or the British schoolteacher in Sudan who
faced flogging and a lynch mob because her class named a teddy bear
Mohammed. Indeed, totalitarianism is often the imposition of a
leader's conception of dignity on a population, such as the
identical uniforms in Maoist China or the burqas of the Taliban.

A free society disempowers the state from enforcing a conception of
dignity on its citizens. Democratic governments allow satirists to
poke fun at their leaders, institutions, and social mores. And they
abjure any mandate to define "some vision of 'the good life'" or
the "dignity of using [freedom] well" (two quotes from the
Council's volume). The price of freedom is tolerating behavior by
others that may be undignified by our own lights. I would be happy
if Britney Spears and "American Idol" would go away, but I put up
with them in return for not having to worry about being arrested by
the ice-cream police. This trade-off is very much in America's DNA
and is one of its great contributions to civilization: my country
'tis of thee, sweet land of liberty.

So is dignity a useless concept? Almost. The word does have an
identifiable sense, which gives it a claim, though a limited one,
on our moral consideration.

Dignity is a phenomenon of human perception. Certain signals from
the world trigger an attribution in the mind of a perceiver. Just
as converging lines in a drawing are a cue for the perception of
depth, and differences in loudness between the two ears cue us to
the position of a sound, certain features in another human being
trigger ascriptions of worth. These features include signs of
composure, cleanliness, maturity, attractiveness, and control of the
body. The perception of dignity in turn elicits a response in the
perceiver. Just as the smell of baking bread triggers a desire to
eat it, and the sight of a baby's face triggers a desire to protect
it, the appearance of dignity triggers a desire to esteem and
respect the dignified person.

This explains why dignity is morally significant: We should not
ignore a phenomenon that causes one person to respect the rights
and interests of another. But it also explains why dignity is
relative, fungible, and often harmful. Dignity is skin-deep: it's
the sizzle, not the steak; the cover, not the book. What ultimately
matters is respect for the person, not the perceptual signals that
typically trigger it. Indeed, the gap between perception and
reality makes us vulnerable to dignity illusions. We may be
impressed by signs of dignity without underlying merit, as in the
tin-pot dictator, and fail to recognize merit in a person who has
been stripped of the signs of dignity, such as a pauper or
refugee.

Exactly what aspects of dignity should we respect? For one thing,
people generally want to be seen as dignified. Dignity is thus one
of the interests of a person, alongside bodily integrity and
personal property, that other people are obligated to respect. We
don't want anyone to stomp on our toes; we don't want anyone to
steal our hubcaps; and we don't want anyone to open the bathroom
door when we're sitting on the john. A value on dignity in this
precise sense does have an application to biomedicine, namely
greater attention to the dignity of patients when it does not
compromise their medical treatment. The volume contains fine
discussions by Pellegrino and by Rebecca Dresser on the avoidable
humiliations that today's patients are often forced to endure (like
those hideous hospital smocks that are open at the back). No one
could object to valuing dignity in this sense, and that's the
point. When the concept of dignity is precisely specified, it
becomes a mundane matter of thoughtfulness pushing against
callousness and bureaucratic inertia, not a contentious moral
conundrum. And, because it amounts to treating people in the way
that they wish to be treated, ultimately it's just another
application of the principle of autonomy.

There is a second reason to give dignity a measure of cautious
respect. Reductions in dignity may harden the perceiver's heart and
loosen his inhibitions against mistreating the person. When people
are degraded and humiliated, such as Jews in Nazi Germany being
forced to wear yellow armbands or dissidents in the Cultural
Revolution being forced to wear grotesque haircuts and costumes,
onlookers find it easier to despise them. Similarly, when refugees,
prisoners, and other pariahs are forced to live in squalor, it can
set off a spiral of dehumanization and mistreatment. This was
demonstrated in the famous Stanford prison experiment, in which
volunteers assigned to be "prisoners" had to wear smocks and leg
irons and were referred to by serial numbers instead of names. The
volunteers assigned to be "guards" spontaneously began to brutalize
them. Note, though, that all these cases involve coercion, so once
again they are ruled out by autonomy and respect for persons. So,
even when breaches of dignity lead to an identifiable harm, it's
ultimately autonomy and respect for persons that gives us the
grounds for condemning it.

Could there be cases in which a voluntary relinquishing of dignity
leads to callousness in onlookers and harm to third parties--what
economists call negative externalities? In theory, yes. Perhaps if
people allowed their corpses to be publicly desecrated, it would
encourage violence against the bodies of the living. Perhaps the
sport of dwarf-tossing encourages people to mistreat all dwarves.
Perhaps violent pornography encourages violence against women. But,
for such hypotheses to justify restrictive laws, they need empirical
support. In one's imagination, anything can lead to anything else:
Allowing people to skip church can lead to indolence; letting women
drive can lead to sexual licentiousness. In a free society, one
cannot empower the government to outlaw any behavior that offends
someone just because the offendee can pull a hypothetical future
injury out of the air. No doubt Mao, Savonarola, and Cotton Mather
could provide plenty of reasons why letting people do what they
wanted would lead to the breakdown of society.

The sickness in theocon bioethics goes beyond imposing a Catholic
agenda on a secular democracy and using "dignity" to condemn
anything that gives someone the creeps. Ever since the cloning of
Dolly the sheep a decade ago, the panic sown by conservative
bioethicists, amplified by a sensationalist press, has turned the
public discussion of bioethics into a miasma of scientific
illiteracy. Brave New World, a work of fiction, is treated as
inerrant prophesy. Cloning is confused with resurrecting the dead
or mass-producing babies. Longevity becomes "immortality,"
improvement becomes "perfection," the screening for disease genes
becomes "designer babies" or even "reshaping the species." The
reality is that biomedical research is a Sisyphean struggle to eke
small increments in health from a staggeringly complex,
entropy-beset human body. It is not, and probably never will be, a
runaway train.

A major sin of theocon bioethics is exactly the one that it sees in
biomedical research: overweening hubris. In every age, prophets
foresee dystopias that never materialize, while failing to
anticipate the real revolutions. Had there been a President's
Council on Cyberethics in the 1960s, no doubt it would have decried
the threat of the Internet, since it would inexorably lead to 1984,
or to computers "taking over" like HAL in 2001. Conservative
bioethicists presume to soothsay the outcome of the
quintessentially unpredictable endeavor called scientific research.
And they would stage-manage the kinds of social change that, in a
free society, only emerge as hundreds of millions of people weigh
the costs and benefits of new developments for themselves,
adjusting their mores and dealing with specific harms as they
arise, as they did with in vitro fertilization and the Internet.

Worst of all, theocon bioethics flaunts a callousness toward the
billions of non-geriatric people, born and unborn, whose lives or
health could be saved by biomedical advances. Even if progress were
delayed a mere decade by moratoria, red tape, and funding taboos
(to say nothing of the threat of criminal prosecution), millions of
people with degenerative diseases and failing organs would
needlessly suffer and die. And that would be the biggest affront to
human dignity of all.

Steven Pinker is Johnstone Professor of Psychology at Harvard and
the author of The Stuff of Thought.

By Steven Pinker

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