In “Dignity is a useless concept,” Macklin’s argument ignores an
important historical fact, commits the naturalistic fallacy and would,
based on these oversights, risk the competent, caring practice of
medicine.
First, if one looks at the history of the use of the word
“dignity,” it is clear that each philosophical age has changed its
meaning. For example, dignity referred to external, formal honor in
Aristotle’s time, while Cicero associates it with character.1 Pico della
Mirandola2 links dignity theologically to free choice. Dignity was a
first principle, which Kant3 used to develop the concepts of respect for
persons and autonomy. Hermeneutics would suggest that like other
fundamental concepts, dignity requires contemporary philosophical
interpretation.
Second, I agree with Macklin’s point that currently
dignity is most often invoked as a slogan. However, it would be wrong to
allow such inappropriate and confused use to lead to the conclusion that
dignity ought to or only can be used this way. As others have noted,
dignity is a word in need of a taxonomy.4
Third, the most important
reason that respect for dignity needs to be a bioethical principle is
that, as a premise, it has founded contemporary standards of medical care.
Clinicians’ moral stances influence medical processes and outcomes. While
space precludes argument of the following,5 reflection shows that
respecting dignity enables clinicians to create clinical contexts that
allow them to become more deeply familiar with the genuine patient and her
circumstances than they are under conditions of autonomy. Respect for
dignity is thereby a requisite for high quality medical assessment,
treatment, and good patient outcomes. In other words, branding dignity a
useless concept abolishes the profound respect most associate with persons
and endorses a medicine that could accept patients as physiological
entities and only if they commanded respect on evaluative bases of
characteristics such as demographic descriptors or social mores. Indeed,
as shown elsewhere,5 if “dignity is a useless concept” then medicine must
be prepared to forfeit care, justice, and its current standards for
quality.
1 Cicero. De Officiis. Book 1,XX - XXI Passage 69. Trans. Walter
Miller. Harvard Univ. Press: Cambridge, MA; 1913, p.71
2 Pico Della Mirandola, Giovanni. Oration on the Dignity of Man. trans.
A. Robert Caponigri. Regnery Publishing, Inc.; Washington, D.C.: 1956
3 Kant, Immanuel II:71 (435 –436) Groundwork of the Metaphysics of
Morals. trans. H.D. Paton. Harper and Row; New York: 1964.
4 Mann JM, Gostin L, Gruskin S, Brennan T, Lazzarini Z, Fineberg H.
“Health and Human Rights.” Chap. 1 in. Mann JM, Gruskin S, Grodin MA,
Annas GJ, Eds. Health and Human Rights: A Reader. Routledge: New York
City; 1999, p 15.
5 Mayer, L. Respect for Dignity and Medicine. Article currently
submitted for publication.
Rapid Response:
Clarifying the Concept of Dignity
In “Dignity is a useless concept,” Macklin’s argument ignores an
important historical fact, commits the naturalistic fallacy and would,
based on these oversights, risk the competent, caring practice of
medicine.
First, if one looks at the history of the use of the word
“dignity,” it is clear that each philosophical age has changed its
meaning. For example, dignity referred to external, formal honor in
Aristotle’s time, while Cicero associates it with character.1 Pico della
Mirandola2 links dignity theologically to free choice. Dignity was a
first principle, which Kant3 used to develop the concepts of respect for
persons and autonomy. Hermeneutics would suggest that like other
fundamental concepts, dignity requires contemporary philosophical
interpretation.
Second, I agree with Macklin’s point that currently
dignity is most often invoked as a slogan. However, it would be wrong to
allow such inappropriate and confused use to lead to the conclusion that
dignity ought to or only can be used this way. As others have noted,
dignity is a word in need of a taxonomy.4
Third, the most important
reason that respect for dignity needs to be a bioethical principle is
that, as a premise, it has founded contemporary standards of medical care.
Clinicians’ moral stances influence medical processes and outcomes. While
space precludes argument of the following,5 reflection shows that
respecting dignity enables clinicians to create clinical contexts that
allow them to become more deeply familiar with the genuine patient and her
circumstances than they are under conditions of autonomy. Respect for
dignity is thereby a requisite for high quality medical assessment,
treatment, and good patient outcomes. In other words, branding dignity a
useless concept abolishes the profound respect most associate with persons
and endorses a medicine that could accept patients as physiological
entities and only if they commanded respect on evaluative bases of
characteristics such as demographic descriptors or social mores. Indeed,
as shown elsewhere,5 if “dignity is a useless concept” then medicine must
be prepared to forfeit care, justice, and its current standards for
quality.
1 Cicero. De Officiis. Book 1,XX - XXI Passage 69. Trans. Walter
Miller. Harvard Univ. Press: Cambridge, MA; 1913, p.71
2 Pico Della Mirandola, Giovanni. Oration on the Dignity of Man. trans.
A. Robert Caponigri. Regnery Publishing, Inc.; Washington, D.C.: 1956
3 Kant, Immanuel II:71 (435 –436) Groundwork of the Metaphysics of
Morals. trans. H.D. Paton. Harper and Row; New York: 1964.
4 Mann JM, Gostin L, Gruskin S, Brennan T, Lazzarini Z, Fineberg H.
“Health and Human Rights.” Chap. 1 in. Mann JM, Gruskin S, Grodin MA,
Annas GJ, Eds. Health and Human Rights: A Reader. Routledge: New York
City; 1999, p 15.
5 Mayer, L. Respect for Dignity and Medicine. Article currently
submitted for publication.
Competing interests:
None declared
Competing interests: No competing interests