Some of what Ruth Macklin says about dignity is uncontentious:
appeals to dignity are often vague; the concept is interpreted variously;
references to it sometimes appear sloganistic; and it is often reduced to
respect for autonomy or for persons.
What is contentious is that dignity is useless and could be
eliminated without any loss of content to medical ethics. Dignity cannot
and should not be reduced to respect for autonomy or for persons. Rather
it constitutes an otherwise missing value which enables practitioners and
theorists to discuss aspects of medical practice which other values do not
address.
Criticisms of dignity apply also to other values in medical ethics.
‘Autonomy’ and ‘respect for persons’ are good examples. They also appear
as vague, ill-defined and sometimes sloganistic in codes, reports and in
legislation. Whilst theorists make laudable attempts to clarify these
concepts, such clarification may fail to make its way into professional
documents. This is also the case with dignity. There is now a good deal of
theoretical and empirical work to draw on which makes vague references to
dignity inexcusable. The rapid responses here are likely to advance
thinking on this topic, most significantly, the response of Arthur Caplan.
Fairly extensive previous work also deserves attention. See, for example,
the work of Spiegelberg in Gotesky and Laszlo 1970; Mairis 1994; Haddock
1996; Moody 1998; Mann 1998; Pullman 1999; Seedhouse and Gallagher 2002;
and Nordenfelt 2003.
In response to Professor Macklin’s question ‘Why, then, do so many
articles and reports appeal to human dignity, as it if means something
over and above respect for persons or for their autonomy?’ it might be
asserted ‘Because it does mean something over and above respect for
persons and autonomy’. More, of course, needs to be said. Just as vague
and sloganistic references to dignity will not do so, too, with respect
for autonomy and for persons and these values need to be elucidated.
Autonomy has a range of meanings (See, for example, Husted in Chadwick et
al 1997) and what is meant by respect for persons is not always clear. A
Lockean view of respect for persons, for example, focuses on rational
capacity. If, as is generally held, respect for autonomy and for persons
emphasise and focus on the rational and decision-making capacity of
patients then these values seem insufficient in discussions about the
treatment or non-treatment of those who are incompetent, of body parts or
of the dead. Another value is necessary. That value is dignity. A value
which acknowledges the worth of humans qua human regardless of competence,
sentience or body form. Without dignity, it seems, there can be little (if
any) meaningful discussion about the rights and wrongs of the treatment of
those deemed non-autonomous or non-persons. Dignity is not only a useful
value it is, in fact, an essential one. What Professor’s Macklin’s
provocative piece urges us to do is not to throw dignity out but rather to
reclaim it, embrace it, draw on and develop existing theoretical and
empirical work and not refer to it glibly, vaguely or thoughtlessly.
References
Haddock J. (1996) ‘Towards further clarification of the concept
‘dignity’’ Journal of Advanced Nursing 24, pp.924-931
Husted J. ‘Autonomy and a right not to know’ in Chadwick R., Levitt
M. and Shickle D. (eds.) (1997) The Right to Know and the Right Not to
Know Avebury, Aldershot
Mairis E.D. (1994) ‘Concept clarification in professional practice:
dignity’ Journal of Advanced Nursing Vol. 3, pp. 947-953
Mann J. (1998) ‘Dignity and Health: The UDHR’s Revolutionary First
Article’ Health and Human Rights Vol. 3, No. 2, pp. 31-38
Moody H.R. (1998) ‘Why Dignity in Old Age Matters’ Journal of
Gerontological Social Work Vol. 29, No. 2/3, pp.26-36
Nordenfelt L. (2003) ‘Dignity of the elderly: An Introduction’
Medicine, Health Care and Philosophy 6, pp.99-101
Seedhouse D. and Gallagher A. (2002) ‘Undignifying Institutions’
Journal of Medical Ethics 28, pp.368-372
Spiegelberg H. ‘Human Dignity: A Challenge to Contemporary
Philosophy’ in Gotesky R. and Laszlo (eds) (1970) Human Dignity: This
Century and the Next Gordon and Breach, Science Publishers, New York
Rapid Response:
Defending Dignity
Some of what Ruth Macklin says about dignity is uncontentious:
appeals to dignity are often vague; the concept is interpreted variously;
references to it sometimes appear sloganistic; and it is often reduced to
respect for autonomy or for persons.
What is contentious is that dignity is useless and could be
eliminated without any loss of content to medical ethics. Dignity cannot
and should not be reduced to respect for autonomy or for persons. Rather
it constitutes an otherwise missing value which enables practitioners and
theorists to discuss aspects of medical practice which other values do not
address.
Criticisms of dignity apply also to other values in medical ethics.
‘Autonomy’ and ‘respect for persons’ are good examples. They also appear
as vague, ill-defined and sometimes sloganistic in codes, reports and in
legislation. Whilst theorists make laudable attempts to clarify these
concepts, such clarification may fail to make its way into professional
documents. This is also the case with dignity. There is now a good deal of
theoretical and empirical work to draw on which makes vague references to
dignity inexcusable. The rapid responses here are likely to advance
thinking on this topic, most significantly, the response of Arthur Caplan.
Fairly extensive previous work also deserves attention. See, for example,
the work of Spiegelberg in Gotesky and Laszlo 1970; Mairis 1994; Haddock
1996; Moody 1998; Mann 1998; Pullman 1999; Seedhouse and Gallagher 2002;
and Nordenfelt 2003.
In response to Professor Macklin’s question ‘Why, then, do so many
articles and reports appeal to human dignity, as it if means something
over and above respect for persons or for their autonomy?’ it might be
asserted ‘Because it does mean something over and above respect for
persons and autonomy’. More, of course, needs to be said. Just as vague
and sloganistic references to dignity will not do so, too, with respect
for autonomy and for persons and these values need to be elucidated.
Autonomy has a range of meanings (See, for example, Husted in Chadwick et
al 1997) and what is meant by respect for persons is not always clear. A
Lockean view of respect for persons, for example, focuses on rational
capacity. If, as is generally held, respect for autonomy and for persons
emphasise and focus on the rational and decision-making capacity of
patients then these values seem insufficient in discussions about the
treatment or non-treatment of those who are incompetent, of body parts or
of the dead. Another value is necessary. That value is dignity. A value
which acknowledges the worth of humans qua human regardless of competence,
sentience or body form. Without dignity, it seems, there can be little (if
any) meaningful discussion about the rights and wrongs of the treatment of
those deemed non-autonomous or non-persons. Dignity is not only a useful
value it is, in fact, an essential one. What Professor’s Macklin’s
provocative piece urges us to do is not to throw dignity out but rather to
reclaim it, embrace it, draw on and develop existing theoretical and
empirical work and not refer to it glibly, vaguely or thoughtlessly.
References
Haddock J. (1996) ‘Towards further clarification of the concept
‘dignity’’ Journal of Advanced Nursing 24, pp.924-931
Husted J. ‘Autonomy and a right not to know’ in Chadwick R., Levitt
M. and Shickle D. (eds.) (1997) The Right to Know and the Right Not to
Know Avebury, Aldershot
Mairis E.D. (1994) ‘Concept clarification in professional practice:
dignity’ Journal of Advanced Nursing Vol. 3, pp. 947-953
Mann J. (1998) ‘Dignity and Health: The UDHR’s Revolutionary First
Article’ Health and Human Rights Vol. 3, No. 2, pp. 31-38
Moody H.R. (1998) ‘Why Dignity in Old Age Matters’ Journal of
Gerontological Social Work Vol. 29, No. 2/3, pp.26-36
Nordenfelt L. (2003) ‘Dignity of the elderly: An Introduction’
Medicine, Health Care and Philosophy 6, pp.99-101
Seedhouse D. and Gallagher A. (2002) ‘Undignifying Institutions’
Journal of Medical Ethics 28, pp.368-372
Spiegelberg H. ‘Human Dignity: A Challenge to Contemporary
Philosophy’ in Gotesky R. and Laszlo (eds) (1970) Human Dignity: This
Century and the Next Gordon and Breach, Science Publishers, New York
Competing interests:
None declared
Competing interests: No competing interests