Intended for healthcare professionals

Rapid response to:


Dignity is a useless concept

BMJ 2003; 327 doi: (Published 18 December 2003) Cite this as: BMJ 2003;327:1419

Rapid Response:

Dignity as tacit

Ruth Macklin argues that pruning a multivalenced term from the
ethical lexicon, namely ‘dignity’, will result in no loss of content or
substance ethically or, ultimately, culturally: perhaps clarity will be
gained thereby. One may instead equate dignity with "respect for persons
or their autonomy" [1]. However, is ‘person’ for which one is to have
respect less rich or conflicted a concept, or less excisable for example
when equated with autonomous moral agent (excluding those who not yet, no
longer, or may never fully actualize this human potential)? Autonomy is a
good that is a precondition for engaging in a broad range of human actions
(healing or injurious), but it is not the only good – and as a concept it
may be that it is called upon to do too much work in ethical
consideration. (In particular this applies where ethics is limited to the
articulation of the implications of autonomy - the potentials and powers
and interests of autonomous agents, defined in terms of a capacity to
conceptualize, articulate and pursue explicit goals – in extremis denying
all else.)

With greatly limited autonomy, a person (say with mental retardation)
can live a life ‘of dignity.’ Yet does such a one have a claim upon us in
this regard whether or not they can articulate it (that is without
autonomy and before cultural ‘concessions’)? A recognition (rather than
mere assigning [2]) of dignity in the absence of autonomy is requisite to
call culture to account towards providing conditions for such a life ‘of
dignity’. Recognition implies that there is something present that a
culture may acknowledge, be blind to, see but ignore for reasons of
immediate utility, or perhaps have come into focus and gain force through
a process of reflection. One with mental retardation may not be able to
articulate a personal let alone generic vision of dignity or defend their
‘interest’ in it, yet culture is wrong not to respond to it or infirm not
to see it. Moreover, dignity’s interests (inhering in particulars) apply
to the dead as well as to the living (as painfully clear in the Georgia
undertaking scandal of 2002) [3].

Certainly any recognition of dignity takes place in cultural context
and has constructive elements in expression which may vary widely. But
dignity reduced to social construct (performatively assigned) cannot do
the work of challenging ‘culture’ to provide conditions supportive of a
‘life of dignity’ when such conditions are or become seriously
inconvenient. If assignable, dignity may be rescinded when it does not
serve the interest of ‘culture.’ (This is quite different from a culture -
a shorthand for individuals and institutions - unable to fulfill
recognized duties to either the living or the dead, say in the event of
famine or epidemic. One would say it is possible they did not receive
their due given a tragedy of circumstance, but without culpability.)

In recognition dignity is responded to duly or perhaps ignored, but
is not assigned. In the ‘performative model’ (where dignity exists if
assigned, or evaporates if rescinded), there can be no ‘truth of dignity’
from which to ‘speak truth to power’. Here, flexible to changing fiat (or
calculus), ‘dignity’ may tend to serve a very specific interest of culture
– namely the prevailing powers in culture (perhaps the elite of culture),
or of a local prevailing power where the interests of power are not
limited by a compelling reason not to actualize all potentials and goals
(admitting here goals pursued for seeming majority interest may be for woe
as well as weal). Without ascribing ill motives, denying dignity or making
it contingent may serve the interests of the powerful contra the
vulnerable. (But where ill motives are obvious, extreme but instructive
examples, such as in the rhetorical history of ethnic cleansing, reveal
the psychological advantages of unassigning dignity for endeavors
considered justified or useful yet outside the previous cultural norm.)
In curcumstances of increasing burden, the vulnerable are unlikely to gain
purchase on utilitarian grounds where the effective powers that assign or
rescind dignity also define the implicit utility function and unit of

An ‘only social construct’ account of dignity finally hobbles under
the same 'scope problem' found in behaviorist reductions (all human
activity as 'only behavior'): While describing an aspect, the reduction
cannot engage distinctions that are most vital [4]. An alternative to
deleting or reducing dignity to contingent cultural assignment, without
denying context, is understandng dignity as recognizable in human life
because it names something tacitly present – also when its bearer is not
autonomous.[5] If tacit it may be “implied or indicated yet not actually
expressed” by its bearer[6].

The intuition of a dignity present and implicit in human life
underlies coherence in the claim of human rights beyond local convention,
and to right treatment - continuing even after death. Statutes follow (or
may not follow) recognition. Its violation can be sensed in experience -
whether articulable or not - most acutely by those exploited, but also in
observer and even violator - at least until numbed by repetition.

Kirk Allison, Ph.D.

Associate Director,
Program in Human Rights and Medicine,
University of Minnesota

[1] Macklin R. Dignity is a useless concept. BMJ 2003; 327: 1419-
1420. (accessed
12/30/03; simul sub.).

[2] Specifically, “Dignity reflects a moral status that moral agents
assign to others. It is conferred on a human being by other human beings.”
Caplan AL. Dignity is a social construct. BMJ 2003; 327 re. [1] (24
December 2003)

[3] Cole, TR. We have a sacred covenant with the dead. Los Angeles
Times; Mar 8, 2002; B.17

[4] It should be clear that a person pursuing behavioristly focused
research is not necessarily a reductionist.

[5] Recognition of dignity may extend beyond what is human – more
than one species of dignity may be recognized.

[6] “Tacit.” Webster’s Ninth New Collegiate Dictionary (1985): 1200.
The Oxford English Dictionary (2nd, 1989; online edition) includes the
senses ‘unspoken,’ ‘unvoiced,’ ‘still,’ as well as “Not openly expressed
or stated, but implied; understood, inferred." /00245989?single=1&query_type= word&queryword=tacit& edition=2e&first=1&max_to_show=10

Competing interests:
None declared

Competing interests: No competing interests

31 December 2003
Kirk C. Allison
Associate Director, Program in Human Rights and Medicine
University of Minnesota , Mayo Mail Code 164, Minneapolis, MN 55455