Ruth Macklin examines the use of the term ‘dignity’ in medical
ethics, finds that appeals to human dignity are vague, and thus concludes
that dignity is a useless concept [1]. We disagree on several counts.
While we agree with Macklin’s primary assertion that ‘dignity’ is
often used vaguely or merely as a slogan to make sweeping claims that
might otherwise be questionable, we feel that dignity is far too important
a concept to be dismissed out of hand. As a point of clarification,
‘dignity’ is no more or less vague than many other terms employed in
medical ethics: It can be defined as ‘the quality or state of being
worthy of respect or honor,’ derived from the Latin ‘dignitas’ meaning
‘worth’ or ‘worthiness,’ and its use can be quite deliberate and serious.
Macklin also believes that dignity means no more than respect for
persons or their autonomy. We disagree with this interpretation for
several reasons. First, although dignity is often attributed to persons,
in which case it does imply a duty to respect persons, dignity can apply
more broadly than respect for persons. Dignity may also characterize non-
persons, as Macklin’s example of practicing medical procedures on the
newly dead nicely illustrates. The newly dead, who are not persons
(although they are human), certainly can be thought of as worthy of
respect—respect that presumably cannot be owed to them as ‘persons,’ since
most theoretical accounts of personhood are not inclusive of the dead.
Second, even when dignity is used to describe persons, there remains
a fundamental difference in the moral focus of dignity versus respect for
persons. The idea of ‘dignity’ is primarily concerned with the person-who
-should-be-respected, whereas the duty of ‘respect’ is centered on a moral
agent, the person-who-respects. People have dignity regardless of whether
they are respected by others. To say that a person has dignity is to
imply that that person has value and is worthy of respect, which is
different than saying that someone else has a duty to respect that person.
Dignity is not merely a more vague formulation of respect for persons; it
is the fundamental underpinning of respect for persons.
Mary Catherine Beach, MD, MPH
Patrick Duggan, AB
Gail Geller, ScD, MHS
Phoebe R. Berman Bioethics Institute,
Johns Hopkins University,
Baltimore, MD, USA
Reference:
1. Macklin R. Dignity is a useless concept. BMJ 2003;327:1419-1420.
Competing interests:
None declared
Competing interests:
No competing interests
21 January 2004
Mary Catherine Beach
Assistant Professor
Patrick Duggan and Gail Geller
Johns Hopkins University, Baltimore, Maryland 21205, USA
Rapid Response:
Don't confuse dignity with respect
To the Editor:
Ruth Macklin examines the use of the term ‘dignity’ in medical
ethics, finds that appeals to human dignity are vague, and thus concludes
that dignity is a useless concept [1]. We disagree on several counts.
While we agree with Macklin’s primary assertion that ‘dignity’ is
often used vaguely or merely as a slogan to make sweeping claims that
might otherwise be questionable, we feel that dignity is far too important
a concept to be dismissed out of hand. As a point of clarification,
‘dignity’ is no more or less vague than many other terms employed in
medical ethics: It can be defined as ‘the quality or state of being
worthy of respect or honor,’ derived from the Latin ‘dignitas’ meaning
‘worth’ or ‘worthiness,’ and its use can be quite deliberate and serious.
Macklin also believes that dignity means no more than respect for
persons or their autonomy. We disagree with this interpretation for
several reasons. First, although dignity is often attributed to persons,
in which case it does imply a duty to respect persons, dignity can apply
more broadly than respect for persons. Dignity may also characterize non-
persons, as Macklin’s example of practicing medical procedures on the
newly dead nicely illustrates. The newly dead, who are not persons
(although they are human), certainly can be thought of as worthy of
respect—respect that presumably cannot be owed to them as ‘persons,’ since
most theoretical accounts of personhood are not inclusive of the dead.
Second, even when dignity is used to describe persons, there remains
a fundamental difference in the moral focus of dignity versus respect for
persons. The idea of ‘dignity’ is primarily concerned with the person-who
-should-be-respected, whereas the duty of ‘respect’ is centered on a moral
agent, the person-who-respects. People have dignity regardless of whether
they are respected by others. To say that a person has dignity is to
imply that that person has value and is worthy of respect, which is
different than saying that someone else has a duty to respect that person.
Dignity is not merely a more vague formulation of respect for persons; it
is the fundamental underpinning of respect for persons.
Mary Catherine Beach, MD, MPH
Patrick Duggan, AB
Gail Geller, ScD, MHS
Phoebe R. Berman
Bioethics Institute,
Johns Hopkins University,
Baltimore, MD, USA
Reference:
1. Macklin R. Dignity is a useless concept. BMJ 2003;327:1419-1420.
Competing interests:
None declared
Competing interests: No competing interests