The politics of bioethics.

Author:Neuhaus, Richard John

Is "human dignity" a useful concept in bioethics? Does it shed important light on the whole range of bioethical issues? Or is it instead a useless concept--a slogan that camouflages unconvincing arguments and unarticulated biases?

The President's Council on Bioethics recently asked me this question, and I replied: Useful or useless to what end? In the history of Western civilization's reflections on ethics and morality, it is commonly asserted that the most elementary maxim is "Do good and avoid evil." For purposes pertinent to bioethics, this can also be phrased as "Do right and avoid wrong." The first principle of practical moral reason, in obedience to that maxim, is to direct one's will in accord with the human good.

For that purpose, then, is the concept of human dignity useful? The better phrase is "the dignity of the human person." "Human dignity" may suggest the collective and include efforts such as taking technological charge of the evolution of the human species. "The dignity of the human person" places the accent on the individual--although, to be sure, the individual situated in community. The dignity of the human person may entail an important, although limited, measure of autonomy. Dignity as autonomy features strongly in, for instance, arguments for "death with dignity." Morally, however, the dignity of the human person is affirmed most significantly not in the assertion of one's own autonomy but in the protection of others who are most subject to having their dignity violated. Therefore, in bioethics as in medicine more generally, the first rule is "Do no harm." That first rule enjoins us to protect and maintain something that is recognized as good simply in its being.

The rule "Do no harm" is perceived by some to be a limit on scientific and technological progress, and it is intended to be exactly that. More precisely, it is a frankly moral placing of limits on what some, driven by what is aptly described as the scientific or technological imperative, deem to be progress. Morality is not to be pitted against genuine progress. We should be grateful for all the advances that have been made and no doubt will be made in what Francis Bacon called "the relief of man's estate." But it is precisely the business of ethical and moral reason to make normative judgments regarding present and proposed measures aimed at such relief. This is true with respect to the dignity of the human person and with respect to more ambitious proposals aimed not so much at relieving as at transforming "man's estate." (When reflecting on these questions, it is good to have near at hand C.S. Lewis' The Abolition of Man.)

The ill-defined discipline of bioethics has not served us well in understanding these questions. Militating against the task of normative moral judgment is not only the scientific and technological imperative, with all the fame and glory attending breakthrough achievements, but also the weight of inestimable financial interests. Think, for instance, of what those who can pay will pay for a significant extension of their life span or for the "perfect baby."

It is only somewhat cynical to observe that institutions with the greatest vested interest in dubious advances have recruited the best bioethicists that money can buy.

One must acknowledge that bioethics as an intellectual institution is, in significant part, an industry for the production of rationalized--sometimes elegantly rationalized--permission slips in the service of the technological imperative joined to the pursuit of fame and wealth. Which is not to deny that such permission slips are also issued in the service of what some believe to be the relief of suffering and the enhancement of man's estate. Even when bioethics is conducted with intellectual and moral integrity, a question must be raised about the nature of the authority of those who are called bioethicists. This touches on politics and political legitimacy in addressing bioethical controversies.

International agreements and declarations in the aftermath of World War II often spoke of the dignity of the human person, and it is frequently noted that these usages do not offer clear and unambiguous guidance in bioethical controversies. The President's Council on Bioethics observes, correctly, that in such statements "the meaning, content, and foundations of human dignity are never explicitly defined. Instead, the affirmation of human dignity in these documents reflects a political consensus among groups that may well have quite different beliefs about what human dignity means, where it comes from, and what it entails. In effect, 'human dignity' serves here as a placeholder for 'whatever it is about human beings that entitles them to basic human fights and freedoms.'"

The council adds, however, that "this practice makes a good deal of sense." It makes a good deal of sense indeed. In a world indelibly marked and marred by the Holocaust, the Gulag Archipelago, Mao's Great Leap Forward, and myriad other crimes against humanity, a political consensus as a placeholder against great evils, no matter how intellectually rickety its structure, is not to be scorned.

In A World Made New: Eleanor Roosevelt and the Universal Declaration of Human Rights, Harvard law professor Mary Ann Glendon describes the ways in which the drafters of the declaration were keenly aware that their goal was a political consensus, not a philosophical or moral treatise on human nature and the rights and dignities attending human nature. Given the enormous cultural, religious, intellectual, and ideological diversity of those involved, a political consensus was a great achievement. While rights and freedoms are positively asserted, they are largely defined negatively against the background of evils to which the declaration says, in effect, "Never again!" Thus was the morally elementary rule "Do no harm" given new urgency and specificity.

Nor should it be thought that a political consensus is somehow inferior to a coherent treatise on the moral and philosophical foundations of human dignity. In a...

To continue reading