Is it ethical of BioEdge to use me for its marketing purposes?

I have published some time ago in the Journal of medical ethics a piece in which I decry the ongoing abuse of academic bioethics content by sectarian agitprop outlets such as BioEdge in Down Under, First Things in the USA and so on and so forth. I was very clear that I disapprove of their activities.

Last night BioEdge distributed a fundraising appeal quoting me thus,

The editor of the journal Bioethics has acknowledged that BioEdge has "a larger real-world impact than most bioethics journals could dream of".

To be fair to BioEdge, one of my criticism of its website was that it pretends to be a bioethics news website, when really it is a religious campaign operation. In its fundraising appeal it notes that

Like everyone else, we do have a bias. We are trying to promote human dignity as a foundation for bioethics. 

Credit where credit is due, at least folks more professionally involved with bioethics know that 'dignity' is a cover for a particular ideological conviction (while that conviction remains hidden under the cloak of 'human dignity', the term these days operates like a red flag warning of someone trying to sell you snake oil under this pleasing rhetorical cover).

This event reminds me of a book that I criticised harshly in a review in a leading medical journal. I ended it with a line suggesting that the book is 'well worth reading' because it shows so nicely how not to go about the matter at hand. BioEdge's use of my quote reminds me a bit of the book's publisher. It quoted the bit it found useful and left out the lengthy criticism that preceded it. 

Ethical? Not so sure.  

Dignity's 'wooly uplift'

I have been sufficiently concerned for awhile about the more or less random deployment of terms such as 'human dignity' for and against any and all kinds of normative positions that I have done a bit of research on it while I was a Distinguished Visiting Fellow at Queen Mary, University of London's Graduate School last term. Here's a pre-print of an Editorial I jointly wrote with Anna Pacholczyk, a graduate student at Manchester University for the journal BIOETHICS (2010; 24(2): ii. There's also a longer article forthcoming in the first issue of the JOURNAL OF BIOETHICAL INQUIRY in 2010 that I wrote on my own. Check it out and let me know what you think about it.

DIGNITY'S WOOLY UPLIFT

A. J. Ayer was famously and predictably dismissive of terms such as 'human dignity', referring to them as a kind of 'wooly uplift'.¹ Despite the pervasive presence of appeals to dignity in medical ethics and the common use of this term in professional codes, constitutional texts and various human rights instruments², both the moral basis as well as the meaning of this term continue to remain nebulous at best. Ruth Macklin suggested that we can do without dignity.³ Christian anti-choice campaigners, worried that a term as hegemonic as 'dignity' might be used by their opponents in the context of arguments about assisted dying, are staking their claims as to the true meanings of the term.⁴

Recent empirical research focuses on the importance and meaning of dignity to terminally ill patients. Dignity here, however is little other than an umbrella term for various patient needs being satisfied.⁵ This place-holder function offers us nothing by way of addressing the crucial normative questions that usually give rise to the deployment of 'dignity' in bioethics and biopolicy, such as for instance the moral permissibility or otherwise of assisted dying.

Given that the concept of dignity is not a primitive term of ethics, despite vague noises to the contrary⁶, invoking dignity without clarifying its basis and reach is mere sloganism – an ethical conversation stopper of a kind.⁷

Ethics is commonly and quite rightly so understood as having two primary functions: to guide our actions as moral agents and to provide us with justifications for the guidance provided. Can a hydra-like notion of dignity serve this purpose? In the context of assisted dying, appeals to dignity are used on the both sides of the fence. For instance, the Roman Catholic Church considers euthanasia to be a 'violation of the divine law, an offence against the dignity of the human person.’⁸ On the other hand, organizations campaigning in favour of the decriminalization of assisted dying in its varying forms do not hesitate to campaign in the name of 'human dignity', too.⁹ The situation in the legal context is not much better. When in September 1993 the Canadian Supreme Court issued a ruling on the terminally ill Sue Rodriguez's petition to declare invalid s 241 (b) of the Criminal Code¹⁰ - which criminalizes assisting people to commit suicide – both the majority and minority opinions employed the argument from ‘human dignity’ to support their views. ¹¹

Some scholars accept that we cannot reasonably 'expect dignity to have only one, clearly delineated meaning.'¹² Doris Schroeder argues that this is no reason to get rid of the concept altogether. She maintains that 'dignity is a slippery idea, but also a very powerful one and the demand to purge it from ethical discourse amounts to whispering in the wind.'¹³ A recent defense of the UNESCO Declaration on Bioethics and Human Rights against its critics, asserts that 'human dignity' and other such principles could 'function as guidelines for reviewing or reorganising research practices'.¹⁴ That is a troubling proposition.

The current state of affairs seems to be that, notwithstanding the dubious normative merits of 'human dignity', the fact that it is commonly used is sufficient reason to continue using it. This proposition is evidently flawed. We surely can do better than this.

1 A. J. Ayer. (1947) Language, Truth and Logic. London: Victor Gollancz.

2 C. McCrudden. Human dignity and judicial interpretation of human rights. European Journal of International Law 2008; 19: 655-724.

3 R. Macklin. Dignity is a useless concept. BMJ 2003; 327: 1419-1420.

4M. Somerville, “Defining human dignity”, 22 November 2009, The Gazette (Montreal), online: . Accessed 29 November 2009.

5 H.M. Chochinov. Dignity and the essence of medicine: the A, B, C, and D of dignity conserving care. BMJ 2007; 335: 184-187.

6R. Goddin, “The political theories of choice and dignity” (1981) 18:2 American Philosophical Quarterly 96.

7 R. Van Der Graaf & J.J.M. van Delden, “Clarifying Appeals to Dignity in Medical Ethics from an Historical Perspective” (2009) 23:3 Bioethics 151.

8 F. Cardinal Seper. Declaration on Euthanasia. Acta Apostolicae Sedis 1980; 72: 542. Available at: Congregation for the Doctrine of the Faith http://www.vatican.va/roman_curia/congregations/cfaith/documents/rc_con_cfaith_doc_19800505_euthanasia_en.html [Accessed 29 Nov 2009].

9 D. Hillyard & J. Dombrink. 2001. Dying Right: The Death With Dignity Movement. New York: Routledge.

10 R.S.C., 1985, c. C-46.

11 Rodriguez v. British Columbia (Attorney General), [1993] 3 S.C.R. 519.

12 D. Schroeder. Dignity: Two riddles and four concepts. Camb Q Healthc Ethics 2008; 17: 230-238: 237.

13Ibid: 237.

14 M. Levitt & H. Zwart. Bioethics: An export product? Reflections on hands-on involvement in exploring the “external” validity of international bioethical declarations. J Bioeth Inq 2009; 6: 367–377:370.

Human dignity and individual liberty

There is an argument going on among well-intentioned and more or less knowledgeable bioethicists about the question of whether there is much use in deploying the concept of 'human dignity' in resolving conflicts about normative questions in the field. Here is a good critical take on the issue.

Typically the issue of dignity is wheeled in by opposing sides when they don't like the stance held by the other side, and they have no good arguments left to defend their own take on the matter. Here's a few examples: voluntary euthanasia and physician assisted suicide. There's opponents of physician assisted suicide and voluntary euthanasia who claim that such means to end a persons life are not dignified. Certainly the Roman Catholic Church thinks so. If you know anything at all about this debate, you will know that 'Death with Dignity' is also the battle-cry deployed by voluntary euthanasia groups. The same concept is used without blushing by groups for diametrically opposed means. That's odd indeed.

Up to this point I talked about the concept of dignity as if there was one. Of course, if neither the euthanasia folks nor the anti-euthanasia folks are able to demonstrate that the other side is wrong in their use of the concept of dignity, quite possibly there is something wrong with the concept, or, more to the point, quite possibly there's no concept.

Is voluntary euthanasia the exception pointing to a small problem with the idea of 'dignity', or is there actually more evidence that 'dignity' might just be a vacuous motherhood-and-apple pie thing suitable for and against anything and nothing. Well, in fact, there's plenty of other examples. IVF and artificial insemination (to go the the other end of our lives) are in the same boat as euthanasia. Christians routinely argue (well, claim) that our dignity is violated if we use such means of modern reproduction, allegedly because it's against our nature to do so. Of course, they don't mean a matter-of-fact type nature, they mean their normative understanding of what our nature should be like. It is well known that people who require access to such means of reproduction think their their dignity as rational agents is violated if the state or others prevents them from exercising such a choice (gays and lesbians come to mind, for instance). Both sides deploy the idea of 'dignity' to advance their diametrically opposing stances! Odd indeed.

Pornography is another, and my last example. There is no consensus at all about the question of whether someone violates his her or dignity (and that of others) by watching or participating in the production of pornographic material.

The German enlightenment philosopher Immanuel Kant initially understood respect for someone's dignity really as respect for a rational, autonomous agent. In that sense, dignity is kind of a short for respect for autonomous persons. That probably is a sensible thing. All other things being equal, we should be respectful of at least the self-regarding actions autonomous beings wish to undertake. May be that is what we should be saying, however. Of course, since then religious folks and invariably the UN have stepped in with a deluge of dignity here and dignity there declarations and statements that resulted into dignity being reduced to a campaign tool for everything and nothing at all. Christianity, for instance, quickly removed the Kantian criteria of reason and rationality and agitated for embryos' dignity, and human rights related claims derived from those. In case of doubt the supposedly necessary respect for these embryos' alleged dignity was used to override women's interest in controlling what's happening with their bodies. The UN has declared, for no good ethical reason at all, that reproductive human cloning is dignity violating. This emperor certainly is naked! Human dignity, warm and fuzzy as it may sound, is a useless tool for advancing arguments on any of the relevant fronts in bioethics. This insight is true regardless of the substantive stance that you'd take on any of these controversial issues, by the way. Dignity really is just a rhetorical tool as opposed to a serious conceptual means to advance discussions on these issues.

Today we are probably well advised, should we face the need to make a snap-decision, to reject dignity related claims unless these claims have another rationale attached to them that is based on some other framework. If anything, you'd probably right if you assumed that more often than not human dignity is deployed as a means of preventing people from making self-regarding choices.