November 30, 2021

A dignified debate, but no ground made on dignity

A recent exchange in the Journal of Medical Ethics may have caught the eye of some of our readers.

A recent exchange in the Journal of Medical Ethics may have caught the eye of some of our readers. It focused on the vexed term in contemporary bioethics, dignity.

The article that sparked the debate – a précis of the book Human Dignity in Bioethics and Law by Charles A. Foster – developed the idea that human dignity is an intuitive notion accessible to all people. In the final analysis, Foster claims, the notion of dignity is nothing other than an Aristotelian notion of objective flourishing – to respect human dignity means to allow individual human beings to flourish.

A familiar view of dignity, you might think. But Foster – a British ethicist and barrister – has a peculiar way of adjudicating between competing claims about dignity. For him, the law needs to perform a kind of utilitarian calculus on individual conflicting appeals to ‘dignity’:

“…I propose a ‘transactional’ approach. One should assess the dignity interests of all the stakeholders in a proposed action or inaction… One then weights the dignity scores of all the stakeholders (a patient’s score would generally, but not necessarily, have a higher weight than that of a hospital porter), and notionally tots them up in order to decide how much dignity is in issue in the transaction. A negative score would preclude the transaction. If transaction X has a higher score than Y, X is preferable to Y…”

It’s a… well…interesting approach to the question of dignity. Naturally it garnered criticism from all quarters of the academy.

Richard Huxtable of the University of Bristol questioned the usefulness of the term dignity for expressing Foster’s intuitions:

“If (Fosterian) dignity is as elastic as it appears, we must be left wondering what moral load the concept can bear… Perhaps, with Aristotle to hand, Foster does not ultimately need dignity as such…[I wonder] whether what is said need not be spoken in dignity’s tongue.”

Fordam’s Charles C. Camosy agrees with Huxable. Camosy argues that for Foster’s idea of dignity needs a thick and, to some extent, perfectionistic conception of the good. This, Camosy says, is a necessary feature of any defensible ethical system:

“This is the condition of every normative tradition: from care feminism, to hedonistic utilitarianism, to Foster’s transactional dignity. Western bioethics’ focus on autonomy and clinical pragmatism has papered over this inconvenient truth, but it is one we must face squarely if our discipline is to have a genuinely plural approach to normative traditions.”

In his response to Camosy and Huxable, Foster was gracious yet insistent:

“Those reflections have made me wish that I’d made things clearer, but have not made me rewrite my basic thesis… We don’t need a scale that enables us to obtain accurate absolute dignity estimations. All we need to be able to do is to identify competing dignity considerations (as opposed to considerations better characterised in other ways—for instance, as pure autonomy issues) and then lay them alongside one another and see which is larger. Having done that, you can embark on the Bayesian exercise. And, yes, all that’s easier said than done.”

A Bayserian weighing of dignity? Indeed, easier said than done. This debate might leave some readers wondering whether it can be done at all.

Debate on human dignity in JME — civil, but frank
Xavier Symons
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bioethics discourse