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«W hile most of the art world turned to abstraction towards the middle of the twentieth century, Philadelphia-born Alice Neel (1900-1984) courageously ...»

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Alice Neel (1900-1984), T.B. Harlem, 1940, American. Oil

on Canvas. 76.2 x 76.2 cm.

Courtesy of the National Museum of Women in the

Arts, Washington, D.C.; gift of Wallace and Wilhelmina

Holladay. © Estate of Alice Neel.

W hile most of the art world turned to abstraction towards the

middle of the twentieth century, Philadelphia-born Alice Neel (1900-1984)

courageously chose to remain a figure painter. Occasionally she painted the rich

and famous–artists, playwrights, scientists, even a papal nuncio–but mostly her subjects were the unnoticed, the overlooked, the difficult. They were her neighbors in Spanish Harlem: stay-at-home mothers, pregnant mothers, door-to-door salesmen, restaurant workers, tradesmen. Nor did she shy away from those most would rather not confront–a dying, querulous old woman, a middle-aged man in the late stages of cancer, a young man ravaged by tuberculosis. But whether her subjects are young, old, famous, unknown, nude or clothed, Neel’s gift was to reveal their common denominator: an ineffable, undefinable, invisible human quality we call dignity.

T.B. Harlem, completed in 1940, is one of the most well-known of Neel’s paintings.

Gaunt and resigned, the subject could have been a young man dying on a battlefield of World War II pinned with a medal of honor. Instead he is a young man in a Harlem hospital fighting an all too prevalent disease to the death. His badge of honor covers the wound of thoracoplasty, or surgically induced lung collapse, then a radical treatment of last resort for tuberculosis. Neel also accurately portrays the side-effects of both the treatment and the disease: owing to the loss of several ribs on the affected side, compensatory thoracic and cervical curvatures of the spine pull it into the opposite directions of an S-curve. Atrophied muscles of the arms and hands and the lax abdominal muscles suggest that the battle has been a long one; the atrophy is the result of disuse, the protuberant abdomen indicative of a long-standing lack of proper nutrition. But Neel’s painting is not a medical treatise on tuberculosis. It is rather an eloquent essay on the inherent dignity of human beings that exists quite independently of exterior circumstances.

M. Therese Southgate, MD Human Dignity and Bioethics Essays Commissioned by the President’s Council on Bioethics Washington, D.C.

WWW.BIOETHICS.GOV March 2008 Contents Letter of Transmittal to The President of The United States..... xi Members of The President’s Council on Bioethics............ xi Council Staff..........................

–  –  –

Part V. Theories of Human Dignity 16 The Nature and Basis of Human Dignity Patrick Lee and Robert P. George....................409 17 Two Arguments from Human Dignity Paul Weithman..................................435 18 Dignity and Bioethics: History, Theory, and Selected Applications Daniel P. Sulmasy, O.F.M...........................469

–  –  –

The President The White House Washington, D.C.

Dear Mr. President,

With this letter I am pleased to send you Human Dignity and Bioethics:

Essays Commissioned by the President’s Council on Bioethics. Like the Council’s earlier volume, Being Human: Readings from the President’s Council on Bioethics, this book is an anthology, in this case a collection of essays exploring a fundamental concept crucial to today’s discourse in law and ethics in general and in bioethics in particular.

Since the Council’s establishment in 2001, the concept of human dignity has figured frequently in many of the Council’s reports.

As a result, there have been repeated requests for clarification of the meaning of the term. The Council has decided to respond by putting the question to a diverse group of scholars, including members of the Council, the better to provide a sense of the breadth of opinions on what has become a controversial subject.

These essays make it clear that there is no universal agreement on the meaning of the term, human dignity. Some argue that human

xixii | Letter of Transmittal

dignity has lost its traditional meaning. Others, by contrast, hold firmly to the view that dignity is an essential identifying and irreducible element of human nature. Still others take a more biological than philosophical or theological viewpoint on the question of the meaning of human dignity. An appreciation of the variety of these views is critical, if we are to understand the divergences in how we think and act in response to the challenges posed by contemporary bioethics.

Ultimately, the fundamental questions in law and ethics will be shaped by what we think it means to be human and what we understand to be the ethical obligations owed to the human person. We believe that the two volumes—Being Human and Human Dignity and Bioethics—provide the public and policymakers with the materials for a deeper understanding of the foundations upon which we build our answers to life’s most challenging questions.

–  –  –

Floyd E. Bloom, m.d.

Professor Emeritus in the Molecular and Integrative Neurosciences at The Scripps Research Institute, and the founding CEO and board chairman of Neurome, Inc.

BEnjamin S. CarSon, Sr., m.d.

Professor and Director of Pediatric Neurosurgery, Johns Hopkins Medical Institutions.

rEBECCa S. drESSEr, j.d., m.S.

Daniel Noyes Kirby Professor of Law and Professor of Ethics in Medicine, Washington University, St. Louis.

niCholaS n. EBErStadt, Ph.d.

Henry Wendt Chair in Political Economy and Government, American Enterprise Institute.

–  –  –

daniEl W. FoStEr, m.d.

John Denis McGarry, Ph.D. Distinguished Chair in Diabetes and Metabolic Research, University of Texas Southwestern Medical School.

miChaEl S. gazzaniga, Ph.d.

Director of Sage Center for the Study of Mind, University of California, Santa Barbara.

roBErt P. gEorgE, j.d., d.Phil.

McCormick Professor of Jurisprudence and Director of the James Madison Program in American Ideals and Institutions, Princeton University.

alFonSo gómEz-loBo, dr. Phil.

Ryan Family Professor of Metaphysics and Moral Philosophy, Georgetown University.

William B. hurlBut, m.d.

Consulting Professor, Neurology and Neurological Sciences, Stanford Medical Center, Stanford University.

lEon r. KaSS, m.d., Ph.d.

Addie Clark Harding Professor in the Committee on Social Thought and the College at the University of Chicago and Hertog Fellow in Social Thought, American Enterprise Institute.

PEtEr a. laWlEr, Ph.d.

Dana Professor and Chair of the Department of Government and International Studies, Berry College.

Paul mChugh, m.d.

University Distinguished Service Professor of Psychiatry, Johns Hopkins School of Medicine.

gilBErt C. mEilaEndEr, Ph.d.

Richard and Phyllis Duesenberg Professor of Christian Ethics, Valparaiso University.

Members of The President’s Council on Bioethics | xv janEt d. roWlEy, m.d.

Blum-Riese Distinguished Service Professor of Medicine, Molecular Genetics and Cell Biology, and of Human Genetics, Pritzker School of Medicine, University of Chicago.

diana j. SChauB, Ph.d.

Professor of Political Science, Loyola College.

–  –  –

Audrea R. Medina Adam Schulman, Ph.D.

Information Technology Specialist Senior Research Consultant xvii This collection of essays on human dignity, like previous reports of the Council, is the result of a collaborative effort. Customarily, the Council has not singled out individual staff members who have contributed to the reports. However, in the case of this volume on human dignity, I would like to express our gratitude for the singular efforts of Adam Schulman and Thomas W. Merrill for their excellent editing and coordinating of the collection.

Edmund D. Pellegrino, M.D.


–  –  –

H uman dignity—is it a useful concept in bioethics, one that sheds important light on the whole range of bioethical issues, from embryo research and assisted reproduction, to biomedical enhancement, to care of the disabled and the dying? Or is it, on the contrary, a useless concept—at best a vague substitute for other, more precise notions, at worst a mere slogan that camouflages unconvincing arguments and unarticulated biases?

Although the President’s Council on Bioethics has itself made frequent use of this notion in its writings, it has not, until now, undertaken a thematic exploration of human dignity, its meanings, its foundations, and its relevance for bioethics. In the meantime, at least one critic, noting that “appeals to human dignity populate the landscape of medical ethics,” has recently called into question whether human dignity has any place in bioethical discourse at all.1 It would seem timely, then, for the Council to take up the question of human dignity squarely, with the aim of clarifying whether and how it might be a useful concept in bioethics. That is the purpose of the present volume of essays, some contributed by Council Members, others by guest authors at the invitation of the Council.

3 4 | Adam Schulman The task of this introduction is to illuminate, in a preliminary way, the question of human dignity and its proper place in bioethics.

To that end, it will first give some examples of how human dignity can be a difficult concept to apply in bioethical controversies. It will then explore some of the complex roots of the modern notion of human dignity, in order to shed light on why its application to bioethics is so problematic. Finally, it will suggest, tentatively, that a certain conception of human dignity—dignity understood as humanity— has an important role to play in bioethics, both now and especially in the future.

The Problem of Human Dignity in Bioethics: Some Examples That human dignity might be at least problematic as a bioethical concept is suggested by the many ways it gets invoked in bioethical debates, often on different sides of the same issue. Consider, for example, a question raised in the fourth chapter of Taking Care, the

Council’s recent exploration of ethical caregiving at the end of life:2

Is it morally acceptable for an elderly patient, diagnosed with early Alzheimer’s disease and facing an inexorable decline into dementia and dependency, to stop taking his heart medicine in the hope of a quicker exit, one less distressing to himself and his family? One possible answer discussed in our report is that it is morally permissible (and perhaps even admirable) for such a patient, who finds the prospect of years of dementia humiliating or repellent and who is reluctant to become a burden to his family, to forgo medication and allow heart disease to carry him off in a more dignified and humane way. Another possible answer is that it is morally impermissible, because deliberately hastening the end of one’s life, even by an act of omission, is incompatible with the equal dignity and respect owed to all human life. A third answer is that respect for the dignity and autonomy of all persons requires us to defer to the personal choice of a competent individual in such intimate matters, regardless of how he or she might decide. Note that all three answers (and perhaps others that could be given) are grounded in part in some appeal to human dignity, though they reach quite different conclusions.

Bioethics and the Question of Human Dignity | 5

Or, to take an example from the beginning of human life, consider a question that might arise in a neonatal intensive care unit:

What medical interventions are appropriate to save the life of a critically ill premature infant who is likely to survive, if at all, only with severe mental defects? One possible answer is that, because human dignity rests on our higher mental capacities, it is wrong to bring a person into the world burdened with a devastating lifelong mental incapacity. Another answer might be that every reasonable measure should be taken, because the equal dignity of all human life forbids us to declare some lives “not worth living.” Yet a third answer might be that, out of respect for their dignity and autonomy, the parents must be left free to resolve this moral dilemma for themselves.

Or, again, consider an example of biomedical “enhancement” examined in the fifth chapter of the Council’s Beyond Therapy:3 If science were to develop memory-blunting drugs that could free us from the emotional burdens of intrusive and painful memories, would it be ethically permissible to give such drugs freely to people who have suffered grievous disappointments or witnessed horrifying events?

One answer might be that such an invention, with its promise of liberating miserable people from the emotional tyranny of past misfortunes, ought to be embraced as an unqualified enhancement to human freedom, autonomy, and dignity. But another answer might be that human integrity and dignity require of us that we confront our painful memories and learn to deal with them (if possible) and not just “flush” them away by taking a pill. A third answer would be that this decision is properly left to the individual, whose dignity and autonomy entail the right of voluntary, informed consent.* In each of these examples, a variety of strong convictions can be derived from powerful but conflicting intuitions about what human dignity demands of us. Little wonder, then, that some bioethicists are inclined to wash their hands of “dignity” entirely, in favor of clearer and less ambiguous ethical concepts.

* On “human dignity” as used in the Council’s writings, see Gilbert Meilaender’s essay in this volume. For a defense of the equal dignity of all human life, see the essay in this volume by Patrick Lee and Robert P. George.

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