El PAN dio cumplimiento a los Lineamientos

Human dignity is equally a useful concept in the domain of Bioethics (Schulman, 2008; Pellegrino, 2008; Chapman, 2011; Kass, 2008; Andorno, 2009; Griffin-Heslin, 2005). As an umbrella domain, Bioethics covers such important areas as technology, medicine, health, nursing care, and others. The United States of America President’s Council on Bioethics has underscored the usefulness of human dignity to bioethics. In 2008, the Council commissioned essays on Human Dignity and Bioethics. Recognising the usefulness of the concept in bioethics, this publication’s primary aim was to shed “important light on the whole range of bioethical issues” (Schulman, 2008:3). These essays make a deliberate exploration of the idea of human dignity, especially its meanings, foundations, and relevance for Bioethics. This section of the chapter pursues one intention presented by some of the essays, namely to consider the relevance of human dignity to Bioethics. Focussing on the assumptions behind the usage of the concept within bioethics, it broadens our broader understanding of the idea of human dignity.

Just like it is with the legal and political spheres, human dignity is within Bioethics articulated in the context of human rights debates. The problem however is that in some bioethical debates human dignity is conceived as a human rights issue, and not necessarily as a fundamental principle. Thus, as the principle of respect, human dignity plays a crucial role in the emerging global norms relating to bioethics, and has been codified in the UNESCO Universal Declaration on Bioethics and Human Rights. Some consider it as the extension of international human rights law into the field of biomedicine (Andorno, 2009:223). Others, for example McCrudden (2008:20), consider human dignity as a fundamental organising principle. Whether it is used in a human rights context or as an organising principle in a different domain, the ubiquity of human dignity cannot be missed (Malpas & Lickiss, 2007; Donnelly, 2009; Gilabert, 2015). Scholars

72

attribute this ubiquity to the new developments in science and technology. Thus, science and technology has prompted the fast development of bioethics as a discipline servicing many areas. For example, Daniel C. Dennett (2008:39) argues that most debates in Bioethics are prompted by the fear that science and technology are slowly encroaching on life domains in ways that are considered as undermining human dignity. Since science and technology appear to be a major threat to the dignity of human beings, they must be re-directed towards that which is considered as their proper role before they get out of control. Hence, human dignity has emerged as a key point of reference for the said regulation of science and technology.

McCrudden (2013:3) agrees that the visibility of human dignity in Bioethics has been provoked by the developments in the life sciences, in biotechnology particularly, where deep moral questions concerning the direction and the practice of this science are raised. He sees dignity as potentially placing limits on some developments in these areas of scientific development. This is particularly the case in those areas of biotechnology related to genetic engineering and other technologies involving human enhancement. Human enhancement is identified as problematic, so the argument goes, because it compromises human dignity. Such concerns have led to the identification of human dignity as a foundational principle that must be safeguarded at all costs.

However, we should be reminded as McCrudden (2013:56) says, that the relatively recent resort to human dignity as a basic principle in bioethics is in part a consequence of the limits of the human rights project itself, where the disagreements that have persisted about their origin have now been pushed back onto the question of human dignity. It is not sufficient to rely on a practical (political) consensus alone as a method of resolving the meaning of human dignity because in its arbitrariness, it lacks stability and sustainability. In this regard, it is no longer the interest of science but that of human beings to cultivate the spirit of scientific and technological research (Chapman, 2011:9). Hence, although science and technology seem to have excelled in their sphere, such excellence will be useless if it is not at the service of humanity and its dignity. To be at the service of humanity and its dignity, scientific and technological research should be seen to prioritise the interests and welfare of the individual over the sole interest of scientific progress. Hence, the concept of human dignity has become handy in approaching debates about controversial new biotechnologies. However, given the history of the concept of human dignity where its meaning is also controversial, lacking a clearer conception, it becomes very difficult to determine the ability for technological innovation or scientific developments to protect human dignity.

Although the threat arising from recent advancements in science and technology is real, human dignity might as well be under threat even without scientific and technological

73

developments. That is, human life and that of other creatures would still be under threat without having to suffer under scientific and technological advancements. However, the speed and magnitude with which the threat affects life appears bigger and more devastating with technological advancements. Without assuming the role of a moralist bent on undermining the fruits of the free inquiry that has characterised the achievements of the contemporary scientific world, a scientist, and not his tools or discoveries is more liable to questions and worries that human dignity raises. In fact it is to the researcher, and on the basis of her innovative work, that bioethical questions are directed. The hope is that if a given researcher understood what uncontrolled and irresponsible research activities in her field might lead into, she would be in position to focus much of her energies and free inquiry on issues that can positively affect human life. Adam Schulman (2008:6) has in fact asked this question: “Do modern technological inventions relating to biosphere enhance one’s dignity?” However, we can acknowledge that the rate at which biosphere such as the environment gets damaged, is more devastating with scientific and technological innovations. Human disturbance and destruction of the environment which directly or indirectly affect human life, are faster than would be the case in purely natural setting, where such advancements and innovations were non-existent. Human attitude towards the environment also contributes to damage in the biosphere, especially the human life.

Human beings are protected from different kinds of abuse because they have dignity. In the moral domain, the moral status refers to what is so valuable in human beings so that it should be treated with special regard. For Agnieszka Jaworska (2018:1), “an entity has moral status if and only if it or its interests morally matter to some degree for the entity’s own sake”. Thus, moral problems arise when we shift from an entity of value to that without value. It is because of an entity’s value that it is supposed to be treated with dignity, and under no circumstances is it permitted to treat it as a means towards another end. For example, in the context of the use of embryos’ or monetisation, or indeed what Marx famously called the commodification of people, there is always a feeling that one is being treated as a mere means towards a different end (Kapust, 2011:151). Dignity therefore embodies respect accorded to certain entities.

Respect is a form behaviour people owe each other. It does not arise from mere feelings or sympathy. It occurs in the form of a debt. It is an acknowledgement of the dignity of other people. By extension, it is an acknowledgement of human vulnerability whose protection rests in the formation of mutually beneficial relationships. Hence, a moral status becomes the condition, or consists of characteristics, which human beings attribute to an entity, in this case fellow human beings, by virtue of which they are morally significant. Humanity becomes our priority when we

74

act in whatever manner. We often determine the goodness of our actions in terms of how they will affect the interests of others. A moral status is therefore something that has to do with individuals. It is a condition that enables individual human beings to act with freedom. It is for this reason that dignity as freedom or autonomy is the most popular conception of dignity, particularly in the USA (McCrudden, 2013:37). Indeed, this conception underscores the idea that human beings occupy the uppermost position in the hierarchy of moral statuses, and this guarantees them a high degree of protection and inviolability (Toscano, 2011:21).

There question of individual autonomy dominates any discussion concerning the role of human dignity in Bioethics. As an extension to the legal and political function, dignity within bioethics becomes the ability to choose one’s preferences. Understood as a moral status, dignity becomes a protecting and an instantiating dimension of human autonomy. For Stuart M. White (2004:286), this autonomy is further protected and expressed by informed consent which is a legal instrument that allows individuals to define their own interests, and to protect their bodily privacy as is the case for consent to anaesthesia. White (2004:288) further argues that the current medical practice prioritises respect for autonomy, making it more imperative than beneficence. The question of beneficence applies only when a patient is deemed incapable of exercising her autonomy, or when she explicitly entrusts her best interests to the doctor.

Consent, which has to do with a trusting relationship, is an important aspect of dignity emphasised in Bioethics. It is meant to address paternalism. White (2004:289) argues that consent maximises a patient’s welfare by respecting both patient’s autonomy and medical beneficence. The re-establishment of trust in the relationship would facilitate an active, reciprocal, and fluid dialogue between both parties that would enable exploration of the overall best interests of the patient. What this means is that the best way to show respect of human dignity is to allow people of any condition to take part in matters that affect their lives, and medicine is one of those critical areas where respect for dignity is critical. However for White (2004:290), the unconditional respect for patient’s autonomy through consent has several disadvantages. Patients might only ever be partially autonomous, leading to bad, uninformed or impractical decisions. Paternalism, for which autonomy is meant to address, also has a number of disadvantages, but its limited implementation under certain conditions may provide very real benefits to patients undergoing anaesthesia, either in terms of medical outcome or by enhancing autonomy in situations in which patients find themselves vulnerable.

As alluded to earlier, lack of precise meaning for the concept of ‘human dignity’ is exploited to advance conflicting arguments within the contemporary bioethical debates. That is, as

75

a nebulous concept, dignity has become vulnerable to rhetorical manipulation advancing the cause of otherwise conflicting sides of most bioethical debates. Daniel P. Sulmasy (2008:469) has described how the word ‘dignity’ has become something of a mere slogan in bioethics, often invoked by both sides of debates about a variety of scientific and clinical issues, supporting contradictory positions. Debates about euthanasia and euthanasia, for example, provide us with the clearest examples of significance of the notion of human dignity, albeit invoked in contradictory ways. On the surface, it appears proponents as well as opponents have valid and genuine reasons for their case. They might argue that a particular practice ought to be permitted because the extent to which some illnesses and injuries affect people can be extremely overwhelming. Some patients might be persuaded to think of their lives as of no value, a feeling that makes euthanasia a reasonable option. In defending their claim, Macklin (2003:1419) says proponents of the legalisation of euthanasia often appeal to the supposed ‘right to die with dignity’. The appeal to the legalisation of euthanasia is said to be based on the notion of human dignity. On this understanding, dignity is a property that human beings can lose as a result of extreme health deficiency which often leads to helplessness and total dependency on others to function. Thus, pain becomes something that deprives human beings of their dignity, and to preserve this dignity in instances such as this one, people resort to euthanasia (Gentzler, 2003:461). For the patient, the actual suffering constitutes a loss in dignity. Opponents of euthanasia also make dignity-based argument which does not deny the extent to which the gravity of some illnesses and injuries can undermine dignity of a human being. They however argue that to kill oneself, or to ask to be killed in the face of suffering or imminent death, in the case of euthanasia, is precisely the opposite of what it means to face death with dignity. As Jyl Gentzler (2003:462) argues in a Kantian way that to kill oneself is to undermine one’s absolute dignity.

In the Kantian tradition, ending pain through death, becomes an instance of treating oneself as a mere means to an end of limited value. There is no moral justification in treating oneself without due respect. Hence, every form of suicide is in all circumstances considered morally impermissible. On this understanding, there is no chance Kant would support the legalisation of euthanasia (Gentzler, 2003:463). Gentzler (2003:468) thinks an argument can be advanced that that dependency which appears problematic is an essential part of all human lives. Even those most admirable and worth living are involved in some sort of dependence on others. Hence, dependence on others does not conclusively compromise one’s dignity; it simply makes a life more human. It is safer to say that it is part of the design of the human social world. Besides, human beings are generally considered to be capable of resilience and exercising mental strength even in face of

76

danger or absurd conditions that seem to undermine their sense of dignity. No circumstances should eliminate intrinsic dignity that characterises essential nature of human beings. Therefore, legitimisation of euthanasia is considered as undermining the fundamental basis of morality itself, which is respect for intrinsic dignity. The kind of dignity that euthanasia opponents are really worried about is for Sulmasy (2008:487, the attributed dignity which is not that fundamental, and therefore should not be a source of worry.

Kant’s celebrated concept of human dignity, which is associated with individual autonomy, dominates the modern moral discourse. It is seen as a potential resource for contemporary bioethical debates. In the Kantian tradition, to treat someone with dignity is to treat them as autonomous individuals who are able to choose their own destiny (McCrudden, 2008:660). For Shell (2008:333) even though such a claim has a resounding consensus in many quarters, there are those who think dignity is a mere ‘place holder’ and those who think it is useful in bioethical debates. For the liberal and secular left, human dignity is generally associated with personal autonomy and expanded individual choice. For the conservative and religious right, it is generally associated with the sanctity of life and related limits on such choice. Although such conflicts occur because of lack of clarity of meaning, human dignity continues to command great respect through its great symbolic power, and its potential usefulness cannot be disputed. Moreover, as Audrey R. Chapman explains (2011:12), “Human dignity is too important a concept with too rich a heritage to be allowed to be languish on the trash heap of useless concepts”. In a similar way, Andorno (2011:969) emphasises that lack of precise definition, does not by itself prove that dignity is an empty concept or a purely rhetorical notion. Apart from dignity, there are more concepts that would fall in the same category of vague concepts for want of precise definition. Such concepts include freedom, justice, solidarity, happiness, love, etc. as they express social value. There has been no suggestion that they be abandoned because they lack precise meaning. Andorno therefore suggests that such problems exist not because the concept of dignity is too poor, but because it is too rich to be condensed into a single definition that everyone assents to.

The appearance of such controversies in bioethics is attributed to lack of distinction between two different roles that human dignity plays in bioethics. Andorno (2011:972) has identified the dual role that the concept of human dignity plays in bioethics, especially biomedicine: ‘as an overarching policy principle’ and the other ‘as a moral standard of patient care’. These are also considered respectively as objective and subjective components of human dignity. When considered as a very general concept, human dignity fulfils the role of foundational and a guiding normative framework governing biomedical issues. This is the sense that generally

77

prevails in most of the international policy documents where everyone has the right to be recognised and valued as a person. Like all other principles, human dignity does not by itself determine the content of a particular decision attributed to it as its inspiration. It has to be balanced against other principles since it is unable by itself to provide practical guidance for responses to particular pressing issues. The practical effect of it is aided by their legal recognition in different states. Dignity thus is that ‘super’ principle which not only provides the foundation of all legal and social institutions, but also shows a general direction towards which a civilised society should tend (Andorno, 2011:971).

When human dignity is used as a moral standard of patient care, it reflects a much more concrete and context-specific understanding of the patient as a ‘person’. This according to Andorno (2011:971) is based on one’s feelings about herself being a subjective human person. As a patient, one naturally expects certain dispositions, attitudes and behaviours from health care professionals, which recognise her status as a subject. This is the case because patients are in a situation of greater vulnerability, which if not protected can easily be abused through disrespect of their intrinsic worth. Dignity is then more visible in weakness than in power, in vulnerability than in self-sufficiency. This is what it means treating someone in a dignified manner. These two senses by which human dignity is used in biomedicine are but just two sides of the same coin. For Andorno therefore, there is no real conflict between the two different approaches to human dignity. Rather than causing misunderstanding, Andorno (2011:967) expects that such distinction should play a complementary role in bioethics. Their role is that of expressing the same widely shared view that all human beings possess an equal and inherent worth.

Kass (2008:297) has outlined various aspects of human dignity that are at risk in our biotechnological age. They include the dignity of procreation, the dignity of nascent human life, the dignity of human difference, the dignity of bodily integrity, the dignity of dying, and others. In an attempt to protect human beings from such risks, human dignity is invoked as the underlining principle. It is the end for which medical activities should be performed. Research activities in medical practice and nursing care all make dignity their reference point. In order to be deemed