Like the ‘thoughts and prayers’ so commonly offered by politicians in the aftermath of disaster, it is incredibly common to hear ‘autonomy and dignity’ invoked together in response to some threat to human wellbeing. As such, it seems natural to assume they must bear some kind of relation to one another. But are they merely two core human interests, that happen to be vulnerable to the same kinds of threat? Or are they interrelated in a deeper way? What I aim (...) to do in this chapter is draw on the philosophical literature on both concepts to consider how they might be connected, and explore whether certain ways of connecting them are more fruitful than others. I argue that the two most prominent connections drawn in the philosophical literature – that dignity is grounded in autonomy, and that respect for dignity is synonymous with respect for autonomy – are both highly problematic. Instead, I suggest we see autonomy and dignity as mutually supportive. Doing so has both practical and theoretical benefits: it can help us identify threats to both autonomy and dignity; and it exposes theoretical lacunae, especially within the autonomy literature. (shrink)

Philosophers and bioethicists are typically sceptical about invocations of dignity in ethical debates. Many believe that dignity is essentially devoid of meaning: either a mere rhetorical gesture used in the absence of good argument or a faddish term for existing values like autonomy and respect. On the other hand, the patient experience of dignity is a substantial area of research in healthcare fields like nursing and palliative care. In this paper, it is argued that philosophers have much to learn from (...) the concrete patient experiences described in healthcare literature. Dignity is conferred on people when they are treated as having equal status, something the sick and frail are often denied in healthcare settings. The importance of equal status as a unique value has been forcefully argued and widely recognised in political philosophy in the last 15 years. This paper brings medical ethics up to date with philosophical discussion about the value of equal status by developing an equal status conception of dignity. (shrink)

I examine the standard view of dignity in Western literature and Metz’s African community view of dignity as a capacity for communal harmonious living. I argue that moral dignity is not just having a capacity for harmonious communal living, but the moral use of such capacity for the promotion of love, friendship, positive identity and active solidarity, which involves normatively prescriptive and evaluative elements. Thus, a plausible African communal conception of moral dignity, which is founded on a moral conception of (...) personhood and community, involves a combination of capacity and agency that is conceptually tied to communal responsibility and respect for self and others. This indicates that human capacities do not have an inherent moral worth. Capacities are instrumentally good and their worth depends on how they are used to promote the moral good of communal well-being, on which individual well-being or dignity depends. This view captures the various use-senses of dignity, addresses many of the problems with many of the analyses of dignity in the literature, and also indicates its relevance. (shrink)

I defend a novel account of the wrong of subjecting people to non-consensual sterilization (NCS), particularly in the context of the state-sponsored eugenics programmes once prevalent in the United States. What makes the eugenic practice of NCS distinctively wrong, I claim, is its dehumanizing core: the fact that it is tantamount to treating people as nonhuman animals, thereby expressing the degrading social meaning that they have the value of animals. The practice of NCS is prima facie seriously wrong partly, but (...) crucially, on these grounds. I consider and reject accounts of the wrong of NCS that make no reference to its animalizing character, such as that it violates victims’ (procreative) autonomy, amounts to treating them merely as a means, inflicts psychological harm on them, or constitutes an affront to their human dignity. My discussion suggests that the critical vocabulary of bioethics should be expanded beyond talk of rights-violations, benefits and harms, and equal treatment—and that the language of dehumanization is indispensable to bioethicists. (shrink)

This book offers a unique and insightful analysis of Western and Middle Eastern concepts of dignity and illustrates them with examples of everyday life. Dignity in the 21st Century - Middle East and West is unique and insightful for a range of reasons. First, the book is co-authored by scholars from two different cultures (Middle East and West). As a result, the interpretations of dignity covered are broader than those in most Western publications. Second, the ambition of the book is (...) to use examples from everyday life and fiction to debate a range of dignity interpretations supplemented by philosophical and theological theories. Thus, the book is designed to be accessible to a general readership, which is further facilitated because it is published with full open access. Third, the book does not defend one superior theory of dignity, but instead presents six Western approaches and one based on the Koran and then asks whether a common essence can be detected. -/- The answer to the question whether a common essence can be detected between the Koranic interpretation of dignity and the main Western theories (virtue, Kant) is YES. The essence can be seen in dignity as a sense of self-worth, which persons have a duty to develop and respect in themselves and a duty to protect in others. The book ends with two recommendations. First, given the 7 concepts of dignity introduced in the book, meaningful dialogue can only be achieved if conversation partners clarify which variation they are using. Second, future collaborations between philosophers and psychologists might be helpful in moving theoretical knowledge on dignity as a sense of self-worth into practical action. The “scourges” of a sense of self-worth and dignity are identified by psychologists as violence, humiliation, disregard and embarrassment. To know more about how these can be avoided from psychologists, is helpful when protecting a sense of self-worth in others. (shrink)

On 24 July 2017, the long-running, deeply tragic and emotionally fraught case of Charlie Gard reached its sad conclusion. Following further medical assessment of the infant, Charlie’s parents and doctors finally reached agreement that continuing medical treatment was not in Charlie’s best interests. Life support was subsequently withdrawn and Charlie died on 28 July 2017.Box 1 ### Case summary and timeline21–23 Charlie Gard was born at full term, apparently healthy, in August 2016. At a few weeks of age his parents (...) noticed early signs of muscle weakness. At 2 months of age, he was admitted to Great Ormond Street Hospital with poor feeding, failure to thrive and respiratory failure. He was admitted to intensive care, where investigations led to the diagnosis of a rare severe mitochondrial disorder – infantile onset encephalomyopathic mitochondrial DNA depletion syndrome. The specific genetic form of MDDS in Charlie Gard had previously been reported in approximately 15 infants, with typical clinical features including early onset, rapid progression and death in infancy.24 By that point, Charlie was paralysed and unable to breathe without respiratory support. He was found to have congenital deafness, and his heart, liver and kidneys were affected by the disorder. Doctors felt that Charlie’s prognosis was extremely poor. In early 2017, Charlie’s parents identified an experimental treatment, previously used in a different form of MDDS, which they hoped might benefit Charlie. In mouse models of a myopathic form of MDDS, early supplementation with deoxypryrimidine nucleosides apparently bypasses the genetic defect and leads to a reduction in the biochemical defect and in the severity of the clinical phenotype.25 26 Doctors at GOSH initially planned to use nucleoside treatment in Charlie, but in January he developed evidence of electrical seizures, and clinicians became convinced that treatment, both continued intensive care and the requested …. (shrink)

Controversial cases in medical ethics are, by their very nature, divisive. There are disagreements that revolve around questions of fact or of value. Ethical debate may help in resolving those disagreements. However, sometimes in such cases, there are opposing reasonable views arising from deep-seated differences in ethical values. It is unclear that agreement and consensus will ever be possible. In this paper, we discuss the recent controversial case of Vincent Lambert, a French man, diagnosed with a vegetative state, for whom (...) there were multiple court hearings over a number of years. Both family and health professionals were divided about whether artificial nutrition and hydration should be withdrawn and Lambert allowed to die. We apply a ‘dissensus’ approach to his case and argue that the ethical issue most in need of scrutiny is different from the one that was the focus of attention. (shrink)

Harm reduction has been advocated to address a diverse range of public health concerns. The moral justification of harm reduction is usually presumed to be consequentialist because the goal of harm reduction is to reduce the harmful health consequences of risky behaviors, such as substance use. Harm reduction is contrasted with an abstinence model whose goal is to eradicate or reduce the prevalence of such behaviors. The abstinence model is often thought to be justified by ‘deontological’ considerations: it is claimed (...) that many risky behaviors are morally unacceptable, and therefore that we have a moral obligation to recommend abstinence. Because harm reduction is associated with a consequentialist justification and the abstinence model is associated with a deontological justification, the potential for a deontological justification of harm reduction has been overlooked. This paper addresses this gap. It argues that the moral duty to protect autonomy and dignity that has been advocated in other areas of medical ethics also justifies the public health policy of harm reduction. It offers two examples—the provision of supervised injection sites and the Housing First policy to address homelessness—to illustrate the argument. (shrink)

Emergency care research sometimes involves incapacitated adults as research participants. The ethical principle of respect for autonomy may not necessarily apply to an incapacitated person unable to act in an autonomous manner, although it can be argued that researchers still have a duty of respect towards such people because they have moral status despite being incapacitated. Sharing some common ground with theories of moral status based on ‘humanness’ and the ability for rational thought is the notion of human dignity, which (...) features in arguments regarding researcher conduct with incapacitated patients. However, human dignity premised upon the unique ability of humans for rational thought and moral self-regulation is contingent upon these capabilities – a limitation that possibly makes dignity a less useful framework for research conduct in emergency care research. In this article, I will discuss the different conceptions of human dignity – as equality, status and virtue – and then draw on more recent literature that explains human dignity as a social constraint and as a factor influencing the conduct of healthcare professionals and researchers. I will address questions of whether dignity as a principle ought to apply only to those who have the ability to think rationally, or to all humans regardless of their condition or mental status. I will argue that, in relation to offering protection to research participants in emergency conditions, it is immaterial which view is taken. (shrink)

Appeals to the dignity of people with dementia are widespread in the current literature on dementia care. One influential account of dignity in the wider philosophical and bioethical literature that has remained underexplored in the context of dementia care is that of Martha Nussbaum. This paper critically examines Nussbaum’s account of dignity and aims to determine what moral guidance this account can offer for the provision of care to people with dementia. To that end, first, I identify four possible objections (...) to appeals to dignity in dementia care. These objections are (1) redundancy of the dignity talk, (2) exclusionary implications, (3) reliance on (suspect forms of) speciesism and (4) unclear practical implications. Then, I discuss whether, and to what extent, Nussbaum’s account of dignity can overcome these objections. I argue that Nussbaum’s account, in its original form, struggles to overcome the problem of exclusionary implications and consequently the problem of unclear practical implications. I argue for a modified version of Nussbaum’s account of dignity. I demonstrate that this modified version can better overcome all of the four objections, and it provides relatively clearer moral guidance for the provision of care to people with dementia. The modified version of Nussbaum’s account is predicated on a novel dementia-specific model of flourishing, which draws on Kitwood and Bredin’s empirically informed list of indicators of well-being for people with dementia. (shrink)

Jacobson finds two distinct meanings of “dignity” in the literature on dignity and health: intrinsic human dignity and social dignity constituted through interactions with caregivers. Especially the latter has been central in empirical health research and warrants further exploration. This article focuses on the social dignity of people marginalized by mental illness, substance abuse and comparable conditions in extramural settings. 35 studies published between 2007 and 2017 have addressed this issue, most of them identifying norms for social dignity: civilized interactions, (...) non-stigmatizing treatment, treatment as unique individuals, being taken seriously, maintaining a positive identity, experiencing independence, relating to others, and participating in daily life. We argue that these norms belong to ideal theory, whereas we agree with Robeyns and others that improving practice is better served by non-ideal theory. Towards this end, we derive from the literature four building blocks for a non-ideal theory of dignity: avoid violations of dignity rather than seeking to promote it; dignity is not a goal to be reached; it requires ongoing effort; promoting dignity is a balancing act; contradictory norms can make it impossible to realize; and dignity can be undermined by organizational and discursive constraints. (shrink)

Once limited to issues in maritime and trade law, today the most recognizable examples of international law govern issues such as human rights, intellectual property, crimes against humanity and international armed conflicts. In many ways, this proliferation has been a welcomed development. However, when coupled with international law’s decentralized structure, this rapid proliferation has also posed problems for how we (and in particular judges) identify if, when, and where international law exists. This article puts forward a novel, dignity-based account for (...) how we answer this question: arguing that an international law exists if and only if it is consistent with respecting dignity. The upshot of this account is two-fold. First, it explains many features of international law that other theories leave unaccounted for or under-explained. And second, my dignity-based account provides for a mechanism through which the system can continue to be developed and improved. (shrink)

Although appeals to human dignity became quite popular after the end of War World II in various moral and legal settings, the term retained an air of semantic indeterminacy, and scholars are of opposing minds concerning its usefulness and significance. In this essay I intend to offer a sketch of a “deflationary” account of human dignity – viewed as one moral value among many others – according to which it is conceived as the minimal respect we prima facie owe to (...) our own personality, as well as to the personality of everyone else without any restriction or exception. This account is accompanied by a justification, which does not presuppose the endorsement of a particular moral theory, and envisages dignity as a bulwark to counter the morally abhorrent consequences of many categorical and normatively tainted dichotomies western societies have created. (shrink)

ZusammenfassungNicht erst seit Ruth Macklins einflussreichem Aufsatz „Dignity is a useless concept“ ist eine breite Debatte um Sinn und Unsinn des Begriffs der Menschenwürde in der Medizinethik entbrannt. In diesem Beitrag möchte ich mein Augenmerk auf die von Macklin prominent gemachte Substitutionsthese richten. In ihrer einflussreich gewordenen Fassung propagiert diese eine Ersetzung des Menschenwürdebegriffs durch denjenigen der Autonomie. Doch was ist damit genau gemeint? – Ausgehend von einer Analyse von Macklins Argumenten möchte ich zeigen, unter welchen Bedingungen die Substitutionsthese die (...) von ihren Vertretern häufig in den Vordergrund gestellten eleminativen Ergebnisse zeitigt – die Rede von einem eigenständigen begrifflichen Gehalt von „Würde“ sollte aufgegeben werden. Im Verlauf der Untersuchung werden auch die Vorzüge einer solchen Position gegenüber stärker eliminativ auftretenden Standpunkten und Positionen deutlich, die den Ausdruck als berechtigt, aber unanalysierbar betrachten. (shrink)

Nicht erst seit Ruth Macklins einflussreichem Aufsatz „Dignity is a useless concept“ ist eine breite Debatte um Sinn und Unsinn des Begriffs der Menschenwürde in der Medizinethik entbrannt. In diesem Beitrag möchte ich mein Augenmerk auf die von Macklin prominent gemachte Substitutionsthese richten. In ihrer einflussreich gewordenen Fassung propagiert diese eine Ersetzung des Menschenwürdebegriffs durch denjenigen der Autonomie. Doch was ist damit genau gemeint? – Ausgehend von einer Analyse von Macklins Argumenten möchte ich zeigen, unter welchen Bedingungen die Substitutionsthese die (...) von ihren Vertretern häufig in den Vordergrund gestellten eleminativen Ergebnisse zeitigt – die Rede von einem eigenständigen begrifflichen Gehalt von „Würde“ sollte aufgegeben werden. Im Verlauf der Untersuchung werden auch die Vorzüge einer solchen Position gegenüber stärker eliminativ auftretenden Standpunkten und Positionen deutlich, die den Ausdruck als berechtigt, aber unanalysierbar betrachten. (shrink)

The discussion of the nature and value of dignity in and for bioethics concerns not only the importance of the concept but also the aims of bioethics itself. Here, I challenge the claim that the concept of dignity is useless by challenging the implicit conception of usefulness involved. I argue that the conception of usefulness that both opponents and proponents of dignity in bioethics adopt is rooted in a narrow understanding of the role of normative theory in practical ethical thinking. (...) I then offer an alternate understanding of the nature and value of dignity. I begin by recognizing that claims that one’s dignity has been violated point to an important difference between “respect for autonomy” and “respect for persons.” I then suggest three different conceptions of how dignity can be normatively guiding for bioethics, and conclude that, ultimately, understanding dignity as the cornerstone of a reflective perspective that frames moral reflection and deliberation is valuable for doing bioethics well. (shrink)

Patient safety is a central aspect of healthcare quality, focusing on preventable, iatrogenic harm. Harm, in this context, is typically assumed to mean physical injury to patients, often caused by technical error. However, some contributions to the patient safety literature have argued that disrespectful behavior towards patients can cause harm, even when it does not lead to physical injury. This paper investigates the nature of such dignitary harms and explores whether they should be included within the scope of patient safety (...) as a field of practice. We argue that dignitary harms in health care are—at least sometimes—preventable, iatrogenic harms. While we caution against including dignitary harms within the scope of patient safety just because they are relevantly similar to other iatrogenic harms, we suggest that thinking about dignitary harms can help to elucidate the value of patient safety, and to illuminate the evolving relationship between safety and quality. (shrink)

The goal of this paper is to sketch and defend a novel conception of dignity. I begin by offering three desiderata that a theory of dignity should be able to satisfy: it should be able to explain why all human beings are owed respect, and what kind of respect we are owed; it should be able to explain how acts such as torture damage dignity, and what kinds of harms this brings about; and finally, it should be able to explain (...) why dignity is held to a higher degree by certain individuals. After demonstrating that the dominant, Kantian-inspired conception of dignity cannot fulfill these desiderata, I develop a novel conception of dignity that centers around the role of normative standards. Dignity, on this conception, involves being subject to, and then upholding, relevant normative standards; to violate someone’s dignity is to prevent them from upholding those standards. Importantly, these standards can have either a subjective or a communal source, which in turn explains both the agential and social harms that accompany dignity violations. I then draw on the idea of social dignity to explain human dignity. Unlike the dominant philosophical conception, I take human dignity to be a status that is conferred, rather than a status that is inherent. (shrink)

This paper focuses on a distinct puzzle for understanding the relationship between dignity and human rights. The puzzle is that dignity appears to enter human rights theory in two distinct roles: on the one hand, dignity is commonly pointed to as the foundation of human rights, i.e. that in virtue of which we have human rights. On the other hand, dignity is commonly pointed to as that which is at risk in a subset of human rights, paradigmatically torture. But how (...) can dignity underpin all human rights, and yet only be at stake in very specific human rights violations? And if dignity is lost in torture, how can the tortured retain their human rights? In this paper I offer a solution to these puzzles, in the form of a new theory of dignity. On this new theory, an individual’s dignity can be constituted via either of two pathways: the agent’s own normative competencies, or the authority of her community. The former is what’s typically at stake in practices such as torture; it in virtue of the latter that we have human rights. (shrink)

John Christman has recently objected to substantive conceptions of autonomy on the grounds that they introduce unwanted perfectionism into political thinking. I defend substantive conceptions of autonomy against Christman’s critique on two fronts. First, I defend substantive conceptions of autonomy against the charge that their utilisation in political theory would result in the inappropriate exclusion from democratic respect of individuals in oppressive relations. Second, I defend substantive conceptions of autonomy from the charge that they fail the ‘endorsement constraint’, i.e. that (...) incorporating a substantive conception of autonomy into the concept of the person at the heart of a political theory would be alienating for citizens. (shrink)

Live broadcasts of surgical procedures are most common at professional conferences, but they are not uncommon in the wider public arena, with operations having recently been transmitted in realtime on public television in the UK. This phenomenon raises ethical concerns familiar from the professional context, along with some distinct considerations which merit further attention. In this article I aim to examine the issues in terms of patient autonomy, patient welfare and the public interest. Prompted by the interest recently expressed by (...) the Royal College of Surgeons of England, under each topic I pose a series of questions, before closing with a call for enhanced ethical oversight, such as might be afforded by a clinical ethics committee. (shrink)

This article examines the nature of human dignity against the background of old age and introduces the novel idea of treating human dignity as a formal principle related to the more foundational notion of indignity. The discussion starts with the objection that the notion of human dignity can be used to justify contrary positions and is therefore inconclusive. This pitfall can be averted by appealing to the notion of indignity rather than dignity in one's moral reasoning and decision‐making. Cases of (...) indignity are more primary and indicate the violation of the very core of a human being. The verifiable property of vulnerability is central to this identification of indignity, as is illustrated by reference to the experiences of elderly people. The article argues for applying the concept of human dignity to reverse the conditions that existed before a particular indignity emerged, rather than trying to define positively the notion of human dignity in the first place. (shrink)

Property-based models of the ownership of body parts are common. They are inadequate. They fail to deal satisfactorily with many important problems, and even when they do work, they rely on ideas that have to be derived from deeper, usually unacknowledged principles. This article proposes that the parent principle is always human dignity, and that one will get more satisfactory answers if one interrogates the older, wiser parent instead of the younger, callow offspring. But human dignity has a credibility problem. (...) It is often seen as hopelessly amorphous or incurably theological. These accusations are often just. But a more thorough exegesis exculpates dignity and gives it its proper place at the fountainhead of bioethics. Dignity is objective human thriving. Thriving considerations can and should be applied to dead people as well as live ones. To use dignity properly, the unit of bioethical analysis needs to be the whole transaction rather than the doctor-patient relationship. The dignity interests of all the stakeholders are assessed in a sort of utilitarianism. Its use in relation to body part ownership is demonstrated. Article 8 of the European Convention of Human Rights endorses and mandates this approach. (shrink)

The discussion around dignity in nursing philosophy has been underway for many years. The literature still lacks philosophical arguments that would justify the thesis that all people have dignity. Scholars who defend dignity as an intrinsic value most often refer to Kant. However, Kant does not seem to be the most suitable candidate to defend the thesis that all human beings possess dignity. In this paper, I attempt to show that Aristotle's and Aquinas's views can help justify this thesis. To (...) this end, I distinguish between actual dignity, potential dignity, and existential dignity. I state that all human beings have existential dignity or potential dignity. (shrink)