Human Dignity and Bioethics

20 | F. Daniel Davis
of intrinsic respect because they have been chosen, organized and
guided in a way that makes sense from a distinctly individual point of
view.” 4 Macklin’s favorable comparison of this sense of dignity with
the Council’s “hopelessly vague” usage of the concept is but a Trojan
horse for the central contention of her critique: namely, that dignity
is a poor, blurred substitute for what she describes as the principle
of medical ethics, respect for persons—or, as she later says, respect for
autonomy. Even in the Nuffield report, she argues, the truth of the
matter emerges: dignity adds nothing to, and in fact casts a confusing
haze over, the ideas clearly conveyed by the principle of respect
for autonomy. 5
Macklin’s critique of human dignity is, to say the least, open to
question; and many of the respondents who were moved to submit
rejoinders to her article did raise pointed questions: 6 In what sense is
respect for persons the principle of medical ethics? Does respect for
persons mean the same as respect for autonomy? Does either principle
fully exhaust the meaning of human dignity? Is dignity really
reducible to autonomy? In what follows I will merely touch on possible
responses to these questions, for what intrigues me here is the
provocation implicit in Macklin’s critique: her comparison of human
dignity and respect for persons (or autonomy) invites historical analysis
and reflection on the role that concepts of this sort have played
in the work of national forums in public bioethics.
Respect for persons is one of three principles enunciated in the
1979 Belmont Report, the final report issued by the National Commission
for the Protection of Human Subjects of Biomedical and Behavioral
Research*, the first major national forum in public bioethics
in the United States. A quarter of a century later, human dignity has
been a pivotal concept in some (albeit not all) of the reports of the
President’s Council on Bioethics, the country’s current national forum
in public bioethics. How does the principle of respect for persons (as
well as the other two principles, beneficence and justice) function in
the deliberations and reports of the National Commission? What is
the meaning of the principle, what are its origins, and what has been
its fate since 1979? Likewise, how does the present Council appeal
to and ground its arguments in the concept of human dignity, and
what does the Council mean by human dignity, which, like respect for
* Hereinafter, “the National Commission.”