Human Dignity and Bioethics

486 | Daniel P. Sulmasy, O.F.M.
on the flourishing of the affected individual. As I have defined it elsewhere,
“A disease is a class of states of affairs of individual members
of a living natural kind X, that: (1) disturbs the internal biological
relations (law-like principles) that determine the characteristic development
and typical history of members of the kind, X,…(4) and
at least some individuals of whom (or which) this class of states of
affairs can be predicated are, by virtue of that state, inhibited from
flourishing as Xs.” 32 Thus, an anatomical variation such as an anomalous
branch in the brachial artery going around the median nerve
may violate the law-like generalizations and characteristic development
of human beings, but such a variation has no adverse effect on
the flourishing of any human being and is not a disease. By contrast,
a condition such as rheumatoid arthritis inhibits one’s ability to walk,
to care for oneself, to open a jar, or to hold a spoon. It causes such
pain that one may lose the ability to concentrate on other aspects
of life. It is a real disease. Rheumatoid arthritis inhibits one who
bears the stamp of intrinsic dignity from flourishing as a human being,
either directly or by virtue of the fact that health is required for
so many other forms of human flourishing—family life, friendship,
work, art, politics, scholarship, and more. Respect for an afflicted individual
requires, in recognition of this dignity, a concrete response.
Medicine is one of the major forms of human response to such affliction,
capable at times of restoring the flourishing of the individual,
and at other times limiting the degree to which the disease or injury
detracts from human flourishing. In terms of concrete medical practice
this can mean either cure, or assistance with the activities of daily
living, or amelioration of pain or other symptoms if this is possible.
The duty to provide such care follows from P-IV. A society that fails
to provide for health care has violated P-IV.
Health is also a fundamental condition for attributions of value,
either reflexively by an individual, or by the attribution of others.
To see this, one need only reflect on the ways in which illness
and injury assault the attributed dignity of human beings. Those
who are ill are robbed of their stations in life. They lose valued independence.
They often become disfigured. They lose their social
productivity. They lose esteem in the eyes of others and may even
begin to question their own value. If there are any duties to build
up the attributed dignities of human beings, surely health care is