Friday, May 16, 2008

The dignity of stupidity

It seems that the biggest bioethics news of the week has to do with two concepts that look funny together: dignity and stupidity. Steven Pinker has written a rather brittle essay -- entitled 'The Stupidity of Dignity' -- in response to the recent publication of a report by the President's Council on Bioethics, Human Dignity and Bioethics. For those who keep track of such things, Ruth Macklin wrote an article about five years back with the catchy title 'Is dignity a useless concept?', and she answered her own question in the affirmative, arguing that the term is religious in origin, has no real place in bioethics and should be replaced without remainder by the secular concepts of autonomy and respect for persons. Human Dignity and Bioethics is a 555-page rejoinder to Macklin's challenge. According to Pinker, it is a lousy rejoinder: the report, by dredging up concepts of dignity that are fuzzy or contradictory, has failed to show that dignity is of much use to bioethics.

If Pinker just stuck to that, pointing out the lack of progress with conceptual clarity in regard to 'dignity', his essay would have raised few eyebrows. But Pinker goes on to argue, in effect, that while dignity is a useless concept for analysis of bioethical issues, over the last years it has proved a very useful tool for religious conservatives (including members of the President's Council on Bioethics) seeking to influence political leaders on matters concerning science, technology and human values. In fact, most of Pinker's essay is a kind of potted and impressionistic sociology of the conservative origins and tendencies of the Council, rather than a sustained analysis of what is actually said in their report, though he does pick out a few choice gems for comic relief. Leon Kass, the bioethicist in America closest to the ear of President Bush, comes off as someone whose intense concern for dignity casts doubt on his overall mental health: the man vigorously opposed to IVF turns out to be equally opposed to the (undignified) practice of eating ice cream in public. Imagine, if you will, a group of like-minded moral hypochondriacs imposing their religiously-fueled vision on the rest of society, beating down opponents with resonant (but actually empty) appeals to 'human dignity'. You get Pinker's drift: lovers of human dignity may end up being enemies of human freedom, and when push comes to shove, he will take freedom.

The best parts of Pinker's essay are not about the Council, but his views about the limitations of the concept of dignity: it is relative, it is fungible and it can be dangerous. Unfortunately, Pinker does not draw out more the profound implications, and make the chickens come to roost. Are the 'secular' notions of autonomy and respect for persons in any better conceptual shape than dignity is? What do we mean by autonomy, and how is it immune to being relative, fungible and potentially dangerous? (Those who think this concept is obvious or innocuous should read 2000 years worth of moral philosophy.) Ditto for 'respect for persons'. The bottom line is that when we look at the most fundamental concepts that we use in bioethics, we go from applied ethics to metaethics, and from slogans to philosophy, we reach a place where words can falter, and where everyone is vulnerable to looking a bit stupid.

How does this connect to bioethics in a global context? As discussions about bioethical issues become more frequent and explicit around the globe, there are likely to be conflicts between secularism and religion, modernity and tradition. Each culture will struggle to negotiate ways of reconciling new medical technologies and practices with deep-seated values and customs. This will be messy. But one hopes that these tricky negotiations will not replicate the style and tenor of contemporary American bioethics, marked as it often is (from all sides) with excursions into mudslinging, ad hominem arguments and heaping helpings of contempt. Always engage with others as if they are acting in good faith after serious reflection: a good working principle for bioethics, expressing humility and generosity of spirit, but very difficult to follow.


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