An old post at the Center for Bio-Ethics and Human Dignity puts me in mind of how perilous the past decade has proven for the disabled when it comes to birth–for eugenics has dominated the provision of medical services in ways that are both startling and alarming. Consider the following:
Arguably, one of the best extended contemporary discussions of human dignity and its implications for biomedicine was commissioned under President George W. Bush and convened by his President’s Council on Bioethics. The council’s two reports, Being Human (2003) and Human Dignity and Bioethics (2008), are the results of more than a few public meetings, thousands of pages of expert testimony, and the work of two physician-scholar-chairmen, Leon Kass, MD, and Edmund Pellegrino, MD. The work of the council provoked bioethicist Ruth Macklin to brand human dignity a ‘useless concept.’ Cognitive scientist Steven Pinker even assailed the notion of dignity as ‘stupidity.’
Nevertheless, both the term and the idea for which it stands continue to possess significant currency not only in the popular imagination but especially in medicine and law. In fact, Roberto Andorno, Senior Research Fellow and Lecturer at the Institute of Biomedical Ethics of the University of Zurich, maintains that the notion of human dignity is so ubiquitous in intergovernmental documents in biomedicine that ‘It is therefore not exaggerated to characterize it as the “overarching principle” of international biolaw’ (‘Human dignity and human rights as a common ground for a global bioethics’, Journal of Medicine and Philosophy 34 (2009): 223-240).
How does one account for this discrepancy? Can human dignity be at once both profound and indecipherable? Can it be both ubiquitous and useless? What happens if we expunge human dignity to the dustbin of incoherence, as Macklin and Pinker would have it? The implications of these questions for biomedicine, human rights, and public policy are difficult to overestimate.
Will our posthuman progeny one day see human dignity as a quaint historical artifact of our speciesist predilections? Perhaps. But removing human dignity from the table only seems to move the question of human rights to the foreground. Whence come human rights if not from human dignity? The United Nations’ Universal Declaration of Human Rights of 1948 affirms that ‘recognition of the inherent dignity and of the equal and inalienable rights of all members of the human family is the foundation of freedom, justice and peace in the world . . . .’ If human rights are merely a result of a social contract, humanity as we know it will survive only so long as the contract remains unaltered. In light of the history that gave new birth to this tradition—namely, the Nazi eugenics movement and the violations of human dignity that resulted from it—forfeiting the idea of inherent human dignity would seem potentially disastrous.
When bioethicists like Ruth Macklin brand human dignity as useless they do not of course mean their dignity but rather the dignity of others. That much of contemporary bioethical reasoning descends directly from Victorian utilitarian philosophy is, perhaps, not as broadly understood as it should be–but the taxonomy of utility aside, the founding principle holds that what is good for the majority of the population should be the only yard stick by which ethical decisions are measured. This isn’t news for scholars of disability studies or for historians but it remains news–relevant news–in a time of extraordinary genetic advancements and managed health care. Most Americans do not realize that their right to give birth is not guaranteed in hospitals across the US and this is a co-determination of bio-ethics and the agents of medical insurance. If you’re told your prospective baby will have Down Syndrome you’re just as likely to be prescribed drugs for abortion, or, worse, denied pre-natal care should you insist on having that child. This is chilling news but do not worry: Peter Singer can explain it to you.
As the Institute on Human Dignity and Bioethics puts it:
Human dignity, once a cornerstone for bioethics, is increasingly obscured by a contemporary culture of commodification. Myopic fixation on sexuality, fertility, and reproduction reduces the female body to a resource for medical exploitation and reproductive tourism. Procreation is being engulfed by the reproductive imperative and the child of choice. Without neglecting the ongoing emphases on beginning- and end-of-life issues, our task must include attention to prenatal discrimination, the neglect of the girl child, worldwide disparities in women’s healthcare and maternal mortality, and the objectification and exploitation of the female body.
For commodification we may read utility–there’s money to be protected by eliminating children whose disabilities may conceivably tax the state or, yes, the insurance industry; money to be made promulgating designer babies; and yes, money to be made in medical exploitation. Against this contemporary horror show it is not reassuring to know that bio-ethicists are all too often the children of Bentham and Frances Galton. As my friend Douglas Biklen, now retired from Syracuse University likes to say when discussing our fellow citizens who can’t speak: “presume competence”–what could possible get in the way of this? Can it be that ethical presumption costs too much?