Dignity and Bioethics

May 28, 2008 1:35 PM

The Stupidity of Dignity: Conservative bioethics' latest, most dangerous ploy. Steven Pinker reviews Human Dignity and Bioethics, the latest report from the President's Council on Bioethics.

dgaicun posted Pinker's article in the Leon Kass vs. ice-cream thread, but I think it and the report deserve their own post.

posted by homunculus (28 comments total)

Here's Ruth Macklin's editorial which Pinker mentions: Dignity is a useless concept
posted by homunculus at 1:36 PM on May 28, 2008

Daniel Dennet and Martha Nussbaum have been discussed frequently on MeFi. They each have a chapter in the report:

Daniel Dennett: How to Protect Human Dignity from Science

Martha Nussbaum: Human Dignity and Political Entitlements
posted by homunculus at 1:37 PM on May 28, 2008

all on one page
posted by jepler at 1:54 PM on May 28, 2008

Politicians pandering to people who have really weird ideas would be hilarious if the results weren't so tragic.
posted by mullingitover at 2:15 PM on May 28, 2008

Great leaping lepers, where do these people come from? I don't fucking understand. How does it even happen that there can be people who don't think that the Enlightenment was a good idea? And what the fuck is dignified about dying young of horrible wasting but possibly curable diseases? What the hell is dignified about physical and mental disabilities that, given enough research, we might be able to cure or stop before they're started?

I swear, the fucking Catholic church Bush administration and its opposition to happiness. Why are these people so intent on everyone being miserable?
posted by Caduceus at 2:19 PM on May 28, 2008 [1 favorite]

Because they're miserable, and they think it's the only way to be.

Alternatively, because keeping people miserable keeps them from questioning why such a goddamn fucking moron is boss of the country, and why he makes more money in interest than they see in a year.
posted by dirtynumbangelboy at 2:21 PM on May 28, 2008

How did the United States, the world's scientific powerhouse, reach a point at which it grapples with the ethical challenges of twenty-first-century biomedicine using Bible stories, Catholic doctrine, and woolly rabbinical allegory?

It's a good question. I even wonder how bioethicists have a paying job, but I guess it is a field that pulls a lot of weight in academia, probably because of the media attention and funding it brings schools. But bioethics was already more of a philosophical endeavor than a scientific one, to begin with, and ethical matters are already negotiated between patient and doctor, by law, by fiat of credit rating, and sometimes, if the patient is lucky, by lawsuits and media coverage when those negotiations fail.

The notion of "dignity" in the United States has always been a function of relative wealth -- if you're fortunate, you can access a basic level of dignity by law, and you get better treatment if you have insurance or can otherwise afford the care. If you're not fortunate, you may not get to live to be able to defend your right to personal dignity within the healthcare system.

In the meantime, bioethicists argue endlessly about high-profile edge cases of dignity which involve, for example, cloning, life extension and fertility treatments, which are pointless to debate as the wealthy will have access to this technology as it comes online, regardless. Still, it's a diet of red meat for media and the attention-hungry academics who get to chew it over.

I do wish, concordantly, that the media would have paid more attention to the Genetic Information Nondiscrimination Act recently signed into law by Bush. While presidential councils can put out religious-flavored, non-scientific reports until the cow comes home, in the long run, for the average American, it is actual legislation where the rubber meets the road. Laws like GINA shows that the system can work, in spite of religious interference in state affairs. More directly, these kinds of laws are what really establish that important baseline of dignity that is afforded all citizens.

How on Earth did GINA manage to get past the kind of neo-conservative, Calvinist, world-is-a-marketplace policy makers and council members in the White House? That's a more interesting question, to me. I wish the bioethicists who take their job seriously would ponder what dignity really means in a similar, social context.
posted by Blazecock Pileon at 2:56 PM on May 28, 2008 [7 favorites]

I'm torn, on the other hand, in our post-Rovian world its foolish to keep the kid gloves on while the wingnuts influence medical policy. On the other hand, having seen Pinker's previous polemic hack-job with The Blank Slate, I found it frustrating that he spends the first half of the article setting up an elaborate mass ad hominem attacking the authors of the volume based on their political ties or the popularity of their previous statements. I agree with his counter-argument that dignity is not a solid foundation on which to discuss bioethics, but I found his advancement of that argument to be rather weak. My summary of Pinker's discussion is:

1) The authors are not qualified to discuss the issue because of arbitrary standards set by Pinker. (bad argument)

2) The authors fail to deliver a consistent ethical framework for dignity. (good argument)

3) A Godwin. (bad argument)

4) It is worthwhile to consider dignity in a fuzzy definition and arbitrary situations set up by Pinker. (bad argument)

5) There are alternative bioethical frameworks that do a better job of protecting the moral interests of people. (good argument, poorly presented)

6) Dignity is not a worthwhile framework because the prospective benefits of human biotechnology are predicted to be slim. (weak argument)
posted by KirkJobSluder at 3:03 PM on May 28, 2008 [1 favorite]

You know, somewhere I have an essay, written by a Catholic Archbishop (or maybe even a Cardinal) in the late 50's or early 60's on the morality of this coming organ transplant technology.

His big moral concern: would organs available for transplant go to those in the greatest need?

His other big concern: Or would they just go to the rich.

It doesn't really make me feel any better to see that its not just the United State's stock that's in free fall.
posted by Kid Charlemagne at 3:13 PM on May 28, 2008

I think the article addresses the sorts of people on the Council:

Many people are vaguely disquieted by developments (real or imagined) that could alter minds and bodies in novel ways. Romantics and Greens tend to idealize the natural and demonize technology. Traditionalists and conservatives by temperament distrust radical change. Egalitarians worry about an arms race in enhancement techniques. And anyone is likely to have a "yuck" response when contemplating unprecedented manipulations of our biology. The President's Council has become a forum for the airing of this disquiet, and the concept of "dignity" a rubric for expounding on it.

I recall a historical event (that I believe was related in Guns, Germs, and Steel by Jared Diamond) regarding certain Chinese powers that be and their moral antipathy towards having a navy. Once they were in power, China's navy was severely curtailed. As a result, other countries (particularly European countries) surged by them in terms of power because they did have an effective navy.

Moral revulsion, justified or not, to certain technologies can stymie a nation's success. In Diamond's book, he discusses how the multiple kingdoms of Europe actually served to push the development of technology forward. To whit, if the King of France chose to reject a certain technology, the King of England might very well embrace it, giving England the advantage.

The ray of hope here, of course, is that the same gentleman who headed this council was one of the most vituperative opponents of in vitro fertilization in the 1970's. Once the obvious benefits of this form of conception were made clear, the general public embraced this affront to dignity. This is, of course, mentioned in the linked article.

Anyhow, I find the arguments against bio-research to be one step removed from the argument that we shouldn't treat any illness or disease with any human medicine because doing so interferes with God's will. In essence, this argument is predicated on the idea that, for some reason, God did not intend for us to discover things that heal us - that medicine is somehow not a part of God's plan.

I'm no believer, but I've always been led to believe that, among believers, claiming to know God's plan is the height of hubris.
posted by Joey Michaels at 3:15 PM on May 28, 2008 [3 favorites]

B.P.: In the meantime, bioethicists argue endlessly about high-profile edge cases of dignity which involve, for example, cloning, life extension and fertility treatments, which are pointless to debate as the wealthy will have access to this technology as it comes online, regardless. Still, it's a diet of red meat for media and the attention-hungry academics who get to chew it over.

I think this is rather like saying that attorneys just argue high-profile cases of murder. I'll argue in contrast that most working bioethicists are also working doctors, lawyers and administrators, who actually make the policies that inform that negotiation between care provider (because individual doctors are a dying breed) and patient. Certainly that "negotiation" hardly ever starts from scratch.

I'd say that most bioethics involves rather mundane and applied questions: does a witnessed signature on this informed consent form really constitute informed consent, does this specific protocol protect the participants, what are the risks and benefits of this field trial of bioremediation, what software should researchers use to destroy old data, what guidelines should we use to determine when to risk transporting a patient to another hospital?

But publishing white pages on those questions rarely makes the national news.
posted by KirkJobSluder at 3:21 PM on May 28, 2008 [3 favorites]

KirkJobSlunder, given the way that the Overton Window has been dragged all over hell and gone in the past thirty years or so (see above) I think it's become pretty clear that Godwin's Law has been a lot like the policy of putting out even the minor wildfires back in the 60's. It made the park look tidy (and got kids to stop whining about not being allowed to skateboard in busy streets) but it allowed a lot of dangerous debris to collect on the forest floor allowing bigger and bigger fires to occur.
posted by Kid Charlemagne at 3:39 PM on May 28, 2008

I am continually amazed at the circumlocution that "religiously based ethicists" go through to obfuscate the lack of any real philosophical underpinning for their viewpoints. I got dizzy reading some of the comments defending the President's Coucil and its viewpoints. The speed with which words change their meaning and arguments fold back on themselves is breathtaking.

On the other hand, I particularly liked this commenter's passage (Tom Huffman, by name):

Sometimes religious-based ethics will instead resort to biological classification as a stand-in for moral status. OF COURSE, an embryo is human in the taxonomic sense that it has a human genetic code and belongs to the species homo sapien. But this is neither a necessary nor a sufficient condition for the conferral of full moral rights. It is not necessary because it is easy to image non-humans possessing moral rights. If we were to discover tomorrow that a species of primate that had been sacrificed regularly in the course of research for the cosmetics industry in fact had cognitive abilities well beyond what we had previously imagined--indeed abilities approaching our own--then the research would surely stop immediately. This would occur without our obtaining any additional information about its genetic classification. It is not sufficient because, despite the fact that activists have worked diligently to stop the use of human embryos in scientific research, they have ignored the fact that fertility clinics routinely destroy thousands of unused embryos. So too, the same activists have generally not lobbied legislatures to make abortion a capital crime punishable by death. If even the defenders of religious ethics do not believe that mere biological classification is sufficient for the conferral of full moral rights, then why should the rest of us?

...does a witnessed signature on this informed consent form really constitute informed consent...?

Bioethicists I know would be appalled at calling it an "informed consent form", as they regard informed consent as a process, not a form or single thing. IRBs prefer it be called simply a consent form.
posted by Mental Wimp at 3:48 PM on May 28, 2008 [2 favorites]

I should qualify my statement that I'm referring to Kaplan-eseque, media-saavy bioethicists who like to see their name in the press, rather than a legislator sitting in Congress to debate healthcare laws, or a doctor arguing with an HMO rep for treatment A over treatment B.

I am more skeptical about Pinker's diatribe than what he is going on about. Bush is out of office (fingers crossed) in less than seven months and, as a lame duck has less influence over national policy than usual. It's exceedingly unlikely that this report will do much to change the course of basic research funding in any particular direction, even if McCain takes the reins next January and creates his own cabinet positions and advisory team.

This back and forth is another salvo in the culture wars. I guess I would just like to hear more of a concrete fashion about how the Dignity report was intended to be used to guide changes in existing public policy. Does Kass' philosophical contribution intend to rid us of certain HIPAA guidelines, for example? For the council as a whole, what is the notion of dignity as a means to guide policy in a specific way, and how is that problematic beyond Pinker's personal objections?

I'd say that most bioethics involves rather mundane and applied questions: does a witnessed signature on this informed consent form really constitute informed consent, does this specific protocol protect the participants, what are the risks and benefits of this field trial of bioremediation, what software should researchers use to destroy old data, what guidelines should we use to determine when to risk transporting a patient to another hospital?

And to that point, I would argue that Pinker's essay seems less about bioethics, less about actual impact on society and decision making, than about him expressing his diametrical, cultural opposition to Kass. Which I may agree with, personally, but is a technique that does little to advance his overall thesis and inspires my skepticism of "professional" bioethicists.
posted by Blazecock Pileon at 3:49 PM on May 28, 2008

er, "Council", to use the canonical spelling.
posted by Mental Wimp at 3:50 PM on May 28, 2008

I also felt that the dismissal of some commenters of the fundamental role of autonomy to be a bit shallow. Isn't it the basis for democracy, inalienable rights, and all that?
posted by Mental Wimp at 3:52 PM on May 28, 2008

I'm a fan of Stephen Pinker, but that essay is a mess.
posted by empath at 4:25 PM on May 28, 2008

I didn't read the article, but what's depressing is that A) more conservative thinkers than Pinker even exist and B) less sound ones as well.
posted by birdie birdington at 4:32 PM on May 28, 2008

Kid Charlemagne: Sure, I'll grant that calling Godwin is overused. But, I still think that the argumentum ad Hitlerum as Pinker invokes it here is an argument that is so weak, it does more to undermine Pinker's position rather than support it.

But I'm not surprised that Pinker tries to rally support by associating his opponent with unpopular causes given how much of Blank Slate was similarly wasted.

Blazecock Pileon: I guess I would just like to hear more of a concrete fashion about how the Dignity report was intended to be used to guide changes in existing public policy.

I think it pays for political wonks like Kaas to take the long view of things. Almost all of the Iran Contra cast of characters who created a Latin American foreign policy based on lying about paramilitary militias and assassination had new jobs in the White House weeks after Bush was elected. Kissinger still seems to have his hand the the pie off the books. In the lean Democratic times, well, that's what think tanks are for.
posted by KirkJobSluder at 4:32 PM on May 28, 2008

I'll also add that "government report" carries a weight of authority that anti-abortion and reproductive rights groups can use in local battles over emergency contraception and family planning. There are a lot of battles that go on around these issues on hospital boards, in statehouses, and on school boards that are likely to continue regardless of who wins the next presidential election.
posted by KirkJobSluder at 5:28 PM on May 28, 2008

Um, Pinker is a liberal.
posted by Maias at 5:37 PM on May 28, 2008

From the article:
Of course, institutional affiliation does not entail partiality, but, with three-quarters of the invited contributors having religious entanglements, one gets a sense that the fix is in.

Or, in a nation where %92 of the population believes in God and %51 in Creationism, one in which %20 of the population is so scientifically illiterate that THEY BELIEVE THE SUN REVOLVES AROUND THE FUCKING EARTH, you could argue that the government-sponsored bioethics council reflects the demographics of the country that paid for it.

I'd call that democracy in action.

But seriously, while I would've liked to see an actual biologist or medical researcher on the committee, the fact is that most Americans equate ethics with religion, and so most Americans would prefer to receive ethical guidance from people who speak their language. Scientists are notoriously bad at talking about ethics, because they're used to arguing over facts and become incredulous and argumentative when people refuse to believe them.

Americans in particular don't take kindly to being talked-down to. So when it comes to moral philosophy, a scientist must be prepared to approach the table as a peer, even a supplicant, to the public at large in order to convince them of the ethical soundness of their groundbreaking foetal humandroid organ harvest pods or whatever.
posted by xthlc at 6:21 PM on May 28, 2008

Kass has a problem not just with longevity and health but with the modern conception of freedom. There is a "mortal danger," he writes, in the notion "that a person has a right over his body, a right that allows him to do whatever he wants to do with it." He is troubled by cosmetic surgery, by gender reassignment, and by women who postpone motherhood or choose to remain single in their twenties.

So in this man's worldview, the state has a legitimate interest in controlling virtually every aspect of a person's lives, from what they look like, to their personal identity, even denying women the choice of living alone. What a revolting sentiment. For all the rhetoric out of American conservatism about keeping the government off people's backs, it certainly has a way of attracting the most profoundly authoritarian adherents.
posted by [expletive deleted] at 6:45 PM on May 28, 2008 [3 favorites]

[America,] where 20% of the population is so scientifically illiterate that THEY BELIEVE THE SUN REVOLVES AROUND THE FUCKING EARTH.... Americans in particular don't take kindly to being talked-down to.

Deeply ironic, that.
posted by five fresh fish at 6:50 PM on May 28, 2008

I disagree with Pinker's argument. He says that dignity is an almost useles concept. Yet all through the essay he uses similar terms callousness, mistreatment, dehumanization, and 'respecting the rights and interests of another'. These terms and phrases are really the same thing, yet I doubt that he is willing to give them up.

Dignity is indeed a relative term. That is the source of political battles and wars. He defines it differently than fools like Kass, but that doesn't mean you throw out the term or you risk throwing out all the terms. There's a slippery slope where you first call it relative, then you call it useless, then finally you, or at least the people listening to you and taking what you say at face value, abandon it (and all other similarly relative concepts like ethics) altogether. He brings up horrors like the Nazis but he doesn't give us the vocabulary to argue against it.

He needs to just admit that he has his own view of human dignity that is different than the Bush wackos and leave it at that.
posted by eye of newt at 7:58 PM on May 28, 2008

I enjoyed the article; it almost makes me want to renew my subscription to TNR (but my wife says we already have too many periodicals cluttering up the house). Coincidentally I am reading a book on medical ethics right now and the chapter I am on goes into great detail on the Terri Schiavo case; if that is the Republican idea of dignity in the context of bioethics I will gladly pass.

I also enjoyed an ice cream cone last night and refuse to let Dr. Kass make me feel bad about it.
posted by TedW at 6:14 AM on May 29, 2008

Dignity is indeed a relative term. That is the source of political battles and wars. He defines it differently than fools like Kass, but that doesn't mean you throw out the term or you risk throwing out all the terms.

I think he was saying due to its variant definitions, as a concept it was useless for formulating ethical policy, not as a concept per se. He prefers the less fungible "autonomy" as a solid footing for ethical policy in science and medicine.
posted by Mental Wimp at 4:27 PM on May 29, 2008

The evolution of morality
posted by homunculus at 5:05 PM on June 23, 2008