This is a repost that I thought might be of special interest since so many are commenting about HBO's "You Don't Know Jack" presentation. The original post, “What is dignity? Is it a useful concept?” can be found here, along with the original comments. 

 “Dignity” is a word we hear often in a variety of contexts.  And while we all probably think we know what dignity means, there seems to be a lot of disagreement about what constitutes dignity and what does not.  What is a dignified life as opposed to an undignified life?  Do animals have dignity, and do they deserve to be treated with dignity?  What does it mean to have dignity or to be treated with dignity?  What does it mean to violate dignity? Do we grant dignity, receive dignity, or just inherently possess dignity?  Does anyone know? 

Within the field of bioethics there is much debate about the meaning, or perhaps more precisely the “usefulness”, of the term dignity. Steven Pinker wrote an article entitled, The Stupidity of Dignity. Pinker references Bush’s Council on Bioethics and the “disquiet” that is often associated with biomedical innovation saying: 

“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. This collection of essays is the culmination of a long effort by the Council to place dignity at the center of bioethics. The general feeling is that, even if a new technology would improve life and health and decrease suffering and waste, it might have to be rejected, or even outlawed, if it affronted human dignity.” (Emphasis added) 

Pinker then references a 2003 editorial by bioethicist Ruth Macklin, Dignity Is a Useless Concept: 

“Macklin argued that bioethics has done just fine with the principle of personal autonomy--the idea that, because all humans have the same minimum capacity to suffer, prosper, reason, and choose, no human has the right to impinge on the life, body, or freedom of another. […] Once you recognize the principle of autonomy, Macklin argued, ‘dignity’ adds nothing.”

So, I’m wondering; what exactly is “dignity” and is it a useless word or concept?  

This issue of dignity is referenced in an article by Peter Singer from January 2007 called A Convenient Truth.  The article addresses a bioethical controversy about treatment administered to a nine-year-old girl named Ashley in Seattle, Washington, whose intellectual development “has never progressed beyond that of a 3-month-old” but who is expected to live a normal lifespan.  Interestingly, there was a recent episode of Law & Order which also followed this very storyline.  The opening paragraph of Singer’s article asks: 

“Can it be ethical for a young girl to be treated with hormones so she will remain below normal height and weight, to have her uterus removed and to have surgery on her breasts so they will not develop? She cannot walk, talk, hold a toy or change her position in bed. Her parents are not sure she recognizes them. She is expected to have a normal lifespan, but her mental condition will never improve.” 

As one might expect, one of the big issues is the question of who benefits from Ashley’s treatment; the parents or Ashley.  It seems obvious that the two need not be mutually exclusive; both Ashley and her parents could benefit.  As Singer says, “…the line between improving Ashley’s life and making it easier for her parents to handle her scarcely exists”. 

The article outlines three primary objections to this treatment.  First is the argument that it is “unnatural”.  Singer briefly outlines refutations to that objection, and moves on to the second objection, which is the “slippery slope” to more children being “modified” for the convenience of parents.  Singer replies to that charge saying: 

“In any case, the ‘best interest’ principle is the right test to use, and there is no reason that other parents of children with intellectual disabilities as profound as Ashley’s should not have access to similar treatments, if they will also be in the interest of their children.” 

The third objection is based upon the concept of dignity, the focus of this essay.  This seems to be the objection to Ashley’s treatment upon which Singer’s article focuses most.  Singer writes: 

“Finally, there is the issue of treating Ashley with dignity. A Los Angeles Times report on Ashley’s treatment began: ‘This is about Ashley’s dignity. Everybody examining her case seems to agree at least about that.’ Her parents write in their blog that Ashley will have more dignity in a body that is healthier and more suited to her state of development, while their critics see her treatment as a violation of her dignity.”

So, there it is; the question of what is dignity and what violates dignity.  And considering that we all think we know what dignity is, it is interesting that there is no clear consensus about what constitutes dignity or what violates it.  For instance, as Pinker points out: 

“We read that slavery and degradation are morally wrong because they take someone's dignity away. But we also read that nothing you can do to a person, including enslaving or degrading him, can take his dignity away.” 

Singer immediately delves into this philosophical dilemma of what constitutes dignity.  He says: 

“As a parent and grandparent, I find 3-month-old babies adorable, but not dignified. Nor do I believe that getting bigger and older, while remaining at the same mental level, would do anything to change that.” 

Do Animals Have Dignity?

But Singer takes the issue one step further saying: 

“We are always ready to find dignity in human beings, including those whose mental age will never exceed that of an infant, but we don’t attribute dignity to dogs or cats, though they clearly operate at a more advanced mental level than human infants. Just making that comparison provokes outrage in some quarters. But why should dignity always go together with species membership, no matter what the characteristics of the individual may be?” 

Do dogs, cats, and animals in general, have dignity?  Should they be treated with dignity?  Is dignity related to intellectual functioning, as Singer seems to suggest?  If it is related to intellectual functioning, are individuals of average mental ability less worthy of dignity than geniuses?  With regard to those who think Ashley’s dignity was violated by the treatment administered to her, what constitutes the dignity that was violated?  Since she is incapable of doing anything that would create her dignity, I must conclude that Ashley’s dignity is an inherent trait.

So, what is dignity?  As it turns out, answering that question is no easy task.  

Pinker points out, regarding the report from Bush’s Council on Bioethics, “The report does not, the editors admit, settle the question of what dignity is or how it should guide our policies” (emphases added).  So, for the purpose of beginning this discussion, I’ll quote what I think is the simplest, most commonly thought definition: “The quality or state of being worthy of esteem or respect.” 

I’m not sure the abovementioned definition helps much because there is, then, as has already been shown, the question of what makes one worthy of esteem or respect, as well as how that esteem or respect would be demonstrated.  In Ashley’s case, there was no clear consensus about her dignity or how to honor her dignity. 

Showing respect to another individual often translates to treating someone with “decency” and “courtesy”, which does nothing to help answer the question because we often defer to people we do not consider worthy of esteem or respect.  As a general rule, treating someone without decency or courtesy, or in another word, rudely, is a show of low, or no, respect and of unworthiness of esteem or respect.  But this still seems to leave us in a quandary with Ashley’s situation.  Was she treated respectfully, decently and courteously, or was she treated rudely and disrespectfully?  I’m not sure that either really applies to Ashley’s situation. 

At this point, the concept of dignity begins to appear not only useless, as Macklin says, but rather more problematic than helpful simply because nobody seems to actually know how to apply the concept consistently. 

I’m going to add one more criterion to what might constitute dignity.  I would amend the aforementioned definition to something like this (improvements/alternatives welcomed): “the quality or state of being worthy of esteem or respect, and worthy of absence of intentionally imposed physical or emotional/mental distress, as well as relief or prevention of such distress whenever possible.”  This particular amendment seems appropriate to me because when we treat someone with decency or courtesy, we are in effect avoiding causing them discomfort, whether emotional or physical. 

Another reason this amendment seems appropriate to me is that when we speak of treating prisoners with dignity, for instance at the Abu Ghraib and Guantanamo detention camps, we primarily refer to providing “creature comforts”, and to not creating undue discomfort or distress such as that which is caused by torture.  So it seems that we do, on a societal level, recognize that treating someone with dignity includes allowing some degree of comfort to that individual.  This line of thought leads me to conclude that if Ashley’s treatment provides her with greater comfort throughout her life, then the treatment does not violate her dignity, but rather honors it.  Likewise, Ashley’s parents, who will be responsible for Ashley’s care for the entirety of her or their lifespan also, have an equal worthiness of consideration for their dignity. 

 With regards to animals, it seems to me that the same holds true.  If someone abuses a pet, or any animal, that person violates the animal’s comfort, and therefore, also violates the animal’s dignity.  In this issue we find another component of violating dignity: neglect, which is one of the major violations of dignity perpetrated by humans on animals.  When humans abuse animals whether pets or “food animals”, the dignity of those animals is violated. 

It seems that one of the greatest ways someone shows respect is to avoid abusing another, whether the other is human or not.  Even here, the issue of what constitutes abuse may sometimes be unclear, but certainly, needlessly removing comfort, or creating discomfort, is abusive while attempting to provide comfort, or to avoid creating discomfort, is a clear attempt towards respect and honoring dignity.  It also seems clear that one of the best ways to become unworthy of esteem or respect is to needlessly cause the suffering of another, whether the other is human or not.  In this sense, then, I also conclude that other animals do have dignity and are worthy of esteem and respect, just as humans are. 

This brings us back to Macklin’s assertion that dignity is really nothing more than “respect for autonomy”.   

Recently, gay marriage has become a high profile issue.  It seems fair to say that disallowing gays and lesbians the same privileges as other citizens unnecessarily creates discomfort and distress for our gay and lesbian brothers and sisters.  This clearly “violates” the dignity of these citizens, unless we are to conclude they have no dignity, and that they are not worthy of esteem or respect, and comfort. 

What of our brothers and sisters with various forms of “mental illness”?  The stigma surrounding these mental states only creates undue discomfort and distress for these individuals. This is another area where neglect is a major issue.

Viewing comfort, or lack of discomfort, as a key to “dignity”, casts many social and policy issues into a different light or a different character.  How often is dignity referenced without explicitly linking it to the concept of “comfort”?  How many social issues such as stem cell research are opposed within the framework of “human dignity” but are never linked to an individual’s worthiness of “comfort” or freedom from suffering?  

“Morality” seems to be connected to dignity, as well.  Considering the concept of comfort, can we separate morality from suffering?  Somehow, to separate the concepts of morality and suffering seems counterintuitive; to cause another being to suffer or to allow someone to suffer needlessly when that suffering can be ended is not generally seen as moral.  Violating a person’s dignity is viewed as an immoral act, and said act of violation is generally associated with imposing some form of suffering or discomfort onto another individual. 

Pride appears to be a factor in what many think of as dignity.  For instance, when one is humiliated, embarrassed publicly, it is often said to offend or violate that person’s dignity.  Being humiliated is an affront to one’s pride, yet, how well one manages that humiliation is often said to exhibit dignity.  As in Pinker’s example of enslaving or degrading an individual, it seems that suffering quietly is often considered a display of dignity.  Interestingly, pride is also one of the "Seven Deadly Sins"; it is a sin in one culture, a virtue in another.  Is suffering quietly more dignified than rising up against the source of imposed suffering?  Again, there seems to be no clear consensus.  Can it be that both acts are equally dignified, despite being opposite acts? 

As one example of the links among dignity, morality, and suffering, I would point to the societal debate concerned with the concepts encapsulated within Oregon’s Medical Marijuana and Death with Dignity acts.  Both of those laws allow individuals to commit what many view as improper and undignified actions in order to avoid suffering, thereby preserving their dignity. So, is it possible to preserve one's dignity through the commission of an undignified act?

Another question that might be explored here is the concept of “dignity of the dead”.  That has always seemed a strange concept to me.  Is someone who is dead capable of having dignity?  It seems unlikely, so it is more likely a case in which dignity is assigned to the dead.  Can the dignity of a dead person be violated?  We've all heard the saying, “Don’t speak ill of the dead.”  This suggests we should show a level of respect towards someone who is dead, often even if that person was not respected while alive. 

That which one person views as honoring dignity, another person views as violating dignity.  Within the same culture, an affront to one's pride is a violation of that person's dignity, yet pride itself is considered undignified.  

I think the term, dignity, mostly and best serves a sort of poetic purpose, as context seems to be a primary reference point for what the word means, and poetry often benefits from a degree of ambiguity in the meanings of words, and there is little consensus about source or interpretation of the content or meaning of dignity. 

For all the more specific meanings and usages associated with dignity, such as in the field of bioethics, and for the purposes of policy decisions and research, I think there are better terms that avoid the ambiguity that comes with the word dignity, which only obstructs intelligent, rational formation of policy. For instance, Bush’s Council on Bioethics has seemingly attempted to place dignity at the center of debates regarding bioethics in research, yet they don't bother to define dignity or to explain how it should guide decisions and policy.

I’ve presented some varying views here, including some of my own, and I hope for a wide-ranging array of comments, varying opinions, and perhaps some views not yet mentioned.