Abstract
Kantian moral concepts concerning respect for human dignity have played a central role in articulating ethical guidelines for medical practice and research, and for articulating some central positions within bioethical debates more generally. The most common of these Kantian moral concepts is the obligation to respect the dignity of patients and of human research subjects as autonomous, self-determining individuals. This article describes Kant’s conceptual distinction between dignity and autonomy as values, and draws on the work of several contemporary Kantian philosophers who employ the distinction to make sense of some common moral intuitions, feelings, and norms. Drawing on this work, the article argues that the conceptual distinction between dignity and autonomy as values is indispensable in the context of considering our obligations to those who are dependent and vulnerable.
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Notes
An example of this kind of argument is given below in second section.
The question of what the concept of autonomy is, or how concepts of autonomy include or exclude dependent individuals is not taken up here. There is a large body of recent work on autonomy that establishes ways to conceive of autonomy as potentially inclusive of dependence on others. Examples include Joel Anderson’s essay directly linking vulnerability and autonomy [1]; Catriona Mackenzie and Natalie Stoljar’s influential essay characterising autonomy as relational, and which contains a thorough overview of critiques of autonomy as independence [2]; and George Agich’s work on caring for elderly people, which outlines specific problems arising in medical and care contexts when autonomy is characterised as independence [3].
To find this quote in other editions of Kant’s Groundwork, see section A 4:421.
The terms ‘worth’ and ‘value’ will be used interchangeably throughout this article.
This interpretation of Kant on the concept of ‘humanity as an existent end’ is drawn from Wood [ch. 5].
To find this quote in other editions of Kant’s Groundwork, see section A 4:429.
This is a point Agnieszka Jaworska makes when describing the capacity of people with advanced dementia to express clear likes, dislikes, preferences, and values [6]. She argues that these exercises of valuing are perhaps a better guide to continuing personhood than more demanding standards of rational competence and autonomy.
Ronald Dworkin argues for this position. In his view, respecting a person’s dignity requires respecting his or her critical interests in shaping a life, according to their own view of what constitutes a well-led life [7]; see ch. 8 in particular.
Kantian dignity has an elevated status in terms of its value, but not a status of one person over another or a status that can be given up or surrendered. See Oliver Senson for the connection between Kant and a traditional Stoic view of dignity as having an elevated status [8]. Sensen argues that dignity gives rise to a duty to live up to one’s status, which is prior to a person’s rights. Duty in this sense comes before rights, not in any temporal sense, but in the conceptual sense that a morality of duty and value is required in order for a person’s rights to have legitimacy or ‘claim value’.
I would word this slightly differently: rather than saying dignity is a value in a person, which may suggest that dignity is some ‘thing’ a person has, I would say that dignity is a person’s value, and as such, is not some ‘thing’ that can be denied or given up.
The issue addressed here is one of regress. One can still ask where dignity comes from, and the Kantian answer is from our existence as end-setting beings with goals and purposes that matter to us.
Here again, using language such as ‘in him’ in Velleman’s case or ‘inner kernel’ in Rosen’s can be tricky. Something ‘in’ him sounds like a thing, as does a ‘kernel’. When talking about dignity as a person’s value, there is no reason to assume it is not the whole person who has the value. The language of an interior or inside dimension lends metaphysical mysteriousness to dignity talk.
Respectful treatment requires taking account of how a person would like his or her body to be treated. This practical implication places constraints on how we treat others, particularly those dependent on us for care. It also includes a constraint on how we may prevail on others to treat us. We cannot prevail on others to treat our bodies as having no worth.
References
Anderson, Joel. 2013. Autonomy and vulnerability entwined. In Vulnerability: New essays in ethics and feminist philosophy, ed. Catriona Mackenzie, Wendy Rogers, and Susan Dodds, 134–161. Oxford: Oxford University Press.
Mackenzie, Catriona, and Natalie Stoljar. 2000. Autonomy refigured. In Relational autonomy, ed. C. Mackenzie and N. Stoljar, 3–31. Oxford: Oxford University Press.
Agich, George. 2003. Dependence and autonomy in old age. Cambridge: Cambridge University Press.
Kant, Immanuel. 1997. Groundwork of the metaphysics of morals. Trans. M. Gregor. Cambridge: Cambridge University Press.
Wood, Allen. 1999. Kant’s ethical thought. Cambridge: Cambridge University Press.
Jaworska, Agnieszka. 1993. Respecting the margins of agency: Alzheimer’s patients and the capacity to value. Philosophy & Public Affairs 28: 105–138.
Dworkin, Ronald. 1993. Life’s dominion. New York: Vintage Books.
Sensen, Oliver. 2009. Kant’s conception of human dignity. Kant-Studien 100: 309–331.
Velleman, David. 1999. A right of self-termination. Ethics 109: 606–628.
Rosen, Michael. 2012. Dignity. Cambridge: Harvard University Press.
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Byers, P. Dependence and a Kantian conception of dignity as a value. Theor Med Bioeth 37, 61–69 (2016). https://doi.org/10.1007/s11017-016-9351-2
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DOI: https://doi.org/10.1007/s11017-016-9351-2