conference proceedings of congress International Bioethics 1999. Bioethics and dignity in a pluralistic society

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Human dignity, topicbioethics

Francesco D'Agostino
Full Professorof Philosophyof Law
University of Rome Tor Vergata (Rome)

I. Meaning of the term "dignity
II. Dignity as an indispensable concept for thinking about bioethics
III. Is the basis in dignity staffor in the "accompanying ethical values"?
IV. Italian Bioethics in the face of this dilemma
V. Pragmatic Bioethics
VI. Bioethics, the Autonomy of Science and Relational Bioethics
VII. The need for continuous "resemanticisation" of the concept of dignity

I. Meaning of the term "dignity 

There is a word core topic, loved by philosophers, lawyers and bioethicists: it is the word dignity. The word appears at degree scrollof the Strasbourg Convention ("Convention on the Protection of Human Rights and Dignity of the Human Being") and is repeated at least three times in the Preamble of the Convention, so that it seems legitimate to elevate it to the role of the only possible and authentic foundation of a European bioethics.

We all have a fundamental intuition about dignity, which Philosophycan perhaps reinforce, but not activate. Those who are blind to the very idea of dignity will hardly allow the reflections of moralists and bioethicists, even if they are of the highest level, to open their eyes or teach them anything. On the contrary, those who have developed the conviction that the very destiny of mankind depends - in an essential way - on human dignity and its defence, will think that it is essential to keep reflection on it alive and active at all times. Because the topicof dignity, insofar as it appears to be shared, must be continually redefined. This is because it is exposed to the risk of a kind of implosion that could empty it of meaning and leave only an external façade without any content.

We resort to the notion of dignity when we are asked - and this experience is often encountered - about the fundamental question of bioethics, expressed in a simple and misleading question which, although often repeated, has not lost its radical nature: why is it not right (in the sense of good, morally lawful) to do everything that science and technology propose to us and everything that they can do? The answer usually given to this question always refers, implicitly or explicitly, to the principle of dignity; it is in the name of human dignity that bioethics manages - sometimes - to say no, even in those cases in which it is well aware that this concept is not capable by itself of altering the course of things. Much less does it succeed in altering it when the essential reasons on which it is based are indeterminate, ambiguous or problematic. In other words: bioethics seems unwilling, or at least unable, to adopt any language other than that of dignity, while at the same time it is aware that this language calls for continuous and tiresome revision, which for some becomes even desperate.

II. Dignity as an indispensable concept for thinking about bioethics 

If the symbolic code of dignity is abandoned, there seem to be no other possible ways. It would not be sustainable, for example, to have a bioethics that would place on science itself the burden of finding, within itself, the reasons that should induce it to self-limit itself. This thesis , on the one hand, tells us nothing about the criteria that scientists should adopt for a possible self-limitation of their actions to be sensible, but, above all, it inevitably tends to rely on the goodwill of scientists and may, perhaps unconsciously, adopt a psychological or emotional criterion in the resolution of a problem instead of basing it on well-argued reasons. Equally problematic and ambiguous is the thesis often used by those who prefer the utilitarian paradigm. In this perspective, bioethical problems should be calculated by weighing up costs and benefits. The passwordwould be this: the useful researchshould be encouraged and the harmful ones should be limited! Leaving aside the question of the general relevance of adopting or not the utilitarian criterion in bioethical reflection as the optimal criterion, there remains a difficult difficulty to overcome, which is how to really calculate the costs and benefits in a complicated context such as ours, with reference letterto practices whose immediate consequences can be perceived, but whose medium and long-term results are... largely unimaginable, in large part unimaginable (in fact, the consistent adoption of the utilitarian thesis could paralyse the entire scientific researchbecause the costs should take into account not only the unavoidable risks related to the diffusion of more advanced technologies, but also - as Luhmann has shown - the fears and often the "terrors" that these technologies trigger).

III. Is the basis in dignity staffor in "accompanying ethical values"? 

What has been said above explains why most bioethicists and biopoliticians try to refer, in order to solve bioethical problems, to accompanying ethical values - all of which can be summed up in the figure of human dignity - values that scientists, and in general all bioethicists, should recognise as a priority, in order to use them as criteria for legitimising any significant praxis in bioethics. This perspective is plausible only under two conditions, both significantly difficult: the first refers to the cognitive possibility of objectively determining the material contents of such values (and in general of the term dignity itself); the second refers to the axiological conditions on which these contents can be universally shared. The one and the other, in fact, are very far from being realised in reality. In particular, the current Italian statusshows that values have a controversial status and are far from being universally shared. On the contrary, one might add that modernity has imposed what Max Weber called ethical polytheism, namely that morality is taking on a paradoxical configuration. Niklas Luhmann expresses this by stating that in highly complex societies such as ours, ethics is dangerous: it is dangerous because it activates axiological conflicts that it is unable to deactivate and recompose. And in fact bioethics, at least in Italy, is a sign of contradiction and laceration much stronger than political ideologies. It is not surprising, therefore, that Italian biolegal bioethics is poor compared to the flourishing bioethical reflection.

IV. Italian Bioethics in the face of this dilemma 

How has Italian bioethics reacted to these difficulties? With fatigue and inadequately. Generally speaking, it has tried to develop a "new ethics", sensitive to the difficulties illustrated above, and therefore with very general characteristics:

a) a general distrust of all theories that postulate "fundamental values" (i.e. all metaphysical foundations);

b) a particular attention to the empirical emergence of bioethical problems (and this explains why, in Italy, bioethics always arrives too late, when the "cases" have exploded and generally irreversible factual situations have been created);

c) a propensity for the elaboration of normative rules to resolve conflicts and controversial situations, not of a substantive but merely procedural nature;

d) a strong appeal to the autonomy and information of the subjects involved in questions of bioethical relevance, in order to entrust to them and to their responsibility the final judgement on the practices that can be carried out and those that should be avoided.

V. Pragmatic bioethics 

A pragmatic bioethics has thus been constructed, essentially rationalistic-individualistic in tone, to which we must recognise unquestionable merits (and in particular respect for the ethical pluralism typical of all advanced societies), but also indisputable limits. It is a bioethics that deludes itself with a generic reference letterto human rights in order to overcome its inability to adequately resolve the immense symbolic and cultural problems typical of technological societies such as ours; an inability that is generated, in all probability, by the profound social decontextualisation that this way of understanding bioethics tends to foster. This decontextualisation is evident in many ways. It is undeniable, and rightly worrying, that alongside general bioethical normativity, numerous forms of anarchic and mutually conflicting or even contradictory bioethical normative sub-systems are multiplying (sometimes endowed with highly ambiguous legitimisations, such as those offered by ad hoc and therefore untrustworthy ethics committees). Equally worrying is the fact that the more bioethical reflections focus on the merely descriptive level of the variables at stake, the more they tend to leave the subjects normatively on their own when it comes to making the final decisions. The consequence of this is that the defensive vocation of bioethics, to which Van Rensselaer Potter (who, as is well known, coined the term bioethics) constantly drew attention, seems in many cases to be fading and weakening. At summary, the difficulty bioethics is facing today consists in the following: on the one hand, it tries to move on the basis of paradigms that do without effective social links; on the other hand, it feels called upon to propose forms of regulation in the same social sphere that, on the other hand, it tries to do without.

VI. Bioethics, Autonomy of Science and Relational Bioethics 

It is therefore necessary to elaborate a modelof bioethical thinking that is able to combine two - apparently divergent - instances: on the one hand, the autonomy of individuals and the intrinsic lawfulness of scientific research- duly guaranteeing them the maximum freedom - must be taken seriously; on the other hand, one cannot give in to the hasty and epistemologically mistaken conclusion that in bioethics individual choices in general, and the actions of scientists in particular, cannot be debatable. Both private individuals, as social actors, and scientists are open to criticism, not in the name of their specific entity as social actors or scientists, i.e. not because it is right that private preferences or the activity of researchare controlled - perhaps by someone who is not a scientist - but in the name of the structural belonging of both to the social system, which cannot, and - even if it could - must not assume as its univocal horizon the one provided by an exclusively scientific image of the world. If this written request is accepted to the end, and it is recognised today that no one can be thought of as an isolated subject, but that we are all people who necessarily belong to a system which encompasses us and which has a partner-relational character, we must recognise the necessary subordination of all of us to all the links, and in particular to the symbolic and cultural ones, which social systems cannot fail to impose, at least implicitly, in order to guarantee their very survival.

It is clear that this requirement is primarily sociological. But it also has bioethical validity, because the relational quality of the bioethical links that thus emerge leads us directly to the root of ethics itself, which, however it is understood, makes reference letterthe fact that the human subject is always constituted and lives as such within relational dynamics that cannot be reduced to mere functional requirements.

VII. The need for continuous "re-semanticisation" of the concept of dignity 

In the great topicof dignity, bioethics (Italian in particular and European in general) has a precious axiological anchorage, which cannot be trivialised or minimised. The topicof dignity, in my opinion, must be constantly re-semanticised, in order to adapt it to the rapid mutation of symbolic and experiential contexts - this is the task and the raison d'être of a general bioethics. The Philosophy- and, in particular, metaphysics - are called upon to make every possible effort in this direction. But, beyond the commitment and good will of philosophers and bioethicists in love with the Philosophy, it is a fact that in our time there is a collective conscience that perceives that human subjectivity cannot be reified, because being subjects carries with it an identity that does not admit functional equivalents. Only if it is read in this perspective does the dictate of the European Convention on Bioethics have a true meaning. This is the line of commitment that should bind us all.