Thomas Aquinas and Recent Questions about Human Dignity

The Travail of “Human Dignity” in Contemporary Bioethics

It is widely held by contemporary moral theorists that the concept of human dignity is in utter disarray. Dignity is variously viewed as an antecedent, a consequence, a value, a principle, and an experience, from philosophical, legal, pragmatic, psychological, behavioral, and cultural perspectives.^[1] To take a more concrete example, some argue that they have a right to end their own lives “with dignity,” while others claim that physician-assisted suicide violates human dignity.^[2] Given this lack of focus on the one hand, and the problem of irreconcilable differences on the other, some scholars have called for the concept of dignity to be purged from the vocabulary of moral philosophy. In this essay, however, I will be arguing that it would be extremely unwise to discard the concept of human dignity, and that Thomas Aquinas can be a good guide for anyone who wants to find a way through many thickets of confusion and misunderstanding.

What is the status of human dignity in bioethics today? Ruth Macklin, Steven Pinker, and Peter Singer are among those who argue that “human dignity” is incoherent rhetoric invoked by religious people whose primary aim is to restrain progress in cutting-edge medical research. ^[3] They have been especially critical of appeals to “dignity” coming from The President’s Council on Bioethics, an advisory council created by President George Bush on November 28, 2001. Executive Order 13237 charged the committee:

1. (1) to undertake fundamental inquiry into the human and moral significance of developments in biomedical and behavioral science and technology;
2. (2) to explore specific ethical and policy questions related to these developments;
3. (3) to provide a forum for a national discussion of bioethical issues;
4. (4) to facilitate a greater understanding of bioethical issues;
5. (5) to explore possibilities for useful international collaboration on bioethical issues.

The Executive Order also called on the Council to study ethical issues such as embryo and stem cell research, assisted reproduction, cloning, uses of knowledge and techniques derived from human genetics or the neurosciences, and end of life issues.

In her essay, “Dignity Is a Useless Concept,” Ruth Macklin claims that The Committee’s appeals to “dignity” have no meaning beyond what is implied by the principles of medical ethics: respect for autonomy; the need to obtain voluntary, informed consent; the requirement to protect confidentiality; and the need to avoid discrimination and abusive practices.^[4] Macklin’s first example is a California law, the California Natural Death Act 1976. The law reads, “In recognition of the dignity and privacy which patients have a right to expect, the Legislature hereby declares that the laws of the State of California shall recognize the right of an adult person to make a written directive instructing his physician to withhold or withdraw life-sustaining procedures in the event of a terminal condition.” What the law is really about, says Macklin, is self-determination, and in this context, “autonomy” can easily replace an appeal to “dignity.”

Next, Macklin takes aim at a report issued by The President’s Council on Bioethics, Cloning and Human Dignity. One passage from the report says, “A begotten child comes into the world just as its parents once did, and is therefore their equal in dignity and humanity.”^[5] However, the report contains no analysis of dignity or how it relates to bioethics, and thus offers no help in determining just when “dignity” is being violated. Macklin grants slightly more weight to “dignity” as it is invoked in a report from the Nuffield Council on Bioethics, Genetics and Human Behaviour: The Ethical Context. Chapter 12 of the report discusses whether there is an inherent conflict between understanding the genetic influences on behavior and the concepts of free will and moral responsibility. The report refers to the sense of responsibility as “an essential ingredient in the conception of human dignity, in the presumption that one is a person whose actions, thoughts and concerns are worthy of intrinsic respect, because they have been chosen, organised and guided in a way which makes sense from a distinctively individual point of view.”^[6] According to Macklin, however, since what the report calls dignity is nothing more than a capacity for rational thought and autonomous action, the word dignity adds nothing to the discussion, and therefore it can be safely abandoned.

Steven Pinker has also been critical of The Council’s appeals to dignity. Unlike Macklin, however, whose criticism is that “dignity” is redundant and lacks conceptual clarity, Pinker accuses The Council of acting in bad faith as a front for the promotion of conservative religious and political ideologies.

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… [Their] 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.^[7]

Pinker is especially worried that religious faith might obstruct or undermine scientific inquiry. In his view, the God of The Bible delights in genocide, rape, and the massacre of infidels. It is only thanks to enlightened secular philosophy, says Pinker, that society no longer condones the ownership of women and the persecution of heretics and homosexuals.

Moreover, says Pinker, religious leaders have always and everywhere tried to block the dissemination of empathy-inducing novels, and stood in the way of such reforms as the elimination of cruel punishment and the abolition of slavery. For Pinker, religion is deeply implicated in humanity’s “inner demons,” which include the urge to exercise domination over others, the desire for revenge, and the thirst for realizing visions of utopia that justify unlimited violence in pursuit of some imagined form of the good.^[8] Since religion is always oppressive, then, and religious people only invoke “dignity” as a way to undermine scientific inquiry and maintain social control over others, we ought to be very wary of their use of the concept of dignity. It would be far better, according to Pinker, for us to focus our efforts instead on developing the secular virtues of empathy for others, self-control over our own desires, and respect for reason.^[9]

Peter Singer’s work presents another set of challenges to the concept of dignity. Singer’s ethical reflections are based on four presuppositions. (1) Our intuitions, and our social and religious views are always inadequate, therefore what we need from moral philosophy is a quest for a rational principle in ethics.^[10] (2) Moral values cannot be objective, because they are not “out there” in the universe waiting to be discovered. (3) The role of reason in ethics is to help us recognize universal principles that transcend our own narrow interests. (4) Equal consideration must be given to all sentient beings, not just our own species.

Singer’s radical emphases on equality, rationality, and utilitarian consequences lead him to defend many controversial claims. Our moral duties to friends and family, he says, are not more important than our duties to strangers, no matter how far away they may be.^[11] If the aged have dementia, says Singer, they are already a burden on the rest of society and ought to be eliminated.^[12] Singer would make it is permissible to kill newborns for almost any reason until they are two years old, since until they reach that age, they lack “self-awareness over time” and contribute nothing to society.^[13] According to Singer, such practices as necrophilia and bestiality are “personal preferences” that should not be restricted, since the social taboos against them lack any foundation in reason.^[14] Animals, too, are sentient beings and the evils of “speciesism” are akin to the evils of racism.^[15] Clearly, in Singer’s moral universe, if “dignity” were a moral reality to be reckoned with, it would be economically counter-productive and it would stand in the way of fulfilling individual human desires.

Thomas Aquinas and Human Dignity

Now I will try to show how Thomas Aquinas’ moral philosophy sheds a very different light on the significance of human dignity.

The first contrast I would like to draw between Thomas Aquinas and contemporary bioethics has to do with the difference between principles applied to cases and the ethics of virtue. When Ruth Macklin invokes the Georgetown principles of autonomy, informed consent, and confidentiality, it is understood that these are abstract principles meant to be applied in very specific situations, on a case-by-case basis. It further assumes that patients and their medical care providers are strangers to each other, “strangers” in the sense that moral and religious pluralism are ubiquitous in a liberal society, and it would be wrong to impose external limits on individual decisions. Each bioethical decision may take on a different shape, because every individual patient’s moral outlook is a matter of subjective preferences.

Yet genetics also has implications beyond the individual, where wider social and political questions emerge. Therefore, genetics is not just a matter for individual ethics. Innovations in reproductive technology and the drive for genetically-based “enhancements” raise significant issues for public discussion and political concern. Given a diverse society, however, the default setting is for clinical applications is to resort to a case-by-case approach; to rely simply on ethical principles such as patient autonomy and informed choice, with very little consideration given to the highest good or the common good.

As Thomas Aquinas describes the moral life, however, there is a priority that should be granted to the moral virtue of prudence.^[16] Prudence, as St. Thomas conceives it, is not free-floating in a subjective way, but directed toward a very specific end, which is friendship with God.^[17] As Proverbs 16:4 says: “The Lord has made all things for Himself.” His aim is not simply to “acquire” souls; instead, He wants to communicate His goodness to them:

Every agent acts for an end: otherwise one thing would not follow more than another from the action of the agent, unless it were by chance. Now the end of the agent and of the patient considered as such is the same, but in a different way respectively. For the impression which the agent intends to produce, and which the patient intends to receive, are one and the same. Some things, however, are both agent and patient at the same time: these are imperfect agents, and to these it belongs to intend, even while acting, the acquisition of something. But it does not belong to the First Agent, Who is agent only, to act for the acquisition of some end; He intends only to communicate His perfection, which is His goodness; while every creature intends to acquire its own perfection, which is the likeness of the divine perfection and goodness. Therefore the divine goodness is the end of all things.^[18]

For St. Thomas, then, moral decisions are not matters of subjective preference, but instead they ought to be guided with a view to this pilgrimage of friendship with God. Will this decision and its consequences move me closer to God? Or, are this decision and its results likely to move me further away from Him and obscure the path that would lead me back to Him? It is in this vocation, in this call from God to seek friendship with Him, that human dignity is to be found.

A creature designed in the image of God, designed to enjoy fellowship with God, already has an inherent and fundamental dignity. People may do very little with this gift, this capacity for fellowship with God. They may ignore it or turn it to idolatrous ends. Others may move heaven and earth to violate someone else’s dignity, but they continue to “have” it nonetheless.

Still, this dignity is dynamic. That is, it can develop and become stronger when we exercise the gifts of faith, hope, and love, or it can become weaker when we sin and turn away from God.^[19] If this dignity is effaced through sin – Aquinas offers a very specific reflection on the way a murderer, for example, might lose his dignity^[20] -- there is a remedy: the humble prayer of confession and the sacrament of reconciliation with God. But none of these things will be found in the philosophy of anyone who thinks that dignity is a “useless” concept.

The second contrast I would like to draw between Thomas Aquinas and contemporary bioethics begins as a response to Steven Pinker’s diatribe against dignity. Pinker speaks about “the stupidity of dignity” because it is tainted by religion. More specifically, religious people try to use the term “dignity” to smuggle religious ideology into public discussions. Pinker believes it does not belong there, according to the presuppositions of his scientific naturalism and enlightenment liberalism.

By Pinker’s account, enlightened people can be good on their own, without any help from God, and they should want nothing to do with a God who delights in genocide, rape, and the massacre of infidels. To be perfectly frank, Christians want nothing to do with that kind of god, either. Or, more to the point, they do not recognize the God they worship in Pinker’s accusations. As it happens, Christians do have in scripture a collection of stories that presents a realistic view of human beings as they are, with all their moral flaws and their proclivities toward hatred, violence, and other forms of wickedness. Sin is recognized in scripture as a universal problem, and because God is love, He offers His help and forgiveness as a solution to that problem. Moreover, there is no reason whatsoever to think that sin and evil have not also infiltrated the “enlightened” university, just as they enter into every human institution, though Pinker himself seems to think that professors and others in academia are somehow immune to the distorted perceptions and corrosive effects of sin. In Primo Levi’s book, The Periodic Table, to take but one example, he describes how “pure” Chemistry lost its moral compass and became a willing participant in mass murder as it was practiced by the German state in World War II.^[21]

Pinker consistently seeks to lay blame at the Church’s door for every kind of atrocity, but the bloodiest governments of the twentieth century were godless totalitarian regimes, violently opposed to religion. Why? Because they saw in religious communities a potential source of prophetic protest, and they wanted to eliminate those voices from the public square. St. Thomas describes several kinds of law, and his discussions of the relationship between these types of law are very relevant when it comes to holding governments accountable for what they do. The eternal law is a moral standard of justice established by God that does not change.^[22] Men and women participate in God’s eternal law, not perfectly, but in great measure, because He has “written” knowledge of good and evil in the hearts of all human beings, and this can be called natural law.^[23] And what is it that natural law protects? Natural law is meant to protect human dignity.

Drawing out the implications of Thomas’ view of natural law, Pope Benedict XVI has said that it includes the following norms: (1) the right to life from conception to its natural end, (2) the right to freedom of religion, (3) the duty to respect and protect the institution of marriage between a man and a woman, (4) the right of such a married couple to have a family and (5) to educate their family.^[24] Human laws, or positive laws, are supposed to be an expression of God’s eternal law, though all too often God’s standard of justice is subverted by unjust human laws. Nevertheless, natural law and eternal law retain the power to sting the conscience of those who would hide behind human laws.

An outstanding account of the priority of divine law and natural law over human law can be found in Evangelium Vitae, in which John Paul II describes a struggle between a “culture of life” and a “culture of death.” In light of this distinction, Pinker’s claim that “violence is on the decline” sounds very odd. In order to make such a claim, Pinker has to turn a blind eye to what has happened in America since 1973, when Roe v. Wade legalized abortion in the United States. Since that watershed Supreme Court decision, sixty million lives have been snuffed out, and it has all been done without violating any law made by human beings. The power granted in that one document made it legally possible to strip unborn children of their God-given dignity, and as a consequence, the womb has become the most dangerous place to live in America. That is why those who are guided by St. Thomas’ teaching about the priority of natural law over human law will never agree with Pinker’s assertion that dignity is stupid.

I want to turn now to Peter Singer’s work, in which we find not so much a quarrel with the concept of dignity as an outright dismissal of what “dignity” is ordinarily taken to mean in ethics. Most of Singer’s attention-grabbing proposals can be traced in some way to his utilitarian assumptions, which rest on three interlocking principles. (1) The consequentialist principle states that the rightness or wrongness of an action is determined by the goodness, or badness of the results that flow from it, not from any inherent qualities.^[25] (2) The hedonist principle says that the only thing that is good in itself is pleasure and the only thing bad in itself is pain. (3) Jeremy Bentham’s principle of extent says that we should take into account the number of people affected by the action.^[26] A simple formulation of ethical utilitarianism, then, says that the rightness of an action is determined by its contribution to the happiness (pleasure) of the greatest number of people affected by it. Notions of human dignity and love are banished from this framework at the very outset. Singer typically does not ask about what is good, but what is permissible. This utilitarian approach to moral questions makes it easy for him to choose the quality of life over the sanctity of life – to sacrifice the very young and the very old when they can no longer “contribute to society.”

For reasons such as these, it is difficult to imagine Singer’s hedonistic/utilitarian individual in the role of a loving husband and father, or a loving mother and wife. Most of us, however, do want to live in strong and vibrant families, and if indeed that it is our desire, it is much easier to find respect for the family in the philosophy of St. Thomas than in Singer’s work. To this end, let us undertake a very brief exploration of what Thomas says about the dignity of family life, then, especially in his understanding of marriage.

What St. Thomas Says about the Family, and How We Learn to Recognize Dignity in the Midst of Family Life

Some Christian philosophers have taken the view that marriage is basically a remedy for a problem, a concession to our unruly natures, in order to prevent sexual sin and to make better provision for the raising of children. St. Thomas, however, has a much richer view.^[27] To be sure, he recognizes a utilitarian dimension to marriage in which the bearing of children and the expectation of finding mutual help in a household figure prominently:

A joining denotes a kind of uniting, and so wherever things are united there must be joining. Now things directed to one purpose are said to be united in their direction thereto, thus many men are united in following one military calling or in pursuing one business, in relation to which they are called fellow-soldiers or business partners. Hence, since by marriage certain persons are directed to one begetting and upbringing of children, and again to one vita domestica, it is clear that in matrimony there is a joining.^[28]

Running much deeper than the utilitarian dimension in Aquinas’ account of marriage, however, is a form of closeness and solidarity between a man and a woman that is absent from Singer’s work.

When a man loves another with the love of friendship, he wills good to him, just as he wills good to himself: wherefore he apprehends him as his other self, in so far, to wit, as he wills good to him as to himself. Hence a friend is called a man's “other self” (Ethic. ix, 4), and Augustine says (Confess. iv, 6), “Well did one say to his friend: Thou half of my soul.” The first of these unions is caused “effectively” by love; because love moves man to desire and seek the presence of the beloved, as of something suitable and belonging to him. The second union is caused “formally” by love; because love itself is this union or bond. In this sense Augustine says (De Trin. viii, 10) that "love is a vital principle uniting, or seeking to unite two together, the lover, to wit, and the beloved.^[29]

For St. Thomas, then, there is a genuine possibility for the friendship of virtue to develop between husband and wife, for them to take mutual delight not only in their physical relationship, but also in their shared desire for friendship with God.^[30]

Without such a religious conception of dignity at the center of marriage and the family – something deeper than the “marriage contract” as it is understood in a liberal society – it becomes much more likely that partners will drift apart whenever the “advantages” of abiding in marriage are no longer apparent to them.^[31] In this respect, a liberal vision of the marriage “contract” does not rise above the analogy of competitive market situations, where individual agents seize upon all sorts of unrestrained strategies in order to gain advantages over others, and considerations of “not-harming” the other do not typically enter into their fields of vision.

St. Thomas’ understanding of dignity, however, calls for families to be guided by “a more excellent way.” How so? Recall Singer’s argument about the kind of obligation we owe to strangers who are far away: that we owe them the same kind of consideration we give to our own family members and to neighbors who are close by. St. Thomas is not an advocate for this kind of universal, cosmopolitan approach to ethics, for it eventually turns into a way of loving no one at all. He believes instead that there is a place in ethics for special relationships, or as he might say, a grace-filled ordering of various loves, (ordo caritatis). This ranking of loves begins with the twofold love command as found in scripture: “You are to love the Lord, your God, with all your heart, and with all your soul and with all your mind. This is the first and greatest commandment. And the second is like to it; You should love your neighbor as yourself ” (Matthew 22:37-39; Luke 10:27-28; Mark 12:30-31).

After that, says St. Thomas, we have a natural duty to love our parents, to show preferential love toward them.^[32] If we are married and have children, it is fitting to show special love for them, too. Next in the order of love we could list more distant kin, followed by fellow citizens, and eventually, strangers who live far away from us.^[33]

The common need with regard to external help is twofold; one in respect of clothing, and as to this we have to clothe the naked: while the other is in respect of a dwelling place, and as to this we have to harbor the harbor less. Again, if the need be special; it is either the result of an internal cause, like sickness, and then we have to visit the sick or it results from an external cause, and then we have to ransom the captive. After this life, we give burial to the dead.^[34]

So for Thomas, our obligation to strangers is far from weak, even if it does appear “lower” in something that might properly be called a “hierarchy of loves.”^[35]

I want to turn now to the neglected dignity of human embryos, bearing in mind what St. Thomas shows us about human dignity and how we first come to recognize dignity in the midst of family life. Thomas Berg describes a simple, but memorable thought-experiment. In a pluralistic society, says Berg, there is deep disagreement about the moral status of embryos: Are they persons or not? In spite of that disagreement, are there ways of mistreating embryos that everyone can agree should be off limits? That is the question Berg put to the other members of a medical ethics committee on which he served. One person responded: “I would not want to see human embryos on my plate at a restaurant.” Another said, “I would not want them used for cleaning floors or for powering cars.” As to the prospect of using them to develop cures for disease, however, Berg laments that none of his colleagues would object to them being used in that way.^[36]

We can expect that those who revere St. Thomas will find the answers they gave to Berg’s question feeble – very feeble and very frustrating. Perhaps, though, they are not altogether futile. For if we even once begin to “hear” that question, then there is no more evading the issue. It forces us to engage in deep moral reflection. When should respect for human life begin? In what degree and to what extremes? What is it about the human embryo that demands any respect at all?^[37]

Informed by St. Thomas’ moral teaching, the Catholic Church regards human embryos as persons made in the image of God, and that is why their mistreatment is so problematic for the Catholic conscience.^[38] The inherent dignity of every person – a dignity that most people first discover in family life and that subsequently they seek to protect and shelter -- is denied them. They are created, not in a family, but in the context of a laboratory, where they are assigned an arbitrary, instrumental value. Some of them are even labeled as “surplus” and discarded in a most profane manner. And that is why John Paul II deserves our deepest respect for recalling, in Evangelium Vitae, the question God put to Cain concerning his brother Abel: “What have you done? Your brother’s blood is crying out to me from the ground!”^[39]