Human dignity is a motherhood concept like freedom of speech or the brotherhood of man. It's great for padding out politicians' speeches. But what happens when it conflicts with another motherhood concept, autonomy, the ability to make free and independent decisions?
An oft-quoted example of this dilemma is the sport of dwarf-tossing. When a town in France banned it in 2002, one of the dwarfs objected. He was participating freely and being treated as a basketball was his livelihood. What was the problem? The case went all the way to the Conseil d'État, the French counterpart to our High Court. It dismissed the dwarf's appeal to autonomy. Allowing himself to be used as a mere projectile compromised his dignity, it said. The dwarf then appealed to the UN's Human Rights and Anti-Discriminational Committee. It also upheld the ban "in order to protect public order and considerations of human dignity".
Calibrating the balance between autonomy and human dignity is very tricky. So tricky, in fact, that quite a number of well-placed bioethicists have taken to denying the existence of (scare quotes) "human dignity" altogether. A few years ago, for instance, Ruth Macklin was widely applauded by many of her colleagues when she wrote in the British Medical Journal that human dignity was a "useless concept", compared to autonomy.
She proved her point by sloshing the idea around in an acid bath of inconsistency and ridicule. "Human dignity" meant different things to different people. Furthermore, she couldn't find a rigorously logical definition. So it should be scrapped.
Granted, autonomy is important, but there's something scary about bioethics without human dignity. After all, it was revulsion at the atrocities committed by Nazi doctors in the death camps which gave rise to modern bioethics. Surely something more than a violation of the victims' autonomy was involved.
For instance, how should we evaluate the exhibits of plastinated bodies which seem to have taken the place of Barnum & Bailey freak shows for 21st century crowds?
Plastination is a technique used by anatomists to preserve specimens for students. Like many useful technologies, it can be used for dubious purposes. A German anatomist, Gunther von Hagens, has had the bright idea of turning plastination into a money-spinner. Since 1995 his flayed and partially dissected corpses have been touring the world: a man playing chess with his brain exposed, a man striding a rearing horse, a woman and her baby in the eighth month of pregnancy and so on. You can see the muscles, tendons, bones and organs bulge and stretch. A recent exhibit in Berlin featured a copulating couple.
"These are blockbuster shows," according to an American analyst of the museum exhibition business. "We haven't seen anything like this since the robotic dinosaurs in the 1980s." Why do the crowds like them? It's a mix of curiosity and disgust. The exhibits do teach a bit of anatomy, but surely giggling at plastinated genitalia is amongst their attractions for the millions.
So is there anything unethical about these exhibits?
Bioethicists like Macklin would say No, provided that people had agreed to donate their bodies. Even on this score, the exhibits might be unethical. Von Hagens and his competitors have been dogged by allegations that some of the bodies, at least, belong to executed criminals, from China , Kyrgyzstan or elsewhere. When an exhibit toured England recently, a leading medical journal, The Lancet, harrumphed that its paperwork was dodgy. "Assurance that all remains on public display were donated with informed consent of the deceased, is imperative," it said in an editorial.
But what if all the "i"s were jotted and the "t"s were crossed? In fact, thousands of people have agreed to donate their bodies. "It's something that you want to do instead of being ashes or worm food, to be some kind of asset instead of being in the ground," one woman said. Von Hagens has even claimed that two-thirds of the males who donated their bodies to his company and one-third of the females agreed to the use of their bodies for the representation of sexual acts.
But isn't there something deeply unsettling about all this which an informed consent form cannot put to rest? Once these exhibits were living, breathing people. Isn't undressing them, treating them as commercial property, and displaying them in poses designed to elicit ribald smirks a degradation of the very idea of embodied humanity? If they did consent, did their loved ones consent? Is the human body just an artefact? What lessons does an exhibit impart to children about the meaning of human existence and the existence of human dignity?
Even the patron saint of "autonomy", the 19th century British philosopher John Stuart Mill, put a limit to autonomy. A contract to sell oneself into slavery, he said, would be "null and void". Certainly our gut feelings about human dignity have to be more rigorously expressed. But it would be a tragedy for bioethics if the idea were scrapped. The French courts got it right. There are some things which autonomy cannot justify.