Foundational Issues in Christian Spirituality and Ethics

Human Value and Dignity

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A central concept in the ethics of many end-of-life issues is the dignity and value afforded to each and every human being. It has been a fundamental theme of this text that, according to the Christian worldview, every human being is made in the image of God and possesses innate dignity and worth regardless of race, ethnicity, socioeconomic status, stage of development, or mental/physical functional capacity. This dignity and value are given by God and are therefore inviolable.
The term human dignity has become an important and powerful rhetorical instrument that is thrown about carelessly in many of the debates surrounding end-of-life issues such as euthanasia, physician-assisted suicide, and the treatment of individuals in so-called permanent or 

persistent vegetative state

. The term itself is not foundational because it can mean different things to different people depending on how it is used and how it is defined. Because human dignity is not always clearly defined in contemporary medical ethics discussions, it can be used by both sides of many discussions to support different positions. This lack of definition and subsequent confusion contributes to much of the polarization surrounding many bioethics issues. A clear understanding of how this term is defined and used to support varying positions is vital to mapping the contours of many of the current debates on end-of-life issues, especially within a secular culture.
In his 1996 encyclical letter, Evangelium vitae, Pope John Paul II affirmed, explained, and defended the Catholic Church’s pro-life stance against abortion, physician-assisted suicide, and euthanasia. In this pronouncement, he maintained the core belief that “society as a whole must respect, defend, and promote the dignity of every human person, at every moment and in every condition of that person’s life” (John Paul II, 1995, n. 81). During the same decade that Evangelium vitae was published, the Swiss organization Dignitas was established. Dignitas was founded to promote euthanasia and the right of persons to choose the manner and timing of their own death as well as provide individuals with the means to do so. Their motto was “to live with dignity, to die with dignity.”
How can the Catholic Church and the organization Dignitas, both with completely different beliefs and practices, appeal to the same concept of human dignity to support their positions? It is obvious that the term human dignity is being used differently and to represent very different ideas. When John Paul II used the term, he was referring to a specific theological concept, namely, the image of God that all human beings possess. On the other hand, Dignitas’s motto was meant to convey the idea that the rational autonomy of every individual was central to their dignity as a human being. Autonomy, in this case, is understood as individual self-rule, without any controlling interference or limitations.

Autonomy

While the differences can be subtle, it is important to distinguish this use of the term autonomy from what is meant by the principle of respect for patient autonomy as one of the principles of medical ethics. The philosophical term autonomy that is implied in Dignitas’s motto and exhibited in their ethical position is much broader, comprehensive, and absolute than the term autonomy as used by Beauchamp and Childress in their book Principles of Medical Ethics.
On the broader understanding of autonomy presupposed by Dignitas, without the right to self-determination, specifically the ability to control the time and manner of one’s death, one was not truly autonomous and, therefore, deprived of dignity. One author has suggested that Dignitas’s motto should read, “To live with autonomy, to die with autonomy” (Genuis, 2016, p. 8). James Griffin (2002) succinctly summarized this view of dignity when he said that, “autonomy is a major part of rational agency, and rational agency constitutes what philosophers have often called, with unnecessary obscurity, the ‘dignity’ of the person” (p. 131).
Because of the way the term dignity has come to simply mask an appeal to more fundamental concepts such as autonomy without adding any significant content, some contemporary bioethics scholars have referred to the term dignity as “stupid” (Pinker, 2008, p. 28) or as a “useless concept” that “can be eliminated without any loss of content” (Macklin, 2003, pp. 1419–1420). Despite the ambiguities of definition, the problem is not with the term dignity itself. Dignity provides a language for discussion about what makes a human being worthy of honor and respect, a concept that is essential to any discussion of medical ethics. The question is, what it is about human beings that makes them worthy of honor and respect—that which provides for, and is foundational to, their dignity? Is that which makes human beings worthy of honor and respect contingent and relative depending on certain characteristics or is it something that is absolute and inviolable?
According to the Christian narrative, human value and worth is based on the more fundamental concept of being created in the image of God, a concept that has been central to many of the arguments in this text. Human life has incalculable value because it is created, upheld, and sustained in spite of sin, redeemed by God, and is ultimately destined for eternal communion and glory with God.
The Christian tradition also speaks in more theologically grounded terms when it talks about the sanctity of human life rather than dignity. The word sanctity comes from the Latin sanctus, which is usually translated as “holy.” In the Bible, holiness, which can sometimes mean righteousness or perfect goodness, has the deeper connotation of being set apart for a special or sacred use. Human life is sacred because all human beings have been set apart from the rest of creation by their Creator. They have been given special purpose and a special relationship with their Creator. This special sacredness is what makes sin so disruptive and so deserving of God’s judgment. This sacredness, because it is given by God, confers a transcendent or alien dignity that is absolute and inviolable. It is absolute because it does not depend on any arbitrary characteristic that a human being may or may not possess, gain, or lose. It is inviolable because it is not relative or dependent on the changing utilitarian needs of society or the majority.
The Christian concept of the dignity of all human life provides the rationale and guidance for the Christian health care professional’s calling, the call to care for human health. It also forms the underlying justification for the Christian response to many of the ethical controversies surrounding end-of-life issues, including physician-assisted suicide, euthanasia, termination of life support, counseling those who are facing their own death or the death of a loved one, and preparing oneself to die well in Christ. Even the medical definition of death, and the controversies surrounding brain death and organ donation, depend on a view of human worth and dignity dependent on the biblical concept of being created in the image of God.