Ontology and Bioethics: the Case of Human Dignity Principle in Human Genetics
-Maurizio Salvi, Ph.D. (from TRT3, 1997)
Eubios Journal of Asian and International Bioethics 8 (1998), 181-183.

In 1993, the International Bioethics Committee (IBC) of UNESCO defined "human dignity" as the "requirement of freedom and solidarity (International Bioethics Committee (IBC) of UNESCO, First Session, Paris, 15-16 September 1993, p.18.). Article 4 of "Presentation of the Preliminary Draft of a Universal Declaration on the Human Genome and Human Rights" published by IBC on 11 September 1996 reads as follows: The protection of the individual with respect to the implications of research in biology and genetics is designed to safeguard the integrity of the human species, as a value on its own right, as well as the respect for the dignity, freedom and the rights of each of its members (CIP/BIO/96/COMJUR.6/5 (rev.) p.8).

Thus we can say that the protection of "the integrity of human species and respect for the dignity freedom and rights of each of its members" is considered a fundamental principle for the development of human culture. Furthermore, these elements are also fundamental to any evaluation of the moral meaning of human genetics. In 1996, the European Commission Group of Consultants for Ethics of Biotechnology (GCEB) confirmed the IBC's proposal (Opinion Submitted by the Group of Adviser on the Ethical Implications of Biotechnology to the European Commission, Brussels, April, 1996) And other legal documents such as the Convention for the Protection of human rights and dignity of the human being with regard to the application of biology and medicine (1997), or the Declaration Universelle sur le GÈnome Humain et les Droits de l'Homme (1998) have defended this idea. But what does this mean? What is human dignity?

Human dignity can be explained in several ways: as an ontological (a "further element") or as a reductionist principle (a "biological element"). When we say that we need to respect human dignity in human genetics, we make the assumption that it is possible to damage this principle by some genetic applications. According to this we have to clarify which applications could endanger the maintenance of human dignity, and how is it possible to continue to develop Human Genetics while respecting human dignity. When we think about human genetics therapeutic applications we often assume that they are developed to treat specific diseases, for example Deficiency of Adenine Deaminasi (ADA); Deficit of Purina-Nucleoside Phosphorilasis (PNP); Duchenne's muscular dystrophy; Haemophilia A and so on). In such cases human genetics is used to restore Human Health (HH). Can we assume that a link exists between human health and human dignity?

The Ambiguity of Human Dignity Principle

The fundamental problem is that the ambiguity of the human dignity concept makes it extremely difficult to construct an exhaustive definition. This analysis is absent in the IBC document because we have no description of clear reasons inducing IBC members to accept HD criterion. This concept has not been defined by the IBC, but it suggests that we have to interpret "dignity" as to mean the integrity of the peculiarities which make an organism a "human being". However, when we talk about human dignity we have two possibilities:

  1. we consider HD as an ontological property of human beings,
  2. we consider HD in reductionistic terms.

If we accept the first view, then we have no reasons for using human dignity to analyse human genetics, because we cannot define a direct correspondence between a physical connotation of an organism (its genome) and a "further element" which is not linked per ipotesi to the genome. If we accept the second hypothesis we can consider human genetics as "re-establishment" of human dignity, because it can be used to restore human biological functionality. We need to analyse both these possibilities.

The Human Dignity as an ontological principle

The concept of "Dignity" in se implies the existence of a further element making the human being "dignus". This view relies on dualistic philosophy. Following this perspective, if an element (dignity) exists which cannot be reduced to an objective human property, it follows that we have to study this element in another way. We have to individuate a further element, which contains "dignitas", and to relate this element to physical features of human beings. Dignity is an attribute that cannot be reduced to some biological or psychological properties of a subject. If we limit ourselves to the ontological value of human dignity we can defend its acceptance only as an axiomatic principle. If we accept the ontological view we accept the existence of an ideal system which has no rational proofs. We are searching for a correspondence between the objective reality and a non-phenomenological view, which relies on non-demonstrable ontological bases. But this is a logical mistake. Since the core of my theory is focused on ontological premises, I cannot build a theory having theoretical connotations, and at the same time linking this view to reality.

When we consider human dignity as an ontological principle we have no reasons for linking it to physical reality. This means that we can use human dignity only at a theoretical level. Our efforts in transforming human dignity from a theoretical principle to a pragmatic one are destined to give incoherent results. According to this human dignity pays the price (acceptance of metaphysic premises) of the lost of its practical appliance.

Another important question linked to human dignity is: why using a non-reductionist view of human beings? In 1984 the philosopher D. Parfit gave several reasons for delaying a dualistic conception of identity. The circle of philosophers and biologists is thinking of human beings in reductionist terms (For an analysis of the different philosophic positions in this topic see: M. Salvi, "Lo specchio e il labirinto, filosofia analitica e identit‡ personale" in Prometeo. Rivista trimestrale di scienze e storia Milano Mondadori ed. Anno 13 n.51, pp. 78-88.) Why should we accept an ethical principle having an axiomatic value? And if a fundamental objective of IBC is the "recognition of the dignity of the individual" what does this mean? If dignity can be "recognised" is it a "container" of human peculiarities? Does this mean that human dignity is not a metaphysic principle? How can we link human dignity to human genetics? If we accept human dignity as a metaphysic tool we need to link it to a "unitary" view on humans beings. This theory would be considered as the "fundamental referent" with regard to which human dignity should be accepted as a "justified" fundamental requirement of human beings. Which theory did the IBC use?

The Human Dignity as a reductionist principle.

If we do not accept the ontological explanation of human dignity we could think that human dignity could be explained in a different way. We could use for example psychological or economic views. In this sense human dignity would involve a conception of human life attributing to some social or economic properties of a subject the sufficient conditions for making him "dignus". Is not easy to link these conditions to cultural diversity. If we take a walk around Mumbai, can we say that poor people are living in conditions of un-dignity? Who decides what level of "dignity" is acceptable? Is a prostitute in Amsterdam an unworthy person (non-dignus)? Must we consider dignity in a theoretical sense? How do we link dignity to the transformations of human genome? Also if we have this "indicative value" of human dignity, when we consider it as a "condition" of the subject, we cannot believe in a genetic change of human as an interaction with human dignity, because the existence of an organism is not the quality of its "life conditions.

On the other hand, if we consider human dignity in reductionist terms, we could suppose that it relies on genetic statistical recurrences that take humans as member of the same species. This means we assume the human genome to be a container of chemical data (similarity among human beings) which contains the fundamental peculiarities of the "human race". If we accept this view, we can define human dignity as the maintenance of a "indefinite" body of chemical recurrences in human genome. If human dignity is a corpus of genetic data we should consider it as a "constitutive" biological property of human beings. In this sense it would not be the human "dignity" that should be safeguarded, but the "human biological constitution". This means human genetics should respect the physiological functionality made by genome, and abstain to manipulate human DNA. In this sense, the medical applications of human genetics may be compromised.

The Relationship between Human Dignity and Human Health

Let us consider now the relationship between human dignity and human health. When we think about the therapeutic application of human genetics, we have a juxtaposition between values: the ethical value of human dignity and the ethical value of human health (and the disvalue of seeking). How could a genetic transformation damage human dignity? When I'm sick is the ontological being of my existence damaged?

If we refute human dignity as an ontological principle, we have to examine at its acceptability as a reductionist principle. In this sense if human dignity is the corpus of genetic peculiarities of the human specie, we have to clarify if when we treat a disease we interact with this "human genetic constitution". But, if we have to respect this genetic information in its entirety, it is not clear how we can say that (for example) a somatic gene treatment does not interact with the human dignity. Consider one who is ill with Anaemia A. He has the biological peculiarities (his genome) connoting him as a human being. Can we allow changing his genetic code if we do not know how human dignity is genetically defined? We could suppose that it is permissible to interact with his genome because we are restoring his biological (non-pathological) functionalities, but if we consider human dignity as "contained" within it, how can we say that we are not "interacting" with human dignity? If we accept the human genetics therapies we are using another metric (the utilitarian ones) which refutes in itself the same initial premises of IBC's document: human dignity as a internal element of the subject which has ethical value in itself. This step conduces to the abandonment of human dignity as a fundamental ethical element in human genetics. According to this, we come back to the initial question: Why use human dignity?

Now we can synthesise the obtained results as follow:
CriterionCriticism:
HD as an ontological principleThe concept of "Dignity" implies the existence of a further element making the human being "dignus". This further element contains the "dignitas" of human beings. When we consider human dignity as an ontological principle we have no rational reasons for linking it to physical reality. Because, human dignity is contaminated by ontological premises through which we interpret reality.
HD as a socio-economical principle We could think of human dignity as a social or economic parameter. Who decides what level of "dignity" is acceptable? Who defines the parameter of "dignity'?
HD as a biological principleWe could think of human dignity in biological reductionist terms. We assume the human genome contains all the fundamental peculiarities of the species-specific "human race". If human dignity is a corpus of genetic data we should consider it as a "constitutive" biological property of human beings. According to this, it would not be human "dignity" that has to be safeguarded, but the "human biological constitution".

Which value can we attribute to human dignity?

If we say that "dignity of the individual" is the milestone of science we assume that we have to use it as a "fundamental principle" in scientific research. But which value has this "milestone"? A normative value or an indicative one? If we follow the purpose of the IBC we would have to conclude that human dignity has a normative value. Why? In Article 9 of IBC's Document we read: States shall undertake to ensure that the principle set out in this Declaration are fulfilled . In the following Article we read: The principles set out in this Declaration shall guide all authorities and other persons responsible for their implementation. Both these articles suggest a normative value of human dignity in human genetics. The reasons for imposing this "pressure" on the Biological community are linked to the need "to prevent all eugenic practices contrary to human dignity or freedom" (p.5). This means human dignity has been identified, in the first place, as a critical tool for outlawing human positive eugenics. This conclusion is reasonable. The problem arises when we define a principle and then pass from the "theoretic" level to the "normative" we consider it as a "right" of human beings. In this view human dignity is defended by the IBC's Declaration as a Human Right. Can we accept this?

In the Presentation of the Preliminary Draft of a Universal Declaration on the Human Genome and Human Rights we read (p.6):"The principles of the protection of persons with respect to the consequences of research on the human genome are based on a set of rights which flow directly from the principle of dignity: The right to equal treatment (...) the right to individual freedom (...) the principle of solidarity among people and countries". These principles are contained in the Universal Declaration of Human Rights (10 December 1948) (DHR). This means human dignity is based on a legal system, which constitutes the moral basis of its acceptance. When IBC identified DHR as the constitutive source of human dignity, it accepted a body of "rights-values" as the fundamental co-ordinates of human society. According to this, human dignity is not the milestone of science, but is DHR to have this value. The acceptance of human dignity relies on the acceptance of DHR. Human dignity is only an extension of the "right to individual freedom". The fundamental steps, which conduce to human dignity as peculiarity of human beings, are contained in the first two articles of IBC's Declaration. In the first one we read: "The human genome is a fundamental component of the common heredity of humanity", in the second one "The genome of each individual represents his or her specific genetic identity". Both these principles are based on legal declarations (Article 1: Convention on the Law of the Sea of 10 December 1982; Convention for the Protection of the World Cultural and Natural Heritage of 16 November 1972, The Declaration of the principles of International Cultural Co-operation of 4 November 1966, Declaration on Race and Racial Prejudice of 22 November 1978; Article 2: Universal Declaration of Human Rights of 10 December 1948). When we pass form "article 1" to "article 2" we see that human genome is considered as a "requirement" of human individuality. In this sense IBC defines two dimensions of value in human genome. The first one relies on the view considering genome as a "shared peculiarity" of humans; the second one considers genome an "individual "property". Transforming the individuals' genetic identity means interacting with something that is "possessed" by the single person as well as individuals constituting (over time) the "human race".

Legal Basis of Human Dignity Principle in the Preliminary IBC draft of 1996*:
Art. 1: The human genome is a fundamental component of the common heritage of humanity,
Art. 2: The genome of each individual represents his or her specific genetic identity
"The principles of the protection of persons with respect to the consequences of research on the human genome are based on a set of rights which flow directly from the principle of dignity: The right to equal treatment (...) the right to individual freedom (...) the principle of solidarity among people and countries".

These principles are contained in the Universal Declaration of Human Rights (10 December 1948) (DHR). This means that human dignity is based on a legal system that constitutes the moral base of its acceptance.

Also if we accept that human dignity is based on a pre-constituted system of values (DHR), why identify human dignity as the main element with respect to human genetics? When we say that each person has the right to posses his genetic endowment, we are defining DNA as something that appertains either to the individual or to humanity, but we are not saying that the concept of property relies on that of dignity.

When we accept the HD-based articles of the final UNESCO Declaration of 1997, or any other similar documents, we are accepting a view that relies on a very strong biological determinism. Since in this view human beings are considered as the result of a phenotype expression of their genome, their genetic endowment becomes the fundamental referent in an analysis of human biological rights. This view relies on a heuristic paradigm, which considers human beings as the result of a "cell farm". Also if we accept this idea, since we are following a highly reductionist approach, why should we substitute this approach with the non-reductionist one, which considers human dignity as a further element of humans? If human dignity is a container of genetic data, should we consider it as a part of the genetic identity?

The fundamental mistake, I believe is made when we identify human dignity with the genetic endowment. This last element is a biological peculiarity, which can be considered in terms of "property". The Human Dignity is a moral explanation that can be reduced to a reductionist view. If we do not explain the link between human dignity and genetic identity, we attribute to the latter a moral value, which is not justified. The DHR does not consider human genome as a "dimension of value" but it attributes to humans a corpus of rights that constitutes the legal and moral basis for building a "free society". According to this, DHR does not define human dignity because this concept has strong ontological features.

The ambiguity of human dignity relies on this problematic step: the link between the biological reductionism (stressing the value of human genetic identity), DHR, and a theoretical view, which conduces to human dignity. And this link is not justified. If we want to maintain the coherence of the moral principle in bioethics we cannot attribute to human dignity either the value of "human right" or the meaning of "the" milestone of human genetics. At the same time we cannot attribute to a principle which is based on axiomatic premises a normative value. The IBC based its document on an initial "imperative" system: the DHR. But we cannot say that since we declare that our analysis is based on a pre-constituted system of Rights, our analysis is automatically "a coherent extension" of them.

In the light of this, I cannot understand how this interpretation of human dignity can be considered as a useful tool for human genetics. In order to do so we would need a moral principle which would be useful for considering human genetics in its different applications, and which would be able to contemplate the biological meaning of human genetics applications. In this bipolar direction I believe the International Community could establish the moral basis of bioethics through human genetics trials.


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