Abstract
Only in recent years have the German bioethical and biopolitical debates begun to decline due to rationalization concerning stem cell research or the pre-implantation diagnosis related to the ethical status of the beginning of human life. This is due to the fact that in these contexts we have to ask whether quality of life assessment is ethically acceptable in principle. A fundamental premise in the current debate is that quality of life assessment and human dignity are incompatible. In this paper four different standards of quality of life assessment are distinguished (the naturalistic, the social, the interpersonal and the personal standard). Then an interpretation of human dignity is developed which rests on the essential feature of human beings to develop the capacity for personal autonomy. Finally it is argued that human dignity in this sense is compatible with quality of life assessments based on the personal and the interpersonal standard.
Zusammenfassung
Seitdem in Deutschland im Kontext der Stammzellforschung oder der Präimplantationsdiagnostik um den ethischen Status des beginnenden menschlichen Lebens gestritten wird, ist das in den letzten Jahren gewonnene Rationalitätspotenzial der deutschen bioethischen und biopolitischen Debatte rückläufig. Dies liegt daran, dass in diesen Kontexten die Frage nach der ethischen Zulässigkeit von Lebensqualitätsbewertungen unumgänglich wird. Eine basale Prämisse in der gegenwärtigen Diskussion stellt die Annahme dar, dass Lebensqualitätsbewertungen und Menschenwürde miteinander unvereinbar sind. In diesem Beitrag werden vier verschiedene Standards der Lebensqualitätsbewertung (der naturalistische, der soziale, der interpersonale und der personale Standard) und konkurrierende Deutungen des Prinzips der Menschenwürde unterschieden. Anschließend wird eine für säkulare und pluralistische Gesellschaften angemessene Deutung des Prinzips der Menschenwürde, welche auf der für Menschen charakteristischen Fähigkeit zur Entwicklung personaler Autonomie gründet, entwickelt. Abschließend wird gezeigt, dass ein so verstandenes Prinzip der Menschenwürde mit einem personalen und einem interpersonalen Standard von Lebensqualitätsbewertung verträglich ist.
Résumé
Depuis qu’en Allemagne, dans le contexte de la recherche sur les cellules souches ou du diagnostic préimplantatoire, la controverse bat son plein sur le statut éthique des débuts de la vie humaine, le potentiel de rationalisme qu’avait atteint le débat allemand sur la bioéthique et la biopolitique perd à nouveau du terrain. Ceci s’explique par le fait que dans ces domaines, la question de l’admissibilité éthique des évaluations qualitatives de la vie est incontournable. Une prémisse de base dans la discussion actuelle est le postulat selon lequel l’évaluation qualitative de la vie et la dignité humaine ne sont pas compatibles. Dans cette contribution, on distingue quatre standards d‘évaluation qualitative de la vie et des interprétations concurrentes du principe de la dignité humaine (standard naturaliste, social, interpersonnel et personnel). L’article élabore pour conclure une interprétation du principe de la dignité humaine adaptée aux sociétés séculières et pluralistes, qui se fonde sur la capacité typiquement humaine à développer une autonomie personnelle. L’article montre enfin qu’une dignité humaine ainsi comprise est compatible avec un standard personnel et interpersonnel de l’évaluation qualitative de la vie.
Wir reden also über Muster im Lebensteppich.
Ludwig Wittgenstein
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Notes
Cf. the very informative account concerning these issues within the European context given in Solter et al. (2003).
For more details cf. the illuminating analysis in Vieth (2003).
I discuss the relation between human dignity and a right to life on the one hand and the ethical issues concerning active euthanasia on the other hand in chapter 6 of Quante (2002a).
The idea that QLA is incompatible with human dignity can actually be found in the vote of those members of the Nationaler Ethikrat, who defend the position that PGD should be prohibited by law (Nationaler Ethikrat 2003).
My translation of: “Ein Verfahren, in dessen Zusammenhang potentielle menschliche Wesen bewußt auf Probe erzeugt und von den zukünftigen Eltern erst nach einer genetischen Untersuchung für existenz- und entwicklungswürdig befunden werden, ist mit der Würde menschlichen Lebens nicht vereinbar“.
I will say more on the distinction between a strict (or strong) and a weak conception of human dignity in the next paragraphs of this paper.
A defender of Counterattack I regards the concept of human dignity as senseless or meaningless. Therefore he obviously cannot hold ICA. Since in this paper I am interested in ICA primarily I will ignore Counterattack I in the following (it has been mentioned here because it plays some role in German biopolitical and bioethical debates); see Merkel (2002) for a crisp and detailed discussion.
It is based on a naturalistic fallacy; see Quante (1994) and chapter 7 of Quante (2003b) for more on this. I should add that such a naturalistic standard seems to be attractive for three reasons: firstly, it seems to help us avoid hard ethical questions by referring to ‘objective facts’; secondly, it suits well with current naturalistic tendencies in other domains of philosophy (e.g. philosophy of mind, language or epistemology); and thirdly, it is naturally allied with the (implicit) naturalistic strand of utilitarianism ( in many varieties).
For sure, nobody in the actual debate defends such a social standard. Besides the fact that the fundamental objection very often relies on slippery slope arguments (without giving any empirical evidence for the claims included therein) the main weakness of the fundamental objection lies in the fact that it presupposes that defenders of QLA rely on (or have to rely on) the naturalistic or the social standard.
It is ethically important to distinguish four kinds of cases here: (1) human beings without the potential of developing personal autonomy at all, (2) human beings with the potential to develop personal autonomy in the future, (3) human beings who have lost their personal autonomy but still have the capacity to regain it, and (4) human beings having lost their personal autonomy without any chance to regain it. In the third and fourth case the problem of living wills and other means of extending one’s autonomy comes into play; see Quante (1999) for details. The difference between the first and the second case is that in the latter the interpersonal standard can be used since the human being assessed can be taken into account as a person counterfactually. This presupposes that we can give a reasonable account of potentiality—see chapter 3 of Quante (2002a) for more on this. In the first case the interpersonal standard can rely only on those aspects which are appropriate for human beings. Since the focus of this paper is on ICA I cannot go into the details here.
This misunderstanding is criticised in by Ach et al. (2000), pp 127–132. It is worth noticing that “to understand” the evaluative stance of another person is not the same as “to accept” it.
It is indisputably very difficult to give an idea of the self-image of our society which is at least fairly adequate; but I take it for granted that secularisation and pluralism as well as the importance of personal autonomy are essential elements of every picture we might outline.
Basing human dignity on the concept of “human nature” is no way out. Either we rely on a non-evaluative, e.g. scientific concept of nature, where in this case we face a naturalistic fallacy, or we ascribe a special ethical value to the biological species. In this case we are committed to an untenable ‘speciesism’. The third option would be to give an evaluative notion of “human nature”. This might be done in a theological or philosophical fashion unfolded in the two traditions described above.
This normality-condition is meant in the following sense: All human beings (in the sense of individual human organisms) fall into the scope of “human dignity“, since they normally—qua species-membership—do have the potential to develop those features necessary for human dignity in the strong sense. Some human embryos with genetic defects de facto will not develop these features during their development. But even in these cases it makes sense to ascribe them the potential to develop them counterfactually: Such a human being would develop these features, if there were no genetic defects. But such a counterfactual claim makes no sense in at least two cases: if we refer to an entity belonging to a species whose members normally don’t develop the features in case; or if we refer to an actually non-existing entity (e.g. a human embryonic stem-cell). The latter claim presupposes that “human dignity” is a feature of human organisms not of ‘sub-organismic’ human life. For detailed and critical analysis of these and related matters I refer the reader to the papers collected by Damschen and Schönecker (2003).
As long as we don’t eliminate this qualification the theological interpretation of human dignity is covered by the absolute-reading as is the philosophical account of human dignity in the strong sense.
My aim in this paper is to show that (and why) ICA is wrong. Furthermore my premise is that QLA is ethically important in bioethics. Defending these claims does not come down to the claim that QLAs are overriding all the other ethically relevant aspects (and I don’t hold this latter thesis).
To say that good instruments are available is neither saying that these instruments are perfect nor saying that they cannot or should not be improved by further research. Quite the opposite is true: If I am right that QLA is a helpful and necessary element of our ethical thinking these instruments have to be optimised.
See
Lohmann (2002) for a careful and illuminating discussion of these issues.
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Quante, M. Quality of life assessment and human dignity: against the incompatibility-assumption. Poiesis Prax 3, 168–180 (2005). https://doi.org/10.1007/s10202-005-0077-x
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DOI: https://doi.org/10.1007/s10202-005-0077-x