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The Concept of Human Dignity

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Published: Jan 31, 2024

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Definition and understanding of human dignity, historical development of the concept of human dignity, importance of human dignity in society, controversies surrounding the concept of human dignity, human dignity in contemporary society.

Universal Declaration of Human Rights
Stanford Encyclopedia of Philosophy
International Covenant on Civil and Political Rights
International Covenant on Economic, Social and Cultural Rights

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Dignity is a complex concept. In academic and legal contexts, it is typically used in the couplet “human dignity” to denote a kind of basic worth or status that purportedly belongs to all persons equally, and which grounds fundamental moral or political duties or rights. In this sense, many believe that dignity is a defining ideal of the contemporary world, especially in western society. However, the concept of dignity has long been associated with many more meanings, some of which cut in distinctly different directions: rank, station, honor, uniqueness, beauty, poise, gravitas, integrity, self-respect, self-esteem, a sacred place in the order of things, supreme worth, and even the apex of astrological significance. Some of these connotations have faded with time. But most have enduring influence.

So, what exactly is dignity? Do its different connotations hang together in any principled way? Does dignity understood as “universal human worth”, for example, have any meaningful connection to “social rank” or “personal integrity”? Is dignity primarily a moral concept or a political and legal one? Even assuming we can make sense of its different meanings, what does dignity demand of us? What does it mean to recognize or respect it? Does it ground rights? If so, which ones? And where does the idea of dignity come from? What, in other words, is its history?

This entry will take up these questions, but without any pretense of being exhaustive. The goal is to provide a general guide to existing theory and debate, with a focus on philosophical approaches to human dignity, and mostly as it figures into the western tradition. The vast literature makes anything more ambitious than this unrealistic, even for an encyclopedic survey.

1.1 The legal history of dignity

1.2.1 the revolutionary platitude, 1.2.2 the kantian platitude, 1.2.3 the imago dei platitude, 1.2.4 the ciceronian platitude, 2.1 dignity’s defining properties vs. dignity’s grounds, 2.2 is a connection to rights a defining property of dignity, 2.3 are distinctiveness and fragility defining properties of dignity, 3.1 virtue, value, status, and the “distinctiveness” point reconsidered, 3.2 individuals vs. species, 3.3 inherent vs. constructed, 3.4 respect: an alternative lens on dignity, 4. skeptical worries, other internet resources, related entries, 1. a historical primer.

In the opening sentence of its preamble, the 1948 Declaration of Human Rights affirms the “inherent dignity” and “equal and inalienable rights of all members of the human family” as the “foundation of freedom, justice and peace in the world” (UN 1948). This claim would surprise our modern ancestors. Until about 1830–1850, neither the English term “dignity,” nor its Latin root dignitas , nor the French counterpart dignité , had any stable currency as meaning “the unearned status or worth of all persons”, let alone the grounds of universal rights or equality. Instead, in everything from Hobbes’s Leviathan (1651) to Samuel Johnson’s Dictionary (1755) to Webster’s Compendious Dictionary (1806), “dignity” was primarily used with a conventional merit connotation—something like the “rank of elevation” that Johnson officially gave it.

How did this sea change in meaning come about? The UN Declaration makes clear that dignity’s moral-political meaning had become normalized by 1948. But what happened before 1948 that explains this transformation? These are not easy questions to answer. Although theorists often include historical remarks in their inquiries, they are just as often brief and subservient to some further, non-historical point. The result is a great many half-told stories about dignity’s past.

There are some notable exceptions. For some time, legal theorists have been etching out the details of dignity’s historical role in law and jurisprudence, especially in connection to rights. Second, theological inquiries into human dignity often engage an older history of ideas, especially the Renaissance thinker Pico della Mirandola or scholastic debates about the biblical doctrine of imago Dei . Third, there is a considerable body of literature on the Enlightenment luminaire, Immanuel Kant, and his famous claim that humans do not have a “price”, only a distinctive and incomparable worth or Würde —usually translated as “dignity” (see, e.g., Korsgaard 1986; Meyer 1987; Hill 1992; Kofman 1982 [1997]; Wood 1999; Kain 2009). Let us turn to these various exceptions, and their challenges.

The connection between law and dignity strikes many as socially and morally urgent. It is thus unsurprising that some serious history of this connection already exists, especially in relation to rights theory (see, e.g., Eberle 2002 or Barak 2015). Nevertheless, the bulk of this history does not look back very far.

For example, Lewis (2007) gives a wonderful overview of the idea of dignity in international law, but his focus is on the writing of, and reaction to, the 1945 UN Charter and 1948 Declaration of Human Rights. Or consider McCrudden’s impressive 2013 edited volume, Understanding Human Dignity. The historical chapters of this volume make important contributions, but again the focus is largely the twentieth century. Scott’s chapter (2013), for example, begins by observing that the 1848 French decree to abolish slavery motivates itself from the consideration “that slavery is an assault upon human dignity ( la dignité humaine )” (2013: 61). She then nicely explores the idea of dignity in the context of post-slavery Louisiana c.1862–96. However, the chapter then jumps forward to a comparison with Brazilian society c.1970–2012. Moyn’s chapter (2013) examines early and middle twentieth century constitutional debates to show that the concept of dignity labors under poorly appreciated debts to a specifically Christian conception of democracy, and for this reason, Moyn argues, we should be skeptical about the long-term utility of dignity for secular rights theory. And Goos’s chapter (2013) offers a close examination of the role of dignity in German thought, but the focus is on post-World War II interpretation of the German Grundgesetz (Basic Law). [ 1 ]

A longer legal history can be found in McCrudden (2008), whose concise review of dignity reaches back to classical Roman thought. McCrudden argues that we can trace the merit connotation of dignity as “elevated social rank” to the Roman idea of “ dignitas homini ” (2008: 656); but also, and crucially, he argues that we can trace our contemporary moral-political notion of the “basic worth or status of human persons” to this same period, when Cicero introduced the idea of “the dignity of the human race” (see also, Cancik 2002). This claim about Cicero is echoed in Michael Rosen’s 2012, Dignity: Its History and Meaning , which is another important entry into dedicated history that focuses on legal connections. Rosen’s history is mostly from a bird’s eye view, but, like McCrudden’s, Rosen’s history has the virtue of taking a long view that stretches back to antiquity. Moreover, Rosen offers some nuanced reflections on eighteenth and nineteenth century connections, including Kant’s influence on the writing of the German Grundgesetz .

Finally, when it comes to legal history, Darwall (2017) offers a sophisticated analysis of dignity’s connections to western Enlightenment conceptions of jurisprudence stretching back to the sixteenth century. Importantly, however, Darwall’s history challenges McCrudden’s and Rosen’s appeal to Cicero as a key source. We will return to this scholarly disagreement and Darwall’s competing proposal below ( §1.2.2 and §1.2.4 ).

1.2 Four Origin Stories

Given the present popularity of studying dignity, we should not only expect the historical contours of dignity to become clearer in coming years, but also for them to be occasionally redrawn. A few important platitudes have already been challenged.

The western creed of human dignity stems from the wisdom of eighteenth-century revolutionary thinkers such as Thomas Jefferson, Alexander Hamilton, or Gilbert du Motier, the Marquis de Lafayette. At the founding of new liberal states like America, or the reformation of existing ones like England or France, political sages like these propounded the inviolable value of individual human beings.

In reality, one looks in vain for dignity in the founding documents of these new republics. The term appears a few times in the English Bill of Rights (1689), but not with our contemporary moral-political meaning. It appears once in the French Déclaration des Droits de l’Homme et du Citoyen (1789), but the connotation is of the privileges that attend public or political office. And for all its fiery rhetoric about equality and the “inalienable” rights of man, the US Declaration of Independence does not mention human dignity at all. Nor does the US Constitution. In fact, it is not until the Mexican Constitution of 1917 and the 1919 Weimer Constitution, that the term appears in a constitutional context possibly with its moral-political connotation (McCrudden 2008; Debes 2009 and 2017b). To this corrective evidence, we should add the testimony of an entirely different set of historical voices—from Sojourner Truth, David Walker, Anna Wheeler, and William Thompson, to Susan B. Anthony, Frederick Douglass, James Rapier, and Ida B. Wells—who remind us that the revolutionary platitude was contradicted by the lived reality within these new republics. These voices decried the systematic oppression and often bloody inhumanity that stained the supposedly egalitarian societies in which they lived.

The early modern concept of dignity originates with Immanuel Kant, who in his 1785 Groundwork for the Metaphysics of Morals , argued that all persons have an inherent value, or dignity, in virtue of their rational autonomy. This value commands a distinct kind of moral respect, which we express by abiding by certain limits in our treatment of others. Thus, Kant argued that we have a categorical duty to treat persons always “as an end” and “never merely as a means” ( Groundwork , 4:429).

This is the greatest dogma about dignity in philosophy. But there are good reasons to rethink it in favor of a more complicated history of ideas. First, although it is well known that Kant is indebted to Rousseau in various ways (see especially Beiser 1992), recent scholarship suggests that when it comes to his ideas about “humanity” and “dignity”, the debt runs deeper than is generally understood (James 2013; Hanley 2017; Sensen 2017). Sensen also argues that it is a longstanding interpretive mistake to think that Kant grounds the obligation to respect others on any “absolute inner value” that humans possess; and that “dignity” is not the name Kant gave to such a value anyway (Sensen 2011 & 2017; see also Meyer 1987). Relatedly, Debes (2021) argues that contemporary philosophers have greatly overestimated Kant’s influence on the historical development of our notion of moral respect for persons.

On top of these corrections, Darwall (2017) argues that the conceptual link between dignity and rights does not originate with Kant. According to Darwall, only certain conceptions of dignity will support the kind of inferences about respect that could justify using dignity to ground human rights. Namely, those conceptions that render dignity as a kind of authoritative standing to make “second-personal” claims—that is, claims by one person to another. However, the original insight for this crucial point, Darwall further argues, comes from the natural lawyer Samuel Pufendorf (see also Darwall 2012).

Writing a century before Kant, Pufendorf argued that human beings have perfect natural rights (rights owed to one another) in virtue of a certain moral “standing” that we assign to each other as a constitutive part of being sociable. Whenever we address another person directly—e.g., with a claim like “You must allow me to speak”—we implicitly treat them as an accountable, responsible being. Otherwise, why address them at all? And the same is true when they address us. In other words, according to Pufendorf, being sociable implicitly involves a reciprocal assumption of basic moral status—us of them, them of us—whenever we interact, and even if the address is one that offends the equal standing of the other. Indeed, this is precisely when “dignity” becomes most urgent. Thus, Pufendorf writes:

There seems to him to be somewhat of Dignity [ dignatio ] in the appellation of Man : so that the last and most efficacious Argument to curb the Arrogance of insulting Men, is usually, I am not a Dog but a Man as well as yourself . (1672: I.VII.I [2003]: 100)

The moralized concept of dignity does not originate in the early modern era. It was celebrated as early as the Renaissance, in Giovanni Pico della Mirandola’s 1486 Oration on the Dignity of Man . Moreover, Pico’s oration is drawn from the older, medieval Christian doctrine of imago Dei (based on Genesis 1:26 and Wisdom 2:23), which tells us that we are made in “in the image of God”, and that this likeness grounds our distinctive moral worth or status.

This story about dignity is to Christian theology what the Kantian dogma is to philosophy. However, these claims are usually misleading if not false. For example, Copenhaver (2017) flatly contradicts the claim that Pico was talking about human dignity in a sense akin to our contemporary moral-political notion. First, Copenhaver notes that the title of the work, which draws our attention, postdates Pico (who never published it). More substantively, Copenhaver argues that Pico’s speech was a public failure in large part because it was entangled with Kabbalah mysteries for how humans can escape the body to increase their status by becoming angels. Finally, Copenhaver points out that Pico uses the Latin dignitas only twice; and

In neither case does dignitas belong to humans, except aspirationally, and neither justifies “dignity” as a translation, with all the Kantian baggage of the modern English word. (2017: 134–5)

Adding to this reversal of fortunes, Kent (2017) marshals extensive evidence from the scholastic tradition against the imago Dei platitude more generally. Although she confirms that both dignity and the doctrine of imago Dei were widely discussed by medieval Christian scholars in the Latin West, she convincingly demonstrates that these discussions did not intersect in a way that supports an inference to our contemporary moral-political notion of the “basic worth or status of humans”. This said, not all interpretations of the Christian tradition, including the doctrine of imago Dei , are beholden to this historical platitude. And the imago Dei line of inquiry on dignity has a somewhat different life in the Jewish tradition. [ 2 ]

“Dignity” derives from the Latin dignitas . And while most Romans used dignitas only in its merit sense, a few, and Cicero in particular, had a proleptic understanding of dignitas that anticipated today’s moral-political sense.

This historical view has attracted more attention lately, as evidenced by its earlier noted endorsement in McCrudden (2008) and Rosen (2012a) (see also, Englard 2000). However, it has been challenged on both philosophical and interpretive grounds. For example, Miriam Griffin (2017) carefully demonstrates that the textual support for this view is very thin. She argues that straightforward lexical analysis of Roman sources offers sparing evidence for connecting dignitas to our contemporary moral-political concept. Moreover, even if we branch out to other ancient Roman concepts to see if dignity might be hiding under different terminology, we run into a fundamental challenge: “Stoics and Roman moralists”, Griffin explains, “think in terms of officia , obligations or duties or functions that our nature, properly understood, imposes on us ”. Correspondingly, “[t]he entitlements and rights of those at the receiving end of our actions is not a prominent aspect of their thinking” (2017: 49).

Admittedly, Griffin allows that in some cases these obligations or duties entail a kind of treatment of others that accords with our contemporary notion of human dignity. Still, this result does not depend on any right that persons have in virtue of “the worth of a human being per se” (2017: 64; see also Meyer 1987; and Lebech 2009, especially p. 46 n. 22.)

To these challenges, Darwall (2017) adds another problem for the Ciceronian platitude. Borrowing from the exact quotations that McCrudden and Rosen use to defend attributing a moral-political notion of human dignity to Cicero, Darwall argues:

Human dignity for Cicero is nothing that could be established by conventional patterns of deference. It is the idea, rooted in the ancient notion of a great chain of being, that distinctive capacities for self-development “by study and reflection” give human beings a “nature” “superior” to that of “cattle and other animals”. Other species are motivated only by sensory instincts, whereas human beings can “learn that sensual pleasure is wholly unworthy of the dignity of the human race”, and be guided by this understanding. [Consequently] nothing in the Ciceronian notion of human dignity requires, or even leads naturally to, basic human rights. The proposition, for example, that “sensual pleasure” is “unworthy” of human dignity is less a thesis about what human beings are in a position to claim from one another by virtue of their dignity than it is an ethical standard to which we are to live up. (2017: 182–3; Cicero quotations cited in McCrudden 2008: 657, and Rosen 2012a: 12)

To be fair, Darwall’s critique hangs on two assumptions about the concept of dignity: (1) that a satisfactory account of dignity will involve a connection to, if not a grounding for, rights claims; and (2) that dignity is in no way an achievement. Both assumptions resonate strongly with contemporary moral-political talk of dignity. Nevertheless, identifying these assumptions should remind us that we have not yet clearly formulated a concept of dignity. So, let us turn to that task. [ 3 ]

2. Formulating Dignity

There is no single, incontestable meaning of dignity. In fact, there are so many possible meanings that it has become commonplace in the literature to worry about the expansive variety of conceptions, and in turn to worry whether dignity is or has become essentially ambiguous. And while its defenders find ways to mitigate or explain away this ambiguity, the concept of dignity has its share of detractors. But we will return to skeptical worries at the end of this entry. For now, and granting the prima facie force of the ambiguity worry, four broad categories of meaning stand out across context and history:

Dignity as Gravitas: a poise or grace associated with behavioral comportment; e.g., the sophisticated manners or elegant speech of nobility, or outward composure in the face of insult or duress.
Dignity as Integrity: the family of ideas associated with living up to personal or social standards of character and conduct, either in one’s own eyes or the eyes of others.
Dignity as Status : noble or elevated social position or rank.
Dignity as Human dignity : the unearned worth or status that all humans share equally (either inherent or constructed).

This “general schema” is rough and ready. Scholars divide the conceptual space in different ways, often advocating intersections between the foregoing four categories, making elaborations on them, or noting wrinkles within them.

For example, Kolnai (1976) argues that the primary function of the concept is descriptive, not evaluative. Dignity is a quality of persons, which is the fitting object of a set of pro-attitudes related to both moral appreciation and aesthetic appreciation. Thus, to be dignified is to comport oneself in a way that is not simply a reflection of authority, rank, moral uprightness, or a regimented or serious adherence to codes of conduct, but instead reflects something of “the beautiful”. As Kolnai puts it, our response to dignity is characterized, at least in part, by “our devoted and admiring appreciation for beauty” (1976: 252). Hence the distinction between (1) and (2) above (see also Brady 2007).

By contrast, although Rosen (2012a) notes that the Latin term dignitas was once part of a critical vocabulary of classical art and rhetoric, used “to characterize speech that was weighty and majestic, in contrast to discourse that was light and charming” (2012a: 13), Rosen largely blends categories (1) and (2) into a single strand of meaning, which he identifies as “dignity as behavior, character or bearing that is dignified” (2012a: 54). Rosen then accepts (3) and (4) but adds his own further category, which he calls “dignity as treatment”: “To treat someone with dignity is…to respect their dignity” (2012a: 58). As we will see more fully in a moment, this addition reflects a common observation by scholars about a tight connection between dignity and its recognition (although, it is not common to claim that the proper recognition of dignity is a separate category of dignity).

Meanwhile, Kateb (2011) stresses the need to distinguish between human dignity qua individual humans, and human dignity qua human species. According to Kateb, both have dignity. But whereas the dignity of individuals can be described as a special kind of “status”—as in category (4) above—the dignity of the human species requires a further concept, namely, of “stature”. He writes, “In comparison to other species, humanity has a stature beyond comparison” (2011: 6). To be clear, Kateb does not think that the human species has an existence above and beyond its members: it is not a natural kind. However, he argues that the interdependence of humans is,

so extensive, so deep, and so entangled…that for certain purposes we might just as well make the human species a unified entity or agency, even though we know it isn’t. (2011: 6)

Correspondingly, we can sensibly talk about the “dignity” of the species. This conclusion cuts against some positions that maintain dignity “proper” can only belong to individuals (Stern 1975; Gaylin 1984; Egonsson 1998).

A more recent schema is offered by Killmister (2020). Killmister proposes three “strands” of dignity: personal, social, and status. To have personal dignity, Killmister argues, is to take oneself to be subject to personal “dignitarian” norms. And to have social dignity is to be subject to social “dignitarian” norms. What are dignitarian norms? Dignitarian norms are norms that either the person themself, or society at large, take to be “ennobling” to uphold, or whose transgression the person or society consider to be “disgraceful or debasing” (2020: 25, 29). Like Rosen, then, Killmister effectively blends categories (1) and (2) , while at the same time drawing attention to a different organizational distinction one might make, namely, between the personal and the social. As for “status dignity”, Killmister argues that explaining this category of dignity requires a distinctive concept of respect. And her argument is worth elaborating because it exemplifies and fleshes out two closely related points shared by many existing theories:

that any satisfactory theory of dignity must explain what it means to recognize dignity; and
that this recognition is best described as a kind of respect .

So, consider: Dignitarian norms, according to Killmister, can typically be redescribed as articulating the grounds of respect—either self-respect (in the case of personal dignity) or respect from others (in the case of social dignity). Moreover, the kind of respect relevant to personal and social dignity, she argues, is what Stephen Darwall (1977) influentially named “appraisal respect”. This kind of respect is a positive evaluative attitude or feeling , which we express towards ourselves or others, for some merit of character. In this sense, respect is akin to esteem. Killmister writes:

to be highly personally dignified is to be such that, by our own lights, we ought to hold ourselves in high esteem…to be highly socially dignified is to be such that, by the light of our community, they ought to hold us in high esteem. (2020: 23)

By contrast, Killmister connects status dignity to what Darwall called, “recognition respect”. Recognition respect is a way of thinking about oneself or others. To recognize-respect someone (at least as Darwall first explained it) is to give appropriate weight to some fact about them in our practical deliberations, and to restrict our choices or actions accordingly.

Killmister thus argues,

We come to have status dignity, when we fall within a particular [social] category, membership in which commands respectful treatment from others in our community. (2020: 22)

She elaborates,

status dignity does not call on others to esteem us, but rather to treat us in ways appropriate to the kind of thing we are. (2020: 23, emphasis added)

Correspondingly, human dignity ends up as “an especially important instance” of status dignity. And all humans deserve recognition respect in virtue of the “fact” of their membership in the category “human” (2020: 129–30).

This said, Killmister’s conclusion diverges from Darwall’s own account of human dignity, which is tied to a revision he made to his theory of recognition respect, which connected recognition respect to the reciprocal “authority” of second-personal address, as discussed in the earlier historical reflection on Pufendorf (see §1.2.3 above; and Darwall 2006, esp. p. 14). Note also that Killmister, like Kateb, eschews thinking of “human” as a natural kind, in favor of understanding it as a social kind.

The previous section offered examples of how the general schema of dignity’s meaning gets modified in existing theory, as well as how each category of meaning might be fleshed out. More examples could be given. But to decide between any of them, it seems crucial to ask, how should we formulate the concept of dignity? In other words, instead of simply cataloging first-order views about its meaning, we need to introduce some second-order criteria.

On the one hand, we need to determine the defining properties of dignity: the distinguishing characteristics or explanatory demands that are supposed to apply to any contentful account of dignity. Such criteria might include, for example, that dignity is “inherent”; that it is “incommensurable” with other values; that it has a “distinctive normative function”; that it has an essential connection to rights; and so on.

On the other hand, we need to determine what grounds dignity: we need to say what it is about humans, or any being with dignity, that satisfies the defining properties. In other words, we need to answer the question: In virtue of what do we have dignity? The most common answer to this question, historically speaking, especially when it comes to human dignity, involves a claim about autonomy. Or if not autonomy tout court, then the “capabilities” for such autonomy (see, e.g., Nussbaum 1995, 2006a, and 2006b). Thus, one finds many variations of the claim that humans have dignity in virtue of their capacity for (or exercise of) “choice” or “rational agency”—claims that are often tethered to the earlier discussed historical platitude about Kant. This said, alternatives to the grounding question about human dignity include brute species membership, sentience, the creative power of humanity, creation “in the image of God”, a politically conferred status as “rights bearer”, the capacity for empathy and caring relationships, the earlier mentioned “personality”, the concrete “particularity” of an individual person, and the possession of “perspective”.

Sorting these views is not easy for a few reasons. First, some of the operative concepts, such as “autonomy”, are themselves hotly disputed. Second, there is no pre-theoretical reason to deny multiple ways of satisfying any given definitional criteria. That is, any given proposal for the defining properties of dignity might be satisfied by more than one ground. For example, depending on the criteria, humans might “have” dignity in virtue of both autonomy and sentience, or both divine creation and our capacity for empathy, and so on. Third, twentieth century theorists rarely took a second-order view on their subject and methods. In turn, they often confused or at least failed to clarify which of the two foregoing challenges they were trying to tackle, articulating dignity’s defining properties or articulating dignity’s grounds.

Thankfully, twenty-first century formulations of dignity are marked by increasingly conscientious attempts to articulate the defining properties of dignity, and to do so in a way that might guide discussion about dignity’s grounds. For example, in “Bedrock Truths and the Dignity of the Individual”, Iglesias (2001) distinguishes between historically older, “restricted” meanings of dignity associated with general schema (1) , (2) , and (3) ; and, on the other hand, what she calls “universal” meanings associated with schema (4) , “human dignity”. She further argues that any satisfactory universalist account must render human dignity as (4a) in some sense “inherent” or “intrinsic”; and (4b) the “grounds” of basic rights. Regarding the latter, Iglesias writes:

The connection is essential. It is rooted in the concept of the human person, in human self-understanding as constituted by the bedrock truths about what and who we are…The universal meaning of the concept of dignity, as inherent to every human being, expresses the intrinsic good that the human being is. The distinct human rights articulate those basic intrinsic goods proper to, and expressive of, each one’s dignity, individually and in community relationships—as dimensions of our very being. These basic goods—guaranteed as rights—must be recognized, respected, and promoted so that the intrinsic good that the human being is himself or herself, personally and as an individual, may be preserved and assured. Thus, the ground for advocacy and defense of human rights resides on what and who the human being is, as a human being, namely on his or her dignity. (2001: 130)

By comparison, Shultziner (2007) adopts a “philosophical-linguistic” method to distinguish moral-philosophical uses of dignity from political and legal “functions” of the concept, especially the use of dignity to ground specific rights and enforceable duties. Regarding the latter, Shultziner stresses that in real world contexts, the rights which the concept of dignity is used to ground vary considerably:

There is no fixed and universal content that spouts out of human dignity and, hence, its content and meanings are determined separately in each legal document in accordance with the political agreement achieved at the time. (2007: 78)

This might seem to express skepticism about the possibility of any general, stable concept of dignity. In fact, it underlines the point of Iglesias’s final criterion (4b) ; namely, that a defining property of dignity is the grounding connection to rights. In other words, strictly speaking, Shultziner agrees with Iglesias that at least one defining property of human dignity—in political contexts—is that dignity grounds rights, even though the content of these rights vary greatly because the grounds of dignity itself vary greatly. [ 4 ]

Another example of second-order thinking can be found in Debes (2009), who argues that any satisfactory “formal” account of human dignity—by which he means an account of its defining properties—must pick out a “distinctive” value or status belonging to humans. And it must be distinctive in the sense that it (a) is not merit based, but instead unearned; (b) is in some sense “incommensurable” with other values; and (c) makes sense of the basic “normative function” of the concept. Regarding (c), Debes argues that the concept of dignity does not purport to be only or even mainly descriptive. Instead, it has a normative purpose or role, namely, “to set off in our practical deliberations whatever ‘dignity’ is applied to—to guard or protect what has dignity” (2009: 61–2).

Or consider Waldron (2012), who tracks a confusion in legal discussions of dignity between (on the one hand) definitional claims about dignity’s defining properties and (on the other hand) claims about dignity’s practical conditions; that is, the conditions of its moral, social, or political recognition. Thus, Waldron notes the way that various human rights charters claim that dignity is “inherent” in the human person; but also “command us to make heroic efforts to establish everyone’s dignity” (2012: 16, emphasis added). Such claims, he writes, may look like an equivocation akin to claiming, as Rousseau once did, that “Man is born free but everywhere is in chains”—a claim that Jeremy Bentham later called “miserable nonsense”. However, Waldron argues that Bentham missed an easy explanation of Rousseau:

[A person] might be identified as a free man in a juridical sense—that is his legal status—even though he is found in conditions of slavery…So, similarly, one might say that every human person is free as a matter of status—the status accorded to him by his creator—even though it is the case that some humans are actually in chains and need to have their freedom represented as the content of a normative demand. (2012: 16–17)

To be clear, Waldron quickly adds that one might shy away from the specific premise of divine creation as a way of grounding human freedom. That metaphysical premise is only an example. His overarching point is that it is not incoherent to make this kind of claim. Because the operative claim about the status of human persons—namely, that they are free—is a claim about a defining property of the concept of “man” (in a juridical sense), it follows that we can distinguish this claim from any further claim about what grounds this “free” status, as well any claim about the worldly conditions that are required for this status to be expressed, realized, or recognized.

Keeping this in mind, we can now understand why Waldron thinks that we are not necessarily equivocating if we claim that dignity is inherent , but nevertheless enjoin others to establish it in practice. He writes,

On the one hand, the term [“dignity”] may be used to convey something about the inherent rank or status of human beings; on the other hand, it may be used concomitantly to convey the demand that rank or status should actually be recognized. (2012: 17)

Importantly Waldron further argues that dignity finds its proper conceptual home not in morality, but in the legal context of rights. He writes, “law is its natural habitat” (2012: 13). This is because, he argues, rights articulate, or flesh out, the kind of status that modern conceptions of dignity typically include or allude to; but also, which his own theory depends on. Thus, for Waldron, it is historically mistaken and theoretically confused to ground our contemporary concept of human dignity on thick metaphysical bases—some inviolable value that “inheres” in humans, whether by dint of divine creation or otherwise. Instead, on Waldron’s view, the contemporary notion of human dignity is essentially Samuel Johnson’s old idea of “elevated rank”, albeit refashioned in the modern consciousness to apply to all humans.

In other words, Waldron explains the historical revolution in our concept of dignity as turning on a leveling up of all people to the kind of social status once reserved only for the noble elite. We simply reappropriated the term “dignity” to describe this high status, ditching its original “sortal” connotation for a new egalitarian one (2012: 57–61). Furthermore, he claims that all this happened through (or mainly through) the paradigm of rights. Oversimplifying for sake of argument: Waldron thinks that people of lower social rank successfully annexed the rights reserved to those of higher ranks, by reinterpreting those rights as human rights. Hence why rights remain the critical apparatus for fleshing out the kind of status relevant to “dignity”, and why the proper home of dignity is law, not morality.

Waldron’s view on dignity has been influential, so a few more notes about it are fitting. First, in making these claims about dignity-as-elevated-rank, Waldron partly aligns himself with Appiah (2010), although Waldron does not seem to notice this. Second, Waldron’s claim about the “home” of dignity is contentious. It is prima facie hard to square with everyday claims about human dignity, which seem evenly spread over moral, political, and legal contexts. And it contradicts Shultziner (2007), discussed above. Moreover, Dimock (2012), Herzog (2012), and Rosen (2012b) challenge it directly, among others (see, e.g., Bird 2013).

Most important, however, in the greater context of discussing the defining prosperities of dignity, it is to register Waldron’s underlying suggestion about an “essential” connection between dignity and rights. As we have seen, this claim finds wide traction in the literature, even in accounts of dignity that are at odds with the Appiah-Waldron view of “dignity-as-elevated-rank”. For example, considering only accounts reviewed so far, Iglesias (2001) made the same claim; Darwall (2017) implies it; and both Kateb (2011) and Killmister (2020) endorse it in different ways. This raises an obvious question: What exactly is the connection between dignity and rights?

It is beyond the scope of this entry to answer this question in anything close to a comprehensive way. (Good starting points include Meyer and Parent 1992; Gewirth 1992, Carozza 2008 and 2013; and Tasioulas 2013). Instead, let us draw out a few points about the connection between dignity and rights as it bears specifically on attempts to make it a defining property of dignity itself. To get at these points, consider a final proposal about the definitional criteria of dignity, from Fitzpatrick (2013):

The primary notion of dignity is the idea of a certain moral status involving possession of an inherent, unearned form of worth or standing —a basic worth or standing that is neither dependent on one’s being of use or interest to others nor based on one’s merits, and which essentially calls for certain forms of respect. (2013: 5546)

Fitzpatrick presents this definition within the context of an encyclopedic effort to capture its meaning. As such, he is understandably aiming at something generic. However, in the light of our analysis so far, the tensions in his attempt are manifest, albeit instructive.

First, describing dignity as primarily a “status” instead of a “value” aligns with those like Waldron, who make a principled distinction between their accounts and all kinds of “worth” or “value” conceptions of human dignity (see, e.g., Killmister 2020, who emphasizes this distinction; and Dan-Cohen 2012, for analysis on its import to Waldron). However, Fitzpatrick immediately equivocates on this point, redefining status as, “worth or standing”. Similarly, consider that those like Appiah-Waldron who think human dignity depends on a refashioned idea of high social rank, must, strictly speaking, reject the property of “inherentness” that Fitzpatrick appeals to. But they might allow for the alternative description of “unearned”, especially if this is interpreted as historically indexed to the refashioned conception of status.

More important for the question about rights is to consider Fitzpatrick’s final remark that dignity, “calls for certain forms of respect”. At first blush, this appeal might seem to be merely a refinement of Debes’s (2009) claim that dignity has a distinctive “normative function”. If so, it would be a refinement that is common to many theorists, as we already noted in §2.1 . However, Fitzpatrick immediately connects this generic claim about respect to two specific elaborations of dignity’s normative function. He writes:

It is in this sense [of an inherent worth or standing that calls for respect] that many hold that all persons possess a fundamental, inalienable dignity, which grounds [1] basic rights…or [2] the authority to make claims and demands of others. (2013: 5546)

Both claims merit elaboration.

The first claim [1] gives voice to the strongest, or at least the most direct way to make the connection to rights a defining property of dignity, by making dignity the normative basis of rights. Thus, suppose one asks of any given right x , what justifies the claim that “ x is a human right”? The answer for those who take this line is, “dignity”. Or at least, “human dignity”.

Now, in one sense, claim [1] is unsurprising given that it has legal reality. For example, although the claim is only implicit in the Universal Declaration of Human Rights (1948) as well as the original Charter of the United Nations (1945), a 1966 amendment to the Charter made it explicit, declaring that rights “derived from the inherent dignity of persons”. Moreover, claims like this have become increasingly common in state constitutions, especially in the west, as well as other international charters and humanitarian declarations (see, e.g., Schachter 1983, Iglesias 2001, Shultziner 2007, and McCrudden 2008, for summaries and analysis).

And yet, it is important to note that such legal claims are almost always brute assertions. They are not conscientious attempts at theory. More exactly, they do not claim that any adequate theory of dignity (as a concept) must account for the grounding relationship between dignity and rights. This is important because, pace FitzPatrick, or those like James Griffin (2008) who adamantly stress dignity as the foundation of rights, some theorists challenge or avoid or even reject claim [1] . This includes skeptics who challenge the viability of any existing substantive accounts of dignity to ground rights (discussed later). But it also includes some theorists who defend dignity (in one form or other). For example, Waldron skirts around the kind of commitment at issue in claim [1]. He allows that dignity involves each person thinking of themselves, “as a self-originating source of legal and moral claims” (2012: 60), but the overarching implication of his argument is that rights articulate the nature of the “high” status humans have been elevated to. Dignity is thus not the normative basis of rights on his view. Instead, legal systems, and rights in particular, “constitute and vindicate human dignity, both in their explicit provisions and in their overall modus operandi” (2012: 67).

Killmister (2020) follows Waldron’s lead, but she is more explicit. “[H]uman rights”, she argues, “form part of our articulation of how members of the human kind ought to be treated” (2020: 143). And, like Shultziner (2007), she warns against attempts to derive the content of rights directly from dignity, a warning that further tells against making claim [1] part of the definitional criteria. Relatedly, Meyer (1989) concludes that insofar as we aim to explain rights, we can never successfully explain dignity: “While having and exercising certain rights is important to our dignity as human beings”, Meyer argues,

what we commonly regard as essential to human dignity would not be explained even if we were able to delineate all of the relevant rights and the particular ways in which each of them expresses or protects human dignity. (1989: 521)

Meyer’s point is enhanced (perhaps even preempted) by Donnelly’s (1982) sociological claim that in cultures where “rights” are or once were a relatively foreign concept, human dignity is not. If Donnelly is correct, then excepting motivational purposes, rights theory is arguably a non-starter for a proper account of dignity’s defining properties (see also, Howard 1992, who partly recapitulates Donnelly’s point).

Piling onto this, Schroeder (2012) and Moyn (2013) warn that the “normative basis” version of the connection claim between rights and dignity—i.e., claim [1] —leaves dignity vulnerable, because our contemporary concept of human dignity carries underappreciated debts to non-secular, theological traditions (see also Addis 2013). And Valentini (2017) argues that the plausibility of claim [1] depends on which other defining properties of dignity we want to defend. Specifically, if dignity is taken to be inherent, she argues, then claim [1] becomes not only “uninformative” because “the notion of inherent dignity is opaque”; it also becomes counterproductive to the aims of most rights theories. This is because, she continues, the inherentness claim pushes rights debates, “into deep metaphysical waters”, and distracts us from the main political function of rights (especially, human rights), namely, to constrain, “the conduct of powerful actors” (2017: 862–3).

Now consider connection claim [2] : dignity grounds the authority to make claims in general. Some have argued that the first connection claim [1] , which makes dignity the normative basis of rights, is ultimately just a special case of the second claim [2], about authority. Perhaps most well-known in this respect is Feinberg (1970 [1980]), who, in the course of arguing that the act or practice of making interpersonal claims is what “gives rights their special moral significance”, adds this passing remark about dignity: “what is called ‘human dignity’ may simply be the recognizable capacity to assert claims” (1970 [1980: 151]). Admittedly, Feinberg does not unpack the point. And it is not perfectly clear if authority per se is part of his conception of this “capacity”. Still, the point seems to resonate with claim [2], especially if we pair Feinberg’s point with Darwall’s views about second-personal authority, considered earlier. Indeed, Meyer (1989) tries to unpack Feinberg in a way that seems to anticipate Darwall’s view. (See also, Forst 2011, who offers a similar line of argument to Darwall, which he credits partly to Ernst Bloch. But see Sangiovanni 2017, who objects to both Darwall and Forst, esp. pp. 50–60).

It is possible to take an even wider view on the defining criteria of dignity. For example, consider Etinson (2020), who represents another case of conscientious second-order theorizing. Etinson argues that a complete theory of dignity should explain not only what “grounds” dignity—“that is, how and why one comes to possess or lose it”—but also its “proper” method—that is, “how inquiry into all of this should proceed and be understood” (2020: 356). The latter demand is akin to calling for an articulation of the defining properties of dignity, in the sense that we have been discussing. However, Etinson adds an important substantive claim about this method: He agrees that dignity is partly distinguished by something like a distinctive “normative function”, but sharpens this claim by suggesting that to explain this function, we should focus specifically on the conditions of dignity’s violation. This refinement is important for two broad reasons.

First, over its long history, inquiry into human dignity has often been conjoined with considerations of what it means to harm dignity: What constitutes disrespect of dignity? Can we lose it? Can it be destroyed? And so on. Call this, the question of dignity’s “fragility”. Sometimes, this question is taken up within a direct examination of dignity (see, e.g., Kaplan 1999 or Dussel 2003). At other times, the motivation is pragmatic. For example, in his reflection on legal appeals to dignity, Schacter (1983) writes:

When [dignity] has been invoked in concrete situations, it has been generally assumed that a violation of human dignity can be recognized even if the abstract term cannot be defined. “I know it when I see it even if I cannot tell you what it is”. (1983: 849)

And in some cases, these reflections go the other way around; that is, from an analysis of a specific kind of dehumanizing harm (slavery, torture, rape, genocide; alienation, humiliation, embarrassment) to dignity, or one of its close cognates like “humanity” (see especially, Neuhäuser 2011; Morawa 2013; Haslam 2014; Frick 2021; Mikkola 2021). [ 5 ]

But whatever the context, it is crucial to distinguish between first-order encounters with dignity’s fragility, and second-order efforts that try to draw a connection between a negative methodology centered on the question of fragility and the positive effort to articulate the defining properties of dignity. It is the latter claim that Etinson makes, illustrated in the following incisive point:

Not all moral wrongs convincingly register as violations of human dignity…And this suggests that dignity is normatively special—that its violation represents a particular type of wrong. (2020: 357)

Essentially, Etinson is arguing that (1) we should add to the defining properties of dignity, that the value or status “dignity” picks out is in some sense “normatively distinctive”; and (2) in order to articulate (positively) what makes it distinctive, we must investigate (negatively) what it means to harm it. Thus, for Etinson, dignity does not simply have the normative function to “set off” the special status of humans in our practical deliberations; it sets off humans in a special way. And this “way” can only be understood through a consideration of dignity’s fragility.

The second reason for underlining this kind of negative methodology comes from Killmister (2020), who also makes second-order claims about the proper method for theorizing dignity. On her view, all the primary senses of dignity in the general schema can be harmed in some way or other. Each can be injured, lowered, embarrassed, humiliated, threatened, frustrated, even destroyed. Correspondingly, it is a criterion of any satisfactory theory, that it explains the nature and conditions of dignity’s fragility in all its primary senses ( categories 1–4 in the general schema).

The emphasis on “all” is important. Killmister’s theory stands out for being an attempt to use the criterion of fragility to offer a unified theory of dignity. And this raises a question beyond whether fragility is a defining property of dignity. Namely, for any given theory of dignity, does it purport to theorize dignity in general, or human dignity in particular? Most literature bearing the term “dignity” in its title will say at some point that it is really or mostly about human dignity. But if so, then are such theories in some sense incomplete? Must a complete theory of human dignity ( category 4 in the general schema) reconcile itself with the other primary senses of the term ( categories 1–3 ), as Killmister implores?

The next section attempts to offer some footholds for answering these new questions. But there is one more point to make here, because it is pertinent to second-order questions about how to formulate dignity. Part of what motivates Killmister’s effort at a unified theory is an attending argument that theories of dignity should fit with everyday ways of speaking about dignity. And everyday talk of dignity, she argues, often refers to the other primary senses of dignity in the general schema. Moreover, she claims that all these ways of talking are connected by the fragility criterion, as well as some of the other defining criteria we have discussed, especially (A) the idea of a normative function and (B) an essential connection to respect. Finally, she treats this “fit” between her account of the defining properties of dignity and everyday talk about dignity as important evidence for the correctness of her own criteria. Nor is she alone in staking evidentiary value on fitness to everyday language. For example, Bird (2013) and Etinson (2020) make similar arguments. [ 6 ] Do we agree? Surely, a good theory of dignity will not run roughshod over everyday usage. Still, exactly how beholden should a theory be?

3. Human Dignity: Touchstones of Analysis

The conclusion of the last section raised the following question about the conceptual landscape of dignity research: Which of the many points being made are relevant to theorizing dignity in general, and which pertain specifically to human dignity? To answer this question, it will help to distill a few enduring themes that characterize the debate over specifically human dignity. These are hardly all the themes that could be identified. Also, because each theme has been introduced in one way or other already, the following is intentionally condensed, with the understanding that any of these leads could be followed into a forest of nuance.

One could take all the existing literature on human dignity and arrange it into three groups, depending on whether any given argument renders dignity as a kind of (i) virtue or quality of character; (ii) value or worth; or (iii) status or standing. Our analysis already laid out the most important aspects in deciding between these classifications. We also noted that the trend in secular accounts is to articulate dignity as a kind of status rather than as a virtue or value. To this it should be added that virtue accounts make up the minority of all modern positions, no doubt because most contemporary positions eschew the hierarchical drift that comes with tying dignity to virtue.

Perhaps less obvious in the literature, is the agreement to articulate what is distinctive about dignity, regardless of which way it is rendered: virtue, value, or status. This “distinctiveness” point is pressing, given Etinson’s (2020) argument that a negative analysis of dignity’s fragility is crucial to understanding what is “special” about dignity as a normative concept. On his view, a good theory of dignity will pick out a “meaningful distinct set of concerns” (2020: 354), if it is to justify using the term at all. The force of this point extends beyond the question of whether fragility is a defining property of dignity. But to appreciate fully why, we need to contextualize it. So, consider the following:

The idea that human beings are morally special or distinctive has found expression in the religion, philosophy, literature, and art of all societies, modern and ancient. And connected to that idea and those expressions is an enduring struggle to understand what this peculiar “value” is. Since antiquity many have leveraged this idea about human distinctiveness into the idea that humans are supremely valuable. The chorus in Sophocles’ Antigone (c. 441 BCE), for example, lauds man as the most “wondrous” of all things in the world, a prodigy who cuts through the natural world the way a sailor cuts through the “perilous” surging seas that threaten to engulf him (verses 332 ff., cited in Debes 2009 at p. 52). Similarly, the Judeo-Christian doctrine of imago Dei trumpets human dominion over the earth and the distinctive value of humanity. Excluding God and angels, the doctrine implies that humankind is preeminently valuable.

Admittedly, these are not references to theory, strictly speaking. However, the historical development of dignity has long been tangled up with this kind of widespread attempt to explain human distinctiveness, even if only implicitly or under cognate terms like “uniqueness” (e.g., Muray 2007 and Rolston 2008). Indeed, one might say that the most basic point of the concept of dignity, especially as it was molded into the category of “human dignity”, just is to describe the distinctive virtue, value, or status of humans. From Cicero’s ancient claim about the special worth of the “human race”; to Schacter’s (1983) anti-Waldron argument that dignity’s importance outside of legal contexts highlights the need “to treat it as a distinct subject” (1983: 854); to Iglesias’s (2001) attempt to explain our “distinctiveness” as human beings; to Kateb’s (2011) claim that human dignity involves the unique role humans have as “stewards” of the earth—in all these arguments the distinctiveness point is in play. Or consider Simone Weil, writing in the shadow of World War II, and who inspired Iglesias:

There is something sacred in every man, but it is not his person. Nor yet is it the human personality. It is this man; no more nor less… The whole of him. The arms, the eyes, the thoughts, everything. Not without infinite scruple would I touch anything of this. (first published 1957 [1986: 50–51])

Similarly, Malpas (2007) explicitly argues that insofar as we are investigating human dignity, it seems we are inquiring into what is distinctively valuable about “being” human, by which he means something like the experience of being human.

This said, we must understand Etinson as arguing that it is not enough to claim that what explains the moral distinctiveness of humans is their “dignity”. We have to say what about human dignity itself is distinctive. And we must do so in a way that would substantiate (in part or in whole) the more general claim of human distinctiveness. After all, Etinson argues, not all kinds of harms to humans count as harms to their human dignity. Not even all harms to their status are obviously harms to their human dignity. Slapping someone in the face is certainly an affront to their status in some sense, and perhaps even necessarily to their social-status dignity ( (3) in the general schema), but not necessarily to their human dignity ( (4) in the general schema). (See also, Valentini 2017.)

So, what is distinctive about human dignity itself? There is more than one way to answer this question. Etinson’s own suggestion, as we have seen, is to use a negative normative lens to articulate what kinds of harms to humans count distinctively as harms against their dignity. But rather than tracing out further particular answers to this question, let us note a few final general observations about the distinctiveness point.

First, most theorists of dignity do not explicitly parse out the need to explain the distinctiveness of dignity itself, as contrasted with human distinctiveness in general. However, I submit that explaining the distinctiveness of dignity (itself) is often part of what many theorists take themselves to be doing, however indirectly. In other words, explaining dignity’s “distinct set of concerns”, to use Etinson’s phrase, seems to be constitutive of many theories of dignity. There is no space to substantiate this contention here, but we risk losing valuable insights about dignity’s distinctiveness if we don’t take this charitable approach.

Second, it is important not to run together the normative upshot of any claim about the grounds of dignity, with a definitional point about dignity’s distinctiveness. For example, if one thinks humans have dignity in virtue of their rational agency, then in one sense, this will entail a kind of distinctiveness. For, it will necessarily inform the substance of whatever rights or duties we think dignity justifies. In other words, the content of such rights and duties will need to be “distinctively” tied to rational agency, and what it means to protect, harm, or nurture this agency. Likewise for any other candidate account of dignity’s grounds. Nevertheless, this is different than talking about distinctiveness as a defining property of human dignity. Scholars like Etinson and Killmister are trying to articulate the distinctive normative function that defines dignity, regardless of its grounds—indeed, which any satisfactory account of dignity’s grounds must be able to explain.

Finally, Debes (2009) adds the following qualification to the “distinctiveness” point:

A proper account of dignity must pick out a distinctive value belonging to humans. This is not equivalent to demanding a value that belongs distinctively to humans.

The latter demand (which some theorists do insist on), not only arbitrarily rules out a shared space of dignity between different entities but also risks ruling out the best options for dignity’s grounds:

For example, if rationality should after all turn out to be the most defensible basis for a theory of human dignity, we [humans] wouldn’t want to yield it simply because we discovered that chimps and whales were rational or that Martians really have been trying to communicate with us for millennia. (2009: 61).

The conclusion of the last section brings to mind another theoretical dividing line in the literature, between those arguing for human dignity qua human individual, and those arguing for human dignity qua species. Which is it?

Some say, both. For example, Kateb (2011) argues that we must explain the uniqueness of persons and the species: “I am what no one else is, while not existentially superior to anyone else; we human beings belong to a species that is what no other species is” (2011: 17). According to Kateb (echoing Cicero), humans are partly divorced from the natural order both individually and collectively, in virtue of possessing unparalleled and morally special capacities for self-creation. Moreover, Kateb is clear that the distinctiveness of human dignity also grounds human normative supremacy. Indeed, on his view, human supremacy is one of the defining properties of dignity: “The core idea of human dignity is that on earth, humanity is the greatest type of being” (2011: 3–4); we are “the highest species on earth—so far” (2011: 17).

Of course, such claims are contentious. But if we want to engage them, it is important to be clear about whether we are doing so at the definitional level, or at the level of dignity’s grounds. For example, recall Cicero’s claim that it is in virtue of our distinctive capacities for self-development “by study and reflection”, that human beings have a “superior” “nature” to that of “cattle and other animals”. This Ciceronian idea about the grounds of dignity shares affinities with many other extant views, including Kant, Pico, and obviously Kateb. And we have considered reasons for rejecting this line of argument. But even if one accepts it, the present point is that one might not endorse Kateb’s claim about the “core idea” of dignity being essentially about the human species. That is, one could agree with Kateb about what grounds dignity but disagree that part of what defines dignity, is the property of species superiority. Stern (1975) and Gaylin (1984), for example, agree that the concept of dignity is most essentially about human worth or status, but argue that this does not imply that the human species possesses dignity. It only implies that each individual human has dignity.

Finally, any claim about the dignity of the species or collective humanity must confront worries about speciesism, and in turn all the objections of those who think that non-human animals have a purchase on the normative space of dignity (see, e.g., Rachels 1990; Pluhar 1995; LaFollette & Shanks 1996; Bekoff 1998; Meyer 2001; Rolston 2008; Singer 2009; and especially Gruen 2003 [2010], who explores the idea of “wild dignity”.)

It is common to talk of human dignity as “inherent”. What this means, however, is often unclear. Sometimes it is redescribed to mean “intrinsic”, other times “inalienable”. It is also often conjoined with claims that dignity is “inviolable”—although this is dubious if inviolability is supposed to be entailed by inherentness. After all, one might agree that human dignity cannot be entirely destroyed because dignity is inherent, but nevertheless allow that human dignity can be harmed, insulted, frustrated, and humiliated.

This is not to suggest that all that is inherent is indestructible. Whether human dignity can really be destroyed depends entirely on why one thinks human dignity is inherent. If one thinks that human dignity is inherent because we have dignity in virtue of possessing a soul, then they probably do not think dignity can be truly destroyed (although they may think it can be degraded; or even, if they subscribe to Christian dogma, that it was in fact degraded by the “fall” from grace). On the other hand, if one thinks that human dignity is inherent because we have dignity in virtue of our capacities for rational agency, then they probably do think dignity can be lost or destroyed, whether by extreme psychological trauma or a sharp blow to the head.

It must also be reiterated that secular theorists of dignity have increasingly turned away from “inherentness” as a defining property of dignity (see, e.g., Darwall 2006; Debes 2009; Kateb 2011; Rosen 2012a; Waldron 2012; Valentini 2017; Killmister 2020). The reasons for doing so vary. Most reflect suspicion about the metaphysical baggage, especially of the theological kind, that historically has gone hand in hand with inherentness claims. But there are often other reasons. For example, for those that think human dignity is defined by the authority or standing to hold others responsible with second-personal claims, dignity only comes into existence within actual second-personal encounters (see, e.g., Meyer 1989, Darwall 2006, Forst 2011, and perhaps Feinberg 1970 [1980]). Or recall Valentini, who argues that the problem with the metaphysical claims needed to back up inherentness is not simply that they are “heavy”, but that they distract us from the core political function of rights. Meanwhile, for those committed to a negative methodology, like Killmister or Etinson, the starting assumption is that dignity can be destroyed. And while this does not entail that dignity is not inherent, Killmister persuasively argues that such fragility strongly tells against inherentness.

All this raises the question: If not inherent, then what? The simple answer is that on many theories dignity is socially constructed. Of course, there are many theories about what it means for something to be socially constructed, with many important differences between them. There is, for example, a chasm of difference between claiming that dignity is constructed as a constitutive part of second-personal relationships ( à la Darwall or Forst) and claiming that it is constructed through the transformation of an old idea about “elevated rank” ( à la Appiah or Waldron). So, the simple answer must be turned into a complicated one, which we cannot do here.

A complete theory of human dignity must articulate the demands that dignity places on us, morally and politically. Some theories, as we have seen, build this expectation into the defining properties of dignity. But even when they do not, there is almost always some appeal, positive or negative, to some claim about what it means to recognize dignity, and most often to some claim about respect —which, furthermore, is usually claimed to be both what dignity demands and what it means to recognize dignity. The subject of respect, however, is its own labyrinth. It boasts an array of meanings, diverse applications, and extensive commentary. This said, two very general points about respect stand out in connection to human dignity.

First, the connection between dignity and respect has been made concrete in various political contexts. For example, Schachter (1983) notes that Article 10 of the International Covenant on Civil and Political Rights provides that,

all persons deprived of their liberty shall be treated with humanity and with respect for the inherent dignity of the human person. (1983: 848)

He marks a similar provision in Article 5 of the American Convention on Human Rights (Ibid). And this connection generates distinct challenges in the political context that reach beyond the human rights discourse. Schachter explains:

In the political context, respect for the dignity and worth of all persons, and for their individual choices, leads, broadly speaking, to a strong emphasis on the will and consent of the governed. It means that the coercive rule of one or the few over the many is incompatible with a due respect for the dignity of the person. (1983: 850)

However, Schachter further points out, many political theories contend,

that substantial equality is a necessary condition of respect for the intrinsic worth of the human person…In particular, relations of dominance and subordination would be viewed as antithetical to the basic ideal [of human dignity]. If this is so, great discrepancies in wealth and power need to be eliminated to avoid such relations. (ibid)

The question thus becomes, how can we achieve such egalitarian objectives, without the kind of “excessive curtailment of individual liberty and the use of coercion” that human dignity is also thought to eschew (1983: 850)? This question figures into some of history’s most influential political theories, from Hegel to Rawls. (For an inroad to understanding the Hegelian line, see Honneth 2007; for the Rawlsian line, see Bird 2021.)

Second, as already hinted, the introduction of respect raises its own distinctive challenge, namely, to explain what respect is. To do this, many theorists appeal, explicitly or implicitly, to what we earlier called “recognition respect”. When we make plans or choose to act, we recognize-respect others when we appropriately take account of some fact about them, by adapting, revising, or even foregoing our plans and choices in the light of that fact. So, which “fact”? Well, if we are talking about respecting persons as persons, in a moral sense, many theorists have answered that human dignity is the operative fact. Or, if they drill down further, then whatever they end up defending as the grounds of human dignity—whether rational autonomy, species membership, an immortal soul, etc.—is the relevant fact. [ 7 ]

However, the last few decades have witnessed a wave of new theorizing about respect. And this has consequences for theorizing about human dignity. The most notable consequence stems from the field of care ethics, where empathy, compassion, and caring have been conceived as distinct kinds of respect. Thus, although human dignity did not figure explicitly into early formulations of care ethics, as conceived by those like Noddings (1984) or Held (2006), care ethics has increasingly been developed in ways that does bring dignity to the fore, e.g., by those like Dillon (1992), Kittay (2005 and 2011), and Miller (2012). Dillon, in particular, gives voice to a profound alternative to rationalist paradigms of human dignity, noted frequently in this entry, and associated especially with Kant. She writes:

[Care respect] grounds respect for persons in something which, considered in the abstract, nearly all human beings have and can be said to have equally - the characteristic of being an individual human “me” - a characteristic which each of us values and thinks is both morally important and profoundly morally problematic not only in others but in ourselves as well, and which pulls our attention to the concrete particularities of each human individual. We are, on the care respect approach, to pay attention not only to the fact that someone is a “me” but also to which particular “me” she is. (Dillon 1992: 118)

The core idea Dillon expresses here about the grounds of dignity qua the concrete “particularity” of an individual person (as she puts it on 1992: 115), traces to Iris Murdoch (1970) and Elizabeth Spelman (1978). It also resonates with the thinking of Simon Weil, noted above in §3.2 . More generally, Dillon’s argument illustrates how taking the concept of respect as our starting point might lead to very different views about human dignity.

The conceptual complexity surrounding dignity has sparked a long history of disagreement about the utility of the concept, with some concluding that it is hopelessly messy or essentially ambiguous. One of the more cited versions comes from the Yale bioethicist Ruth Macklin, who made this complaint in a widely read 2003 editorial. “Dignity”, she asserted, “is a useless concept. It means no more than respect for persons or their autonomy” (2003: 1419).

Macklin’s claim was not backed by much argument. And judging by the literature, her complaint did nothing to slow down the application of dignity in bioethics, where it is now discussed in the context of everything from disability studies, elderly care, human research, cloning, “chimeras”, enhancement, transhumanism, and euthanasia (see the bibliography for leads to each of these). Still, one does not have to look hard to find Macklin’s allies.

For example, Rosen (2012a) claims that “animus against dignity is widely shared among philosophers, in my experience, and goes back a long way” (2012a: 143). He buttresses his claim by recounting the encouragement of a colleague to give the concept “a good kicking”, and by quoting his favorite historical challenges by Schopenhauer and Nietzsche, the former of whom called dignity, “the shibboleth of all the perplexed and empty-headed moralists” (1840 [1965: 100] cited in Rosen 2013: 143). Importantly, however, for Schopenhauer and Nietzsche, the problem wasn’t simply the ambiguity of the concept. They thought that the moralized notion of inherent or distinctive human worth garners widespread credence only because it flatters our pride and allows us to slip into self-deceptive moral complacency. This deflationary hypothesis strikes at the heart of our modern dignitarian ethos.

So, exactly how widespread is skepticism of dignity? There is no simple answer to this question because it depends greatly on what one takes dignity to be. Even defenders of one conception of dignity often express skepticism about other conceptions. For example, we already noted the trend away from thick metaphysical claims about dignity, which make dignity depend on anything like a divinely implanted “soul” or Kant’s “noumenal” idea of the self. Rosen calls such views, “internal kernel” theories, and further notes that reservations about these views are often both metaphysical (no such thing exists) and epistemological (we cannot justify our belief in such things). The present point, however, is that if one’s skepticism about human dignity in general turns on the specific reservation about internal kernel theories, then one should stay open minded. For, as we have seen, there are many alternatives for theorizing dignity that do not depend on such metaphysical commitments.

Still, because there is more than one way to interpret Schopenhauer’s claim that dignity is a “shibboleth”, it may prove helpful to trace out a little further a few possible skeptical lines of argument, albeit briefly. So, here are four ways skepticism tends to play out in the existing literature:

Rosen suggests that Schopenhauer’s main complaint is that “dignity” is an impressive “façade” obscuring the harsh reality behind the idea, namely, that the concept lacks the substance to do the work we assign to it. More exactly, dignity cannot serve as a foundation for morality, including, serving as the normative basis of rights (Rosen 2012a: 143). We encountered this line of thinking already in the earlier discussion of the connection between dignity and rights. Essentially, the complaint is that no extant account of the grounds of dignity (e.g., Kantian rationalist arguments, Judeo-Christian imago Dei arguments, etc.) can satisfactorily explain and justify the kind of normative work dignity is supposed to do. See especially, Sangiovanni 2017, who rejects Aristotelian, Kantian, and imago Dei accounts of dignity as insufficient for the tasks dignity is typically set to, including grounding rights.

A related but distinctively different way of taking Schopenhauer’s objection, is the worry that dignity has been politically manipulated to capitalize on its deceptive potential. As Rosen notes, the general point here is not new. “The idea that illusions are essential to the political order”, he writes, “runs through the Western tradition of political thought from Plato” (2012a: 144). However, Rosen suggests that Nietzsche gets the credit for understanding how powerful an illusion human dignity, specifically, can be, for such political purpose. “Such phantoms as the dignity of man”, Nietzsche writes,

are the needy products of slavedom hiding itself from itself. Woeful time, in which the slave requires such conceptions, in which he is incited to think about and beyond himself! (from “The Greek State”, 1871; quoted in Rosen 2012a: 144)

In fact, this skeptical line goes back further than Rosen seems to appreciate. Thus, in his 1714, Fable of the Bees , Bernard Mandeville essentially made the same argument. Speaking conjecturally about the origins of morality, Mandeville writes:

Making use of this bewitching Engine [of flattery], [the Politicians] extoll’d the excellency of our Nature above other Animals…Which being done, they laid before them how unbecoming it was the Dignity of such sublime Creatures to be solicitous about gratifying those Appetites, which they had in common with Brutes, and at the same time unmindful of those higher Qualities that gave them the preeminence over all visible Beings. (1714 [1988: 43])

Dignity is vacuous. Bracketing any worries about how any given political institution manipulates the idea of dignity to achieve its ends, or how human pride might capitalize on the idea of dignity to facilitate self-deception about our personal moral failings, perhaps the idea of dignity is simply unnecessary. For example, consider the first sentence of Article One of the Universal Declaration of Human Rights : “All human beings are born free and equal in dignity and rights”. What would be lost, Rosen asks, “if one were just to say, ‘All human beings are born free and equal in rights’?” (2012a: 149). A slightly different version of this complaint is that, because of its vacuousness, dignity has become mere dogma. For example, in the legal context, Theoder Heuss, called dignity a “non-interpreted thesis” in law. And Costas Douzinas argued dignity was an empty placeholder in a “hegemonic battle” of competing legal ideologies (see also, McCrudden 2013a for some analysis of both; also, Bargaric & Allan 2006).

Dignity is ambiguous. The thrust of this frequent complaint is that dignity has become a useless concept, not so much because it is empty, but because it has too many meanings. (A few have even claimed that the concept is “essentially” ambiguous, though it is not clear what this is supposed to mean; see, e.g., Shultziner 2007 or Rotenstreich 1983.) When focused, this worry comes in three forms:

the ambiguity of meaning makes “dignity” incomprehensible;
the ambiguity of meaning makes “dignity” susceptible to abuse;
the ambiguity of meaning conceals objectionable subjective opinion or substantive baggage in the concept of “dignity”.

Examples of all these positions can easily be found. But perhaps the best illustrations once again come from the legal context. Regarding (1) : see, e.g., Bates (2005), who acknowledges the problem but then tries to defend dignity. Regarding (2) : see, e.g., Gearty (2014) and Moyn (2013), who argue that the continuing ambiguity of dignity make it too easily abused in courtroom deliberation and democratic theories of rights. Regarding (3) : see Pinker (2008), who argues that dignity is a subjective phenomenon, “relative, fungible, and often harmful”; also Rosen (2012a) and Moyn (2013), both of whom argue that our modern concept labors under underappreciated debts to Christian theology;

These are not all the possible reasons for skepticism about dignity, only the most prevalent. And each is usually sharpened in various ways that make the argument cut deeper than what this summary suggests. This said, the merits of these critiques are disputable. Indeed, much of the foregoing analysis in this entry suggests strategies of response to each.

But perhaps the most fitting way to conclude is with a different kind of question entirely. Namely, how ought we respond to such skeptical attacks, if at all? Thus, it is hard not to think of Frederick Douglass’s warning, delivered in his 1852 “Fourth of July” speech, about the dangers of demanding of anyone, that they argue for their equal and basic human worth or status—especially when so many people remain not simply oppressed, but exposed to vitriolic hate in a world that constantly proclaims its faith and commitment in the ideal of human dignity. “At a time like this”, Douglass said, “scorching irony, not convincing argument, is needed” (1852: 20).

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Acknowledgments

I am deeply grateful to my anonymous referees, who provided careful, generous, and thorough feedback on initial drafts of this entry. For research assistance on various elements of this article I am grateful to Zachary Neemah, Samuel Munroe, Reese Faust, and Alejandro Toledo. The history section draws on my own introduction to Dignity: A History (2017a), by permission of Oxford University Press.

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A brief history of human dignity

Credit: Benjavisa Ruangvaree / AdobeStock

Human dignity means that each of our lives have an unimpeachable value simply because we are human, and therefore we are deserving of a baseline level of respect.
That baseline requires more than the absence of violence, discrimination, and authoritarianism. It means giving individuals the freedom to pursue their own happiness and purpose.
We look at incredible writings from the last 200 years that illustrate the push for human dignity in regards to slavery, equality, communism, free speech and education.

In a New York Times essay published the day of his funeral on July 30, 2020, Congressman John Lewis wrote that his “last days and hours”—in which he watched widespread protests over George Floyd’s murder and saw a square in downtown D.C. christened Black Lives Matter Plaza—filled him with hope. “Around the country and the world you set aside race, class, age, language and nationality to demand respect for human dignity.”

Human dignity is a powerful phrase invoked to peacefully protest against violence, discrimination, and authoritarianism. But when we talk about human dignity, what do we mean?

Human dignity is the inherent worth of each individual human being. Recognizing human dignity means respecting human beings’ special value—value that sets us apart from other animals; value that is intrinsic and cannot be lost.

Liberalism—the broad political philosophy that organizes society around liberty, justice, and equality—is rooted in the idea of human dignity. Liberalism assumes each of our lives, plans, and preferences have some unimpeachable value, not because of any objective evaluation or contribution to a greater good, but simply because they belong to a human being. We are human, and therefore deserving of a baseline level of respect.

Because so many of us take human dignity for granted—just a fact of our humanness—it’s usually only when someone’s dignity is ignored or violated that we feel compelled to talk about it.

But human dignity means more than the absence of violence, discrimination, and authoritarianism. It means giving individuals the freedom to pursue their own happiness and purpose—a freedom that can be hampered by restrictive social institutions or the tyranny of the majority. The liberal ideal of the good society is not just peaceful but also pluralistic: It is a society in which we respect others’ right to think and live differently than we do.

With Google Books Ngram Viewer , we can chart mentions of human dignity from 1800-2019.

We can also map human dignity against mentions of liberalism to see that discussion of human dignity increased with discussion of liberalism.

Then we can search through individual mentions to find how human dignity was discussed and understood over the last 200 years.

For example, German rabbi Dr. Samuel Hirsch gave a lecture in 1853 on “ The Religion of Humanity ” in which he condemned slavery. “That which we love in ourselves, our true human dignity, compels us to recognize and love the same human dignity in all others,” Hirsh said. He wrote:

If I can look upon my brother-man as a creature, as a thing void of any will of his own, instead of as a free personality, that furnishes ample proof that I have not yet recognized the true human dignity in myself. To own slaves is spiritual suicide and homicide. This sin is in no way excusable on account of the kind treatment accorded to the slaves by their owner, as he never can treat them humanely. When man becomes a piece of property he is robbed of his human dignity.

In 1917, Kansas State Normal School published a journal on teaching that called for instructors to help each pupil “make completer use of his one lifetime” because “an abundant life, a life of awareness, a life of dignity is an undertaking worthy of gods.”

Thomas Bell’s 1941 novel Out of the Furnace centered on an immigrant Slovak family in Pennsylvania. A character muses that it wasn’t “where you were born or how you spelled your name or where your father had come from” that mattered; instead,

It was the way you thought and felt about certain things. About freedom of speech and the equality of men and the importance of having one law—the same law—for rich and poor, for the people you liked and the people you didn’t like. About the right of every man to live his life as he thought best, his right to defend it if anyone tried to change it and his right to change it himself if he decided he liked some other way of living better…. About human dignity, which helped a man live proudly and distinguished his death from animals; and finally, about the value to be put on a human life, one’s enemy’s no less than one’s own.

In a 1953 speech , then Secretary of State John Foster Dulles argued that communist countries might be able to achieve short-term material gain, but “results so produced are not a glory but a shame. They are achieved by desecrating the dignity of the human individual.” Dulles believed human dignity meant being entitled to a life that included physical well-being and “freedom to think, to believe, and to communicate with one’s fellows,” “opportunities which permit some exercise of individual choices,” and “the contemplation and enjoyment of what is beautiful.”

American novelist, writer, playwright, poet, essayist and civil rights activist James Baldwin at his home in Saint-Paul-de-Vence, southern France, on November 6, 1979. Credit: Ralph Gatti/AFP via Getty Images

One hundred years after U.S. law stopped allowing Black Americans to be treated as property, Black writer James Baldwin was still calling for Black Americans’ dignity to be equally recognized. It was not enough, not nearly enough, that the 14th Amendment ensured equal protection of the laws; what mattered was how Black Americans were treated by their fellow human beings. In a 1960 Canadian television interview , Baldwin said, “I don’t know what white people see, you know, when they look at a Negro anymore. But I do know very well—I realized when I was very young—that whatever he was looking at, it wasn’t me… I was not a man .”

In his seminal 1963 book The Fire Next Time , Baldwin seemed to echo Dr. Hirsh’s argument from a century earlier:

I am very much concerned that American Negroes achieve their freedom here in the United States. But I am also concerned for their dignity, for the health of their souls, and must oppose any attempt that Negroes may make to do to others what has been done to them. I think I know—we see it around us every day—the spiritual wasteland to which that road leads. It is so simple a fact and one that is so hard, apparently, to grasp: Whoever debases others debases himself.

This, then, is a common thread in our historic understanding of human dignity: Anyone who treats another human being as less than human undermines their own human dignity in addition to undermining the dignity of their victim.

A 1964 New York University Law Review article argued that privacy was a key aspect of human dignity. “A man whose home may be entered at the will of another, whose conversation may be overheard at the will of another, whose marital and familial intimacies may be overseen at the will of another, is less of a man, has less human dignity, on that account,” wrote author Edward J. Bloustein, who later became president of Rutgers University.

Around the world, people are still working toward the full and equal recognition of human dignity. Every year, new speeches and writings help us understand what dignity is—not only what it looks like when dignity is violated but also what it looks like when dignity is honored. In his posthumous essay, Congressman Lewis wrote, “When historians pick up their pens to write the story of the 21st century, let them say that it was your generation who laid down the heavy burdens of hate at last and that peace finally triumphed over violence, aggression and war.”

The more we talk about human dignity, the better we understand it. And the sooner we can make progress toward a shared vision of peace, freedom, and mutual respect for all.

Berkley Center

Human persons and human dignity: implications for dialogue and action.

By: Thomas Banchoff

August 19, 2013

" Contending Modernities ," August 19, 2013

What is the human person? As human beings, we are biological as well as social creatures; we inhabit both physical and cultural space. What distinguishes us as persons , and not just as organisms, is a culture of human dignity – the shared idea that, as human beings, we are entitled to respect and recognition from one another.

Where does the dignity of the human person come from? Broadly speaking, one can distinguish secular-scientific and religious foundations.

From a secular and scientific angle, we have dignity and should respect and recognize one another because of our common humanity. Some emphasize our shared capacity for independent thought; in line with Immanuel Kant, they see autonomy and rationality as a foundation for human dignity. Others focus more on our ability to identify and sympathize with others, an approach related to Jean-Jacques Rousseau’s concept of “pitié” and Adam Smith’s “moral sentiments.”

Recent advances in evolutionary biology and neuroscience have deepened our understanding of this latter, relational approach to the foundations of human dignity. In the long run, evolution appears to have favored the development of ecological sensitivity, group identification and solidarity, and cooperation in the acquisition and shared use of resources. In the here and now, new developments in neuroscience suggest that our brains are much more than autonomous information processors; they change and grow through our interactions and relationships with others and with our external environments.

Interestingly, scientific methods that do not begin with the concept of human dignity are increasingly leading to a conclusion compatible with it — that we have good evolutionary and biological reasons to acknowledge one another as fellow human beings worthy of respect and recognition and therefore endowed with an intrinsic dignity.

For Catholicism and Islam, the focus of the Contending Modernities project , the dignity of the human person has divine foundations. Because God created each of us and cares for each of us, each individual person has an intrinsic and inviolable dignity. The moral theology of the person is most developed in Christianity; it is connected with the mystery of the Trinity (one God in three persons), and in the Incarnation (God becoming a human being.) But the idea of the person, as a creature of an all powerful and merciful God, also plays an important role in Islam. God reveals his law to humankind and calls us to live as His co-regents on earth, honoring one another with recognition and respect.

There is, of course, a fundamental asymmetry between the secular-scientific and the religious understandings of the human person. The non-believer will reject the idea that the dignity of the human person has divine origins, while the believer will typically assert that human dignity has both divine and natural foundations.

Yet this asymmetry need not be a barrier to dialogue. In our contemporary era, even those who reject the idea of human dignity as fuzzy and unscientific generally affirm the importance of according basic respect and recognition to all human beings. The basic idea of the human person and of universal human dignity is shared, even as terminology differs. The 1948 Universal Declaration of Human Rights, which emerged out of decades of contestation within and across secular and religious traditions – and in revulsion against the horrors of two world wars and the Holocaust – remains the clearest and most powerful expression of this far-reaching consensus.

In practice we know that this broad contemporary convergence around the idea of the human person and human dignity, across the secular-religious divide, coexists with fierce disagreement on a range of ethical and policy questions. Is the human embryo or fetus a human person deserving of protection? Are primates or other non-human animals to be considered persons with intrinsic dignity or rights? Should governments work to secure equality of opportunity for their citizens and provide a minimum standard of living for all? Should governments and citizens share their wealth with those in need outside, as well as inside, a nation’s borders? Questions relating to the human person and human dignity can be multiplied across economic, social, cultural, and foreign policy domains (even if, in the United States, they tend to center on bioethics).

A key challenge in such ethical and policy debates, within and across secular-scientific and religious communities, is to keep the ideas of the human person and of human dignity in the foreground. That means asking what is at stake for particular people and their livelihoods in particular contexts, as well as thinking through the ethical implications of our individual and collective decisions for global humanity, at a time when the rapid advance of technology and of globalization in all its dimensions is rendering those decisions more complex and consequential.

A focus on the human person has a further implication, perhaps the most challenging of all – that in all these ethical and policy controversies, we should acknowledge the humanity and dignity of our interlocutors, no matter how much we may disagree.

This article was originally published on the University of Notre Dame blog " Contending Modernities ."

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The President's Council on Bioethics
Washington, D.C.
March 2008

Part 5: Theories of Human Dignity

The word "dignity" has become something of a slogan in bioethics, often invoked by both sides of debates about a variety of scientific and clinical issues, supporting contradictory conclusions. For instance, in arguments about assisted suicide, those who favor the legalization of the practice base their conclusion on a moral imperative to provide "death with dignity," while those who oppose legalization do so because they see intentionally rendering a human being dead, even out of mercy, as a direct assault on human dignity. Certainly this suggests that dignity is a concept in need of clarification.

Ruth Macklin has noted this lack of conceptual clarity surrounding the use of the word "dignity" in the bioethics literature and has concluded that dignity is a "useless concept," reducible to respect for autonomy, and adds nothing to the conversation. This hasty conclusion, casting aside thousands of years of philosophical writing, ignoring the contemporary bioethical discourse of continental Europeans, and sweeping away a whole body of international law, can be justified only by begging the question. If one defines a word completely in terms of another concept more to one's liking, it will always follow that the word in question adds nothing to the concept one already endorses. While shrouded in rhetoric, this is precisely the structure of Macklin's argument. Premise: dignity means nothing more than respect for autonomy. Conclusion: therefore dignity means nothing more than respect for autonomy and (Corollary) therefore dignity adds nothing to bioethical discourse.

A more careful treatment of the topic is in order. In this essay I will, first, describe three ways the word "dignity" has been used in moral discourse, both in the history of Western thought and in contemporary bioethics. I call these the attributed, the intrinsic, and the inflorescent uses of the word.

Second, I will argue that, while all three senses have moral relevance, the intrinsic sense of dignity is the most fundamental from a moral perspective. I will advance this argument in two ways. I will call the first the Axiological Argument and the second the Argument from Consistency.

Third, I will outline some of the general norms that follow from accepting the moral primacy of the intrinsic sense of human dignity.

Finally, I will show how this vigorous understanding of dignity helps to give shape to arguments in bioethics. As examples, I will show (briefly) how it applies to questions about justice and access to health care resources, the care of the disabled, embryonic stem cell research, cloning, euthanasia, and the care of patients in the so-called permanent vegetative state.

I will conclude that a notion robust enough to supply answers to all of these questions is not useless.

Throughout Western history and in contemporary debates, the word dignity has played a prominent role in ethical discussions. It may be surprising to both religious and non-religious persons to know, however, that dignity is not a word that entered the Western moral vocabulary through the Judeo-Christian heritage. Dignity is not an important word in either the Hebrew or Christian scriptures. For almost two millennia, it was not an important theological term. Until very recently, dignity was almost never invoked by moral theologians in making arguments about abortion, euthanasia, or economic justice.

Neither was dignity an important concept for all Western moral philosophers. For instance, dignity was not an important word for Plato or Aristotle. The first Western philosophers for whom dignity was an important philosophical term were the Roman Stoics. Cicero and Seneca, especially, used the word to designate important concepts in their moral philosophies.

Cicero defined dignity as "the honorable authority of a person, which merits attention and honor and worthy respect" ( ). He used the word dignitas frequently in his writings. As one translator put it, the meaning of dignitas in Cicero's use is literally "worthiness," but he often used it (as did others in his day) to refer to a person's standing, reputation, or even office in the civitas. Importantly, in Cicero's account, this dignitas is not so much dependent on the subjective evaluation of others as it is on the ability of everyone to recognize an instance of true human excellence. For example, in Cicero writes,

In other words, for Cicero, one's standing in the community ought to be based on one's true excellence. For him, to have dignity was to have a merited degree of respect from others because of one's excellence as a human being.

The Stoic use of the term, however, is not the only historical conception of dignity. Hobbes, for instance, defined dignity in a very different way. He eliminated any necessary connection to true human excellence and took the meaning of dignity to depend solely upon the inter-subjective judgments of the market. In the he writes:

Hobbes writes clearly and bluntly. Dignity is the value one has to the Commonwealth regardless of whether one actually merits this based on one's true excellence as a human being or on one's nature as a human being.

Kant never explicitly cites Hobbes, but in presenting yet a third view of dignity, he seems to be writing in direct reaction to Hobbes. The Kantian view of dignity ( ) continues to exert a powerful influence to the present day. Kant wrote,

) is the acknowledgement of the dignity ( ) of another man, i.e., a worth which has no price, no equivalent for which the object of valuation ( ) could be exchanged.

Kant connected dignity with his idea that human beings should never be treated as pure instruments of another's will. In the he writes, ".[T]hat which constitutes the condition under which alone something can be an end in itself has not merely a relative worth, i.e., a price, but has intrinsic worth, i.e., dignity." More simply, he states elsewhere, "Humanity itself is a dignity."

Thus, the Kantian view of dignity is neither based on one's value to others, nor on the esteem they ought to show based on one's degree of human excellence, but rather on one's humanity itself. The Kantian view of dignity is powerful, influential, and substantially different from the notions that preceded it. The Kantian notion of may be one of his greatest contributions to moral philosophy.

These three historical uses of the word "dignity" are illustrative of three senses of the word that are still active in philosophical discourse and in ordinary language today. These three general senses of dignity can be understood according to the following names and descriptions.

By attributed dignity, I mean that worth or value that human beings confer upon others by acts of attribution. The act of conferring this worth or value may be accomplished individually or communally, but it always involves a choice. Attributed dignity is, in a sense, created. It constitutes a conventional form of value. Thus, we attribute worth or value to those we consider to be dignitaries, those we admire, those who carry themselves in a particular way, or those who have certain talents, skills, or powers. We can even attribute worth or value to ourselves using this word. The Hobbesian notion of dignity is attributed.

By intrinsic dignity, I mean that worth or value that people have simply because they are human, not by virtue of any social standing, ability to evoke admiration, or any particular set of talents, skills, or powers. Intrinsic dignity is the value that human beings have simply by virtue of the fact that they are human beings. Thus we say that racism is an offense against human dignity. Used this way, dignity designates a value not conferred or created by human choices, individual or collective, but is prior to human attribution. Kant's notion of dignity is intrinsic.

By inflorescent dignity, I mean the way people use the word to describe the value of a process that is conducive to human excellence or the value of a state of affairs by which an individual expresses human excellence. In other words, inflorescent dignity is used to refer to individuals who are flourishing as human beings-living lives that are consistent with and expressive of the intrinsic dignity of the human. Thus, dignity is sometimes used to refer to a state of virtue-a state of affairs in which a human being habitually acts in ways that expresses the intrinsic value of the human. We say, for instance, that so-and-so faced a particularly trying situation with dignity. This use of the word is not purely attributed, since it depends upon some objective conception of human excellence. Nonetheless, the value to which this use of the word refers is not intrinsic, since it depends upon a prior understanding of the intrinsic value of the human. The Stoic use of the word, while it sometimes borders on an attributed sense, is generally an inflorescent sense of dignity.

These conceptions of human dignity are by no means mutually exclusive. Attributed, intrinsic, and inflorescent conceptions of dignity are often at play in the same situation. Yet each has been taken as the central basis for particular moral claims in bioethics.

Does it matter which of these senses of dignity one invokes in ethical discourse? The short answer would seem to be "yes." At the very least it seems important to keep these senses straight. For example, those who claim that death with dignity requires that euthanasia be permissible seem to be using the word "dignity" in an attributed sense, while those who claim that euthanasia is a direct offense against human dignity appear to be using the word in an intrinsic sense. Still others who oppose euthanasia appear to argue from an inflorescent sense of dignity, suggesting that the practice represents less than the most noble and excellent response a human being can make in the face of death. Merely noticing these distinctions can help us clarify arguments and understand points of disagreement.

But more than this, is there anything that can be said about the relationship between these senses of dignity? Is there an order or moral priority? If there is a conflict between moral claims based on differing senses of dignity, does one count more than the other?

I will argue that the intrinsic notion of dignity is foundational from a moral point of view. I will advance two arguments to support this claim. I call these the Axiological Argument and the Argument from Consistency.

The axiological argument depends on the theory of value or axiology. By understanding what values are, how values get into the world, what sorts of values there are, and how they are related, it will be argued that one can arrive at the conclusion that the intrinsic sense of dignity is the fundamental sense.

Classically, axiology distinguishes between intrinsic and instrumental values. Instrumental values, however, are best characterized as a subclass of attributed values. I have argued that the primary distinction in axiology is between intrinsic values and attributed values.

Intrinsic value is the value something has of itself-the value it has by virtue of its being the kind of thing that it is. It is valuable independent of any valuer's purposes, beliefs, desires, interests, or expectations. Truly intrinsic values, according to environmental ethicist Holmes Rolston III, "are objectively there-discovered, not generated by the valuer."

Attributed values are those conveyed by a valuer. Attributed values depend completely on the purposes, beliefs, desires, interests, or expectations of a valuer or group of valuers. That is why I argue that instrumental values are a class of attributed values. An instrumental value is one that is attributed to some entity because it serves a purpose for a valuer. The instrumental value of the entity consists in its serving as a means by which the valuer achieves some purpose. But there can be non-instrumental attributed values as well. For example, the value of humor may serve no clear instrumental purpose.

Attributed values play important roles in human life. The authority of government, for instance, is attributed. The value of money is attributed. The value of technology is attributed. Importantly, some attributed values are morally flawed, such as attributing value to human skin color or attributing too much value to the opinions of other persons.

Intrinsic values and attributed values are asymmetrically related. Intrinsic values, as intrinsic and objective, must be recognized by an intelligent valuer. Recognition, of course, requires attribution, and thus an intelligent valuer must attribute intrinsic value to whatever does have intrinsic value in order to be correct in his or her evaluation. It would be incorrect for the valuer to attribute no value to what has value intrinsically. This is not to suggest that the act of evaluation confers the value, but that the value must be attributed to whatever has intrinsic value in order for the act of evaluation to be correct. By contrast, the mere fact that value has been attributed to an entity has no logical implications with respect to intrinsic value. One may freely attribute value to things on the basis of individual preferences, social customs, or instrumental needs. One may also recognize (i.e., correctly attribute value to) an entity that has intrinsic value. The bare fact that value has been attributed does not allow us to conclude whether the value at stake is attributed or intrinsic.

I have suggested that there is yet a third category of values, inflorescent values. Certain processes or states of affairs in an intrinsically valuable entity are considered especially valuable. This is the case because these processes or states of affairs either are conducive to or instantiate the flourishing of an intrinsically valuable thing as the kind of thing that it is. The flourishing of a member of a natural kind is a good state of affairs, but that goodness depends upon something about the kind of thing that is flourishing. Thus, the value of that state of affairs is, in a sense, derivative. One might be tempted to say that flourishing is intrinsically good, but the goodness of flourishing is always dependent upon the kind of thing that is said to be flourishing, and thus that state of affairs is not, strictly speaking, intrinsically valuable. Rather, it is the thing that is flourishing that is intrinsically valuable, and its flourishing can only be understood in terms of the intrinsic value of that thing.

On this view, human virtues, such as courage, are not, in a technical sense, intrinsically valuable. We seek virtue not for its own sake, but for the sake of our humanity. For instance, since the virtue of courage is a state of affairs of an individual member of the human natural kind, the value of courage is dependent upon knowledge of what kind of thing a human being is and upon the value of being human. Human virtues are good because they instantiate aspects of the flourishing of the human natural kind in virtuous individuals.

What relationship does this discussion have to dignity? "Intrinsic dignity" is just the name we give to the special type of intrinsic value that belongs to members of natural kinds that have kind-specific capacities for language, rationality, love, free will, moral agency, creativity, aesthetic sensibility, and an ability to grasp the finite and the infinite. The phase "attributed dignities" refers to several non-instrumental values that are attributed to members of any natural kind that has intrinsic dignity. The phrase "inflorescent dignity" refers to a variety of states of affairs in which a member of a natural kind that has intrinsic dignity is flourishing as the kind of thing that it is. By definition, then, intrinsic dignity is the fundamental notion of dignity. One defines attributed and inflorescent dignity in terms of intrinsic dignity.

The next step in the argument is to note that, if there are intrinsic values in the world, the recognition of the intrinsic value of something depends upon one's ability to discern what kind of thing it is. This brings me to the notion of natural kinds, a relatively new concept in analytic philosophy. The fundamental idea behind natural kinds is that to pick something out from the rest of the universe, one must pick it out as a something. This, in turn, leads to what its proponents call a "modest essentialism"-that the essence of something is that by which one picks it out from the rest of reality as anything at all-its being a member of a kind. The alternative seems inconceivable-that reality is actually completely undifferentiated and that human beings merely carve up an amorphous, homogeneous universe for their own purposes. Reality is not homogenous but "lumpy." It comes differentiated into kinds of things. It seems bizarre to suggest that there really are no actual kinds of things in the world independent of human classification-no such things, de re, as stars, slugs, or human beings.

Intrinsic value, to repeat, is the value something has by virtue of its being the kind of thing that it is. Thus, the intrinsic value of a natural entity-the value it has by virtue of being the kind of thing that it is-depends upon one's ability to pick that entity out as a member of a natural kind. Intrinsic dignity, then, is the intrinsic value of entities that are members of a natural kind that is, as a kind, capable of language, rationality, love, free will, moral agency, creativity, aesthetic sensibility, and an ability to grasp the finite and the infinite.

One should note that this definition is decidedly anti-speciesist. If there are other kinds of entities in the universe besides human beings that have, as a kind, these capacities, they would also have intrinsic dignity-whether angels, extra-terrestrials, or (arguably) other known animal kinds.

Importantly, the logic of natural kinds suggests that one picks individuals out as members of the kind not because they express all the necessary and sufficient predicates to be classified as a member of a species, but, rather, by virtue of their inclusion under the extension of a natural kind that, as a kind, has those capacities. The logic of natural kinds is extensional, not intensional. As Wiggins puts it,

For example, very few bananas in the bin in the supermarket express all the necessary and sufficient conditions for being classified as fruits of the species We define a banana as a yellow fruit. Yet some specimens in the bin are yellow, some are green, some are spotted, some are brown, and some are even a bit black. Nonetheless, they are all bananas. They fall under the extension that gathers them around an arbitrary good specimen (or two) of a banana.

Health care depends profoundly upon this logic. It is not the expression of rationality that makes us human, but our belonging to a kind that is capable of rationality that makes us human. When a human being is comatose or mentally ill, we first pick the individual out as a human being, then we note the disparity between the characteristics of the afflicted individual and the paradigmatic features and typical development and history of members of the human natural kind. This is how we come to the judgment that the individual is sick, and make the diagnosis of a disease.

So, if there is such a thing as intrinsic value in the world, then intrinsic dignity is the name we give to the value of all the individual members of any and all kinds that, as kinds, share the properties we think essential to the special value we recognize in the human. Thus, because a sick individual is a member of the human natural kind, we recognize that this individual has the intrinsic value we call dignity. It is in recognition of that worth that we have established the healing professions as our moral response to those of our kind who are suffering from disease and injury. The plight of the sick has little instrumental value, rarely serving the purposes, beliefs, desires, interests, or expectations of any of us as individuals. Rather, it is because of the intrinsic value of the sick that health care professionals serve them. Thus I would argue that intrinsic human dignity is the foundation of health care.

The argument from consistency is an alternative means of reaching the conclusion that intrinsic dignity is the primary moral sense of dignity. The argument is simple in its form. Consistency is at least a necessary condition of a valid moral argument, even if one would quickly add that consistency is not sufficient. In discussions about its fundamental moral meaning, the word "dignity" can be defined as the value or worth that a human being has either: (a) in terms of some property that some entities have and some do not, or (b) in terms of simply being human. But I will show that defining the fundamental moral meaning of dignity as the value certain entities have by virtue of their possession of any particular candidate property leads to gross inconsistencies in our universally shared, settled moral positions if applied to all human beings. Therefore, one is led to the alternative: that dignity, in its fundamental moral sense, is defined in terms of simply being human-i.e., as an intrinsic value. This kind of argument depends on the exhaustiveness of the list of candidate properties and is not decisive. But at least it puts the burden of proof on those who oppose assigning moral priority to the intrinsic sense of dignity to come up with an alternative property (such as age, size, strength, brainwaves, or skin color) to define what gives an entity the fundamental worth or value we call dignity.

First, some have argued that human dignity, in its most fundamental moral sense, depends upon the amount of pleasure and pain in a human life. Hedonism certainly has its adherents, whether egoistic or utilitarian. But even hedonists might not want to promote the pleasure/pain calculus as a theory of human dignity. Certainly, most of us are able to tell stories about the extraordinary lessons in human dignity we have learned from persons whose lives have been racked by pain, and most of us also know undignified human beings who have spent their whole lives in the pursuit of pleasure. Basing morality squarely on a balance between pleasure and pain has seemed, since the time of Aristotle, to be an anemic account of morality and human dignity, and one that most people would reject.

Second, some might think that Hobbes was right-that human dignity depends upon one's market price. But there are problems with such a conception of human dignity. The unemployed, the severely handicapped, the mentally ill, and all others who cannot contribute to the economic well-being of society would then have no dignity. Yet our society has gone to great lengths to recognize the dignity of such persons. If we did not believe that human dignity remains even if people are disabled and lose their economic value to society, then we would not be making access ramps for them. This Hobbesian conception of dignity seems inconsistent with some of our most basic moral and social views.

Third, some might think that human dignity depends upon the active exercise of freedom. Dignity, on this view, is the value we give to entities that actively express a capacity for rational choice. But this view is also hard to sustain consistently. One would have to hold that those who have lost control of certain human functions, or have lost or never had the freedom to make choices, have lost or have never had dignity. This would mean that infants, the retarded, the severely mentally ill, prisoners, the comatose, and perhaps even the sleeping would have no human dignity. This seems obviously wrong.

Now some might suggest that these are "straw man" arguments. What counts, they would aver, is the possibility of exercising control and freedom, not the actual exercise of control and freedom. One might suggest that some individuals without full control and freedom nevertheless deserve to be treated with dignity either because they have a potential for exercising such a capacity (so that children, for instance, come to be regarded as placeholders for actual persons with dignity), or they have a history of having exercised such a capacity (so that the demented, for instance, come to be regarded as remnants of persons with dignity). But these arguments are quite tenuous. Who would feel dignified and secure as a placeholder or a remnant? Further, these arguments still cannot answer why those who never could and never will make free, rational choices (such as the severely mentally retarded) are worthy of being treated in accord with human dignity.

Certain advocates of the position that dignity means the capacity to exercise rational choice (at least above a certain threshold level) do not believe their argument is thus refuted. They fail to see how arguments that would lead to the moral legitimization of practices such as infanticide and experimentation upon permanently unresponsive patients without their consent need to be regarded as refutations of their position. Rather, these philosophers fancy themselves heroes, bravely embracing these stark conclusions as the moral consequences of a new and enlightened form of thinking, finally free from the prejudices that weigh the rest of us down.

To argue against this position, one must move the argument one step logically prior to the argument about dignity. One must investigate the underlying theory of the good that drives some philosophers to cling so tenaciously to the idea that dignity means the active exercise of free choice, that they are willing to become champions of infanticide rather than give up the idea of dignity as freedom. One must ask, are things good merely because we choose them? Although space limitations preclude a fuller discussion, simply put, is it not the case, rather, that we choose what we think is good, aware that we can be mistaken in our choices? The meaning of the human good is not exhausted by the exercise of free choice. It is metaphysically impossible to choose one's biological parents. It is metaphysically impossible to choose to come into existence. It is impossible to choose to be loved by someone. In the instant that the choice is one's own rather the free choice of one's lover, what one receives ceases to be love. And it is impossible to choose not to die. Thus, defining the most fundamental human good as the exercise of free choice results in a moral system that simply cannot account for the great human questions, among them: existence, biological relationship, love, and death. The human good must be far deeper than the freedom to choose. The most fundamental meaning of human dignity is not human freedom and control.

Fourth, and finally, some might think that human dignity is something individuals are free to define as they choose, according to their own inner lights. But this view also leads to major moral inconsistencies. First, the concept of a moral term implies that it has universal meaning, a position acknowledged both by Kant and by utilitarians such as R. M. Hare. Second, to say that human dignity is subjective is to claim that one person can never reliably recognize the dignity of another person, because one can never know exactly what the other thinks dignity means at any given moment. This explains why empirical projects designed to understand dignity by asking each in a collection of individuals to describe "what dignity means to me," while well-intended, are profoundly misguided. Morality seems to depend upon our mutual commitment to knowing that each of us has dignity before we open our mouths and explain our notions of dignity to each other. Human dignity cannot be a purely subjective concept.

Thus, the argument from consistency claims that fundamental human dignity must be something each of us has simply because we are human. It is the notion of dignity that drove the U.S. civil rights movement. It is the notion the Rev. Dr. Martin Luther King, Jr., says he learned from his grandmother, who told him, "Martin, don't let anyone ever tell you that you're not a somebody." No matter what value others may attribute to persons because of properties such as skin color, or how free they are to do as they would like, they have dignity because they are somebodies-human beings. Being somebody, being a human being, is the foundation of the notion of human dignity. The argument from consistency says that, if this is what dignity means in civil rights, this is what dignity must mean in bioethics.

The conclusion that intrinsic dignity is the fundamental sense of dignity has significant moral implications. The notion of intrinsic dignity entails both self-regarding and other-regarding moral duties for beings that have intrinsic dignity. One of the primary features distinguishing the intrinsic value of a natural kind that has intrinsic dignity from other natural kinds is a kind-typical capacity for moral agency. All members of a natural kind that has intrinsic dignity (and are individually capable of exercising the moral agency that is distinctive of their natural kind) have moral obligations to themselves, to any other entities that have intrinsic dignity, and to the rest of what exists. The following list describes some of these duties. Space limitations preclude a full discussion of how these principles follow from this theory of dignity, but many will appear quite plausible on their face. This list is also not meant to exhaust the fundamental principles of ethics. It is limited to those fundamental principles that are most directly connected to the theme of dignity. But these duties should be taken as sufficiently fundamental and general to be considered true principles. All members of a natural kind that has intrinsic dignity and are, as individual members of that natural kind, capable of exercising the moral agency that in part constitutes their intrinsic dignity, have the following duties:

P-II. A duty of perfect obligation to respect the capacities that confer intrinsic dignity upon a natural kind, in themselves and in others.

P-III. A duty to comport themselves in a manner that is consistent with their own intrinsic dignity.

P-IV. A duty to build up, to the extent possible, the inflorescent dignity of members of natural kinds that have intrinsic dignity.

P-V. A duty to be respectful of the intrinsic value of all other natural kinds.

P-VI. A duty of perfect obligation, in carrying out PP-I-V, never to act in such a way as directly to undermine the intrinsic dignity that gives the other duties their binding force.

While the language of these principles might seem unfamiliar to bioethicists, the concepts are quite familiar. The second formulation of Kant's categorical imperative might be considered a corollary of P-I. Together, P-I, P-II, P-III, and P-VI elaborate the meaning of Respect for Persons; P-III sounds as if it comes directly from a Stoic discourse on dignity; P-IV and P-VI are related to Beneficence and Non-Maleficence; P-V is the clarion call of environmental ethics. Justice arises from the need to balance the requirements of PP-I-V.

It is also important to note that the duty to build up the inflorescent dignity of any human being depends logically on the intrinsic dignity of human beings. The primary duty is to recognize and respect that intrinsic dignity. The duty of building up the inflorescent dignity of human beings is a way of concretizing the fundamental duty of respect for intrinsic dignity. If one is to show respect for a dynamic, developing, living natural kind as an intrinsically valuable thing, then it follows that one ought to show that respect by concrete actions that help to establish the conditions by which that thing can flourish as the kind of thing that it is. Thus, one waters a rosemary bush and assures that it has proper sunlight. One feeds a human child and teaches him or her to read.

It is the intrinsic value of the human that grounds our moral duties towards our fellow human beings and gives these duties their special moral valence. It is a minor indiscretion to go on vacation and forget to arrange for someone to water one's rosemary bush. It is an unspeakably immoral evil to neglect to feed or educate one's child. Human beings have a special intrinsic value, and it is this value that commands that we act towards our fellow human beings in a special way. The ground of our duties towards our fellow human beings is not merely that they have interests. Rodents also have interests. As David Velleman has argued, from an ethical point of view, there must be something more fundamental to ethics than interests-i.e., a reason to respect a fellow human being's interests in the first place. The question can be asked, for example, why should I care that this person has lost a degree of independence that I have the capacity to restore through the medical arts? Velleman's answer is that we seek to protect and promote a fellow human being's interests because we first respect the human being whose interests they are. This fundamental respect is for intrinsic dignity-the "interest-independent" value of a human being. Without this primary respect, there is no basis for interpersonal morality.

This conception of dignity has important implications for addressing a variety of issues in bioethics.

Access to health care and the just distribution of health care resources are pressing questions both within individual nations and between the nations that constitute our globalized world community. Human dignity is often invoked in such discussions, but without much clarity or rigor.

Intrinsic dignity, as elaborated in this essay, can be understood as the foundation of all human rights. We respect the rights of an individual because we first recognize his or her intrinsic dignity. We do not bestow dignity because we first bestow rights. Human beings have rights that must be respected because of the value they have by virtue of being the kinds of things that they are.

Intrinsic dignity is at the core of all our beliefs about moral obligation. Of particular relevance to discussions of access to health care resources are principles P-I and P-IV.

Absolute rights (also called negative rights or natural rights) are based on P-I, the duty to respect all members of natural kinds that bear dignity. These include, for example, the rights not to be killed, not to be treated disrespectfully, and not to be experimented upon without one's consent. These rights can and should be respected by all persons and all societies regardless of their ecological, historical, physical, social, or economic circumstances. In Kantian terminology, these rights entail duties of perfect obligation.

I have argued that health care is not an absolute right or a natural right in this sense of the word. To assert a right to health care is to assert a positive right-a right to goods and services that must, of necessity, vary according to the ecological, historical, physical, social, and economic circumstances of individual persons and societies. In Kantian terminology, these rights entail duties of imperfect obligation. They apply to the degree that they can be instituted in various circumstances. Such so-called positive rights are based on P-IV, the duty to build up the inflorescent dignity of individuals belonging to a natural kind that has, as a kind, intrinsic dignity.

Health is critical for the flourishing of any member of any living natural kind. This is no less true for members of the human natural kind. Diseases diminish health. Accordingly, the concept of disease necessarily includes reference to the adverse effects of the condition on the flourishing of the affected individual. As I have defined it elsewhere, "A disease is a class of states of affairs of individual members of a living natural kind X, that: (1) disturbs the internal biological relations (law-like principles) that determine the characteristic development and typical history of members of the kind, X,.(4) and at least some individuals of whom (or which) this class of states of affairs can be predicated are, by virtue of that state, inhibited from flourishing as Xs." Thus, an anatomical variation such as an anomalous branch in the brachial artery going around the median nerve may violate the law-like generalizations and characteristic development of human beings, but such a variation has no adverse effect on the flourishing of any human being and is not a disease. By contrast, a condition such as rheumatoid arthritis inhibits one's ability to walk, to care for oneself, to open a jar, or to hold a spoon. It causes such pain that one may lose the ability to concentrate on other aspects of life. It is a real disease. Rheumatoid arthritis inhibits one who bears the stamp of intrinsic dignity from flourishing as a human being, either directly or by virtue of the fact that health is required for so many other forms of human flourishing-family life, friendship, work, art, politics, scholarship, and more. Respect for an afflicted individual requires, in recognition of this dignity, a concrete response. Medicine is one of the major forms of human response to such affliction, capable at times of restoring the flourishing of the individual, and at other times limiting the degree to which the disease or injury detracts from human flourishing. In terms of concrete medical practice this can mean either cure, or assistance with the activities of daily living, or amelioration of pain or other symptoms if this is possible. The duty to provide such care follows from P-IV. A society that fails to provide for health care has violated P-IV.

Health is also a fundamental condition for attributions of value, either reflexively by an individual, or by the attribution of others. To see this, one need only reflect on the ways in which illness and injury assault the attributed dignity of human beings. Those who are ill are robbed of their stations in life. They lose valued independence. They often become disfigured. They lose their social productivity. They lose esteem in the eyes of others and may even begin to question their own value. If there are any duties to build up the attributed dignities of human beings, surely health care is one of the primary means of doing so.

As argued above, however, the fundamental reason one provides health care is out of respect for intrinsic dignity. And intrinsic dignity inheres in the human with a radical equality. In its intrinsic sense, dignity is inalienable and does not admit of degrees. Thus, a duty to build up the inflorescent dignity of human beings through health care, founded upon respect for intrinsic human dignity, applies equally to all. So, while there might not be a natural right to health care, a just society has a moral obligation, founded upon human dignity, to provide equal access to health care, to the extent possible in its particular ecological, historical, physical, social, and economic circumstances.

Thus the conception of dignity presented here provides a normative basis for determining what it means for a society to distribute health care resources justly. This would seem to make dignity a useful concept.

As I discussed earlier, understanding the three senses of dignity presented in this essay helps to explain three very different ways the word has been invoked in debates about euthanasia and physician-assisted suicide. This, in itself, seems a significant contribution to bioethics. Proponents of euthanasia and assisted suicide argue that the practice ought to be permitted because the assaults that illness and injury mount upon the attributed dignities of human beings can be so overwhelming that some patients might be led to attribute no more worth or value to themselves, thus making euthanasia a reasonable option. Opponents of euthanasia make two dignity-based arguments: one based on an inflorescent sense of dignity and the other based on an intrinsic sense of dignity. Neither argument denies the assault that illness and injury can mount against the attributed dignity of a human being. The argument from inflorescent dignity suggests, however, that the value of the human is expressed most fully (i.e., flourishes) in the ability to stand up to such assaults with courage, humble acceptance of the finitude of the human, nobility, and even love. To kill oneself in the face of death or to ask to be killed, on this view, is precisely the opposite of what it means to face death with dignity.

The argument from intrinsic dignity suggests that the fundamental basis for the duty to build up the inflorescent dignity of sick human beings-the root of any motivation to attribute dignity to them-is the intrinsic value of the human, the value human beings have by virtue of being the kinds of things that they are. As argued above, no circumstances can eliminate that intrinsic dignity. As Duty P-VI states, there is a duty of perfect obligation, in carrying out PP-I-V, never to act in such a way as directly to undermine the intrinsic dignity that gives the other duties their binding force. Thus, while one might, out of human sympathy, suggest that a duty to build up attributed dignity legitimizes euthanasia, the conception of dignity presented in this essay would argue that this cannot be permitted because it undermines the fundamental basis of morality itself-respect for intrinsic dignity.

A conception of dignity with the explanatory power to understand the basis for arguments on both sides of the debate about euthanasia as well as the normative power to settle that argument in favor of prohibiting the practice seems much more than a "useless" concept.

The proper treatment of persons with disabilities has become a matter of great controversy in bioethics, with significant implications for our society. A famous philosopher has even argued with a disability rights activist about these issues in the pages of the Could the conception of dignity presented here illuminate these debates?

First, it is clear that disability does not transform a human being into another natural kind. One classifies a person as disabled because one has first picked that individual out as a member of the human natural kind, noting the kind-typical features that the individual does not express. The disabled therefore have intrinsic dignity. Respect for intrinsic dignity would dictate, as argued above, that one recognize the radically equal intrinsic dignity of a severely mentally retarded adult and of a philosophy professor at an Ivy League university. No matter how severe the disability, there are no gradations in intrinsic dignity. It is the value one has by virtue of being the kind of thing that one is-a member of the human natural kind.

Second, respect for intrinsic dignity would prohibit, as described above, euthanizing disabled human beings of any age on the basis of their disability. As discussed, in violation of P-VI, this practice would undermine the most fundamental basis of any human morality.

Third, as discussed above, the duty to build up the inflorescent dignity of human beings-a duty based on respect for intrinsic dignity-carries with it a notion of the radical equality of the intrinsic dignity of all human beings. Just as skin color, income, education, and social worth ought not be the basis for differential access to health care, likewise disability ought not be invoked as a basis for justifying unequal access to health care.

Yet, as a duty of imperfect obligation based on P-IV, the duty to provide health care to the disabled will have limits even in the wealthiest society. A disabled person cannot be euthanized, but there will be limits to how far one goes in sustaining the life of a disabled person, just as there will be limits to how far one must go in sustaining the life of any person. These limits include the physical, psychological, social, spiritual, and economic resources of the individual in his or her particular circumstances as well as the limits of a society's resources. It is critically important to add, however, that any criterion for deciding upon limits must not be based on the disability in itself, since this would constitute a judgment regarding the worth of the person and violate the principle of equal respect for intrinsic dignity. Rather, such judgments must be based on the same criteria one would use for deciding on the limits of care for any individual, whether disabled or not. That is, based on the inefficacy of the intervention, on absolute scarcity, or on the individual's own judgments about burdens and benefits. Limits based on judgments of social worth, whether made by physicians or third parties, are inconsistent with the meaning of respect for intrinsic dignity.

Thus, the conception of dignity presented here is in full harmony with the traditional distinction between killing and allowing to die, converging on that distinction by noting differences in the types of dignity and the moral duties associated with each. The conception of dignity presented here provides a strong basis for preventing discrimination against the disabled and for supporting claims of equality of access to health care for the disabled. Such a conception of dignity would appear quite useful to bioethics.

A currently vexatious issue facing biomedical science is the morality of using human embryonic stem cells for research. Arguments opposing this practice on the basis of respect for human dignity have been vigorously attacked in the bioethics literature as vacuous. Does the conception of human dignity presented in this essay shed any light on these arguments?

If there is such a thing as intrinsic value, then, as I have argued, it is the value something has by virtue of its being the kind of thing that it is. Intrinsic value inheres in natural kinds, since artifacts have only attributed, and not intrinsic, value. I defined intrinsic dignity as the intrinsic value of natural kinds that have, as natural kinds, the capacity for language, rationality, love, free will, moral agency, creativity, aesthetic sensibility, and an ability to grasp the finite and the infinite. These are characteristic features of the human natural kind. Thus, the human natural kind (at least) has intrinsic dignity.

As I have argued, this value is not based on the active expression by an individual of any one (or even several) of the particular characteristics that confer intrinsic dignity on the natural kind as a whole. I made this argument in two ways. First, I explained that the extensional logic of natural kinds dictates that one first pick out an individual as a member of a kind by including it under the extension provided by one or two representative samples of the kind, backed by a full understanding of the typical history, the development, and the law-like generalizations that characterize members of that kind. The very notion of natural kinds entails acceptance of this "modest" essentialism. The presence or absence of no single specifiable characteristic or set of characteristics is sufficient to determine this "essence," in all of its modesty. Second, I showed that each of the candidate characteristics one might suggest, by intensional logic, as the dignity-conferring characteristic, leads to gross inconsistencies when applied universally, clashing with our most deeply held moral views. One is therefore led, by a process of elimination, to accept that dignity is the worth all human beings have simply by being human.

On the basis of all that I have explained about dignity thus far, it follows that if a human embryo is a member of the human natural kind, then it has all the intrinsic dignity of the human natural kind. And if that is true, then it cannot be killed, even to do good for others, without violating the fundamental moral duties that flow from recognizing intrinsic dignity. Thus, the fundamental question with respect to whether a human embryo has intrinsic dignity is whether that embryo is an individual member of the human natural kind.

What else is a human embryo, however, but an individual member of the human natural kind at the earliest stages of its development? This is what a human embryo is, biologically and ontologically. It is not a different kind of thing (say a slug or a porpoise). It is what every human being is (or was) at 0-28 days of development.

Judith Thompson has argued that "a fetus is no more a human being than an acorn is an oak tree." Thompson is precisely correct in her analogy, but precisely wrong in the biological, ontological, and moral conclusions she draws from it. Despite her rhetorical fervor, Thompson has it backwards. A fetus (or an embryo) is a member of the human natural kind at the earliest stages of development, just as an acorn is a member of the oak tree natural kind at the earliest stages of its development. Every human being's history can be traced back, as a continuous existent, to its own embryonic stage. Every oak tree's history can be traced back, as a continuous existent, to its own acorn stage. In fact, the continuity is clearer in the case of human development. The concept of natural kinds has been introduced into philosophy to do just this: to account for the continuity and change of individuals over time. "Embryo" and "acorn" are not terms used to sort different natural kinds. Rather, these words are used to distinguish phases within the development of two distinct biological natural kinds. "Embryo" is a phase-sortal term for animals and "acorn" is a phase-sortal term for oaks. If intrinsic value inheres in individuals as members of kinds, then it inheres in them throughout their natural histories as members of that kind undergoing the development that typifies the kind. Thus the intrinsic dignity of the human inheres in embryonic members of the human natural kind every bit as much as it does in adult members of the human natural kind.

Space limitations preclude a full discussion of long-standing arguments about the distinction between persons and members of the human natural kind. Suffice it to say that "person" is not a phasesortal, like "fetus" or "adolescent." Even if "person" were a phasesortal, one could not make personhood the basis for intrinsic dignity without completely subverting the notion of intrinsic value, which must, by definition, inhere in each individual by virtue of its being the kind of thing it is, and not by virtue of the phase it is in during its development as a member of that kind.

Some have argued that the fact that an early human embryo can split into two, forming twins, means that there is no individual until after 14 days of development, so that any developing entity younger than 14 days is not an individual human being and therefore has no dignity. As Germain Grisez and Robert P. George have pointed out, however, this argument is totally specious. The fact that one amoeba can split into two amoebas is not an argument that what was there before the split was not an amoeba. It is among the law-like generalizations and is typical of the natural history and features of individual members of the human natural kind that they can split before 14 days of development and form identical twins. This is hardly an argument that human embryos younger than 14 days are not individual members of the human natural kind in whom intrinsic dignity inheres.

Finally, some have argued that the fact that some human zygotes will develop into tumors known as hydatidiform moles means that one need not regard the developing entity as human, since it could be a mole. For simplicity's sake I will consider only the case of a complete hydatidiform mole. It is uncertain whether this "mole" objection is intended as an ontological argument or an epistemological argument. Interpreted as an ontological argument, it is tainted with genetic reductionism, presuming (falsely) that whatever has a 46 XX or XY set of chromosomes is a human being. But a hydatidiform mole is neither a human being nor a human embryo. A mole is not even an organism. Its chromosomes are only of paternal origin, and these are abnormally imprinted, even if the DNA sequence is totally human. No actual embryo ever develops, only abnormal trophoblastic tissue. From its origin, a mole is a different kind of thing, even though it has human genes. As a different kind of thing, a mole does not have intrinsic dignity. Therefore, the possibility of mole formation is not an argument that a human embryo in the Petri dish does not have intrinsic dignity. If what is in the dish is a human embryo, then it has intrinsic dignity. If what is in the dish is a mole, then it does not.

Interpreted as an epistemological argument, however, this line of reasoning suggests that, because one might not be able to determine until later in development whether what is growing in the uterus or the Petri dish is a mole, one therefore cannot speak meaningfully of the intrinsic dignity of a five-day old blastocyst. It is true that, given current technology, there is no good way to tell an embryo from a mole at 5 days of developmental age. by contrast, it has been demonstrated that even at the 2-cell stage one can detect characteristic abnormalities in hydatidiform moles. However, prescinding from the question of whether one has epistemic access to the true (if modest) essence of the thing undergoing development, as a practical matter this possibility does not seem morally decisive. Moles are rare. If there is a 99.9% chance that what I see stirring in the woods is a fellow hunter, and a 0.1% chance that it might be a deer, prudence suggests not shooting. And any epistemic doubts I might have about what stirs-in the woods, the womb, or the Petri dish-do not suffice to change the ontological status of the thing that stirs. There is a correct answer to the question, is this a mole or an embryo? If what is in the dish is an individual member of the human natural kind in the embryonic stage of development, then it has intrinsic dignity. My uncertainty does not change the kind of thing that it is, nor does my uncertainty change its intrinsic value.

A theory of dignity that can provide such explanations and guidance in moral decision-making about the treatment of human embryos would not seem useless.

All of the arguments I raised above about why it is a violation of intrinsic human dignity to destroy already existing human embryos for research purposes apply to creating human embryos expressly in order to destroy them for research purposes. However, a different set of considerations arises in examining the morality of cloning to bring babies to birth.

Curiously, cloning to bring babies to birth has met with widespread opposition by persons of many different philosophical and theological orientations. Most subscribe to the notion that this practice would deeply offend human dignity. There has yet to be, however, an entirely compelling explanation of exactly why this might be so. Does the conception of dignity offered in this essay shed any light on this bioethical issue?

The intuitions of many observers may be captured by attempting to understand how the difference between an artifact and a natural kind is related to the conception of dignity that I have presented. Artifacts have no intrinsic value. The value of an artifact is purely attributed-conferred on the artifact by its artificer. Typically, this attributed value is instrumental. I make a knife in order to cut things because cutting them is useful to me. I manufacture a mobile telephone because telephones have an instrumental value to me that is enhanced by making that instrumental value portable. The very notion of the intrinsic value of biological entities, as I have discussed, entails the notion of natural kinds-the value things have by virtue of being the kinds of things that they are. Intrinsic dignity is the name we give to the intrinsic value of members of the human natural kind. This value is discovered, not made. It is decidedly non-instrumental.

The introduction of various reproductive technologies into clinical medicine has worried many observers for many years, but few have articulated these worries carefully. The possibility of cloning for reproductive purposes seems to have led many observers to agree that these long-standing worries have had genuine moral substance. The President's Council on Bioethics has expressed this unease as the difference between begetting and manufacture. A child born of the normal course of affairs is begotten. A child brought to birth after having been cloned seems manufactured. The conception of dignity expressed in this essay perhaps gives a more fundamental basis for explaining the worry captured by the pithy distinction between begetting and manufacture. Cloning blurs the line between the value one discovers in the human as a natural kind (i.e., intrinsic dignity) and the value that is merely conferred upon artifacts by human attribution.

In one very serious sense, a human clone would be an artifact. As such, it would have value only to the extent that value would be conferred upon it by its artificers. If the clone were created and then destroyed for research purposes, perhaps one could convince oneself that what one had destroyed was not a member of the human natural kind and therefore had no dignity. But if that clone were brought to birth, one could not avoid confronting the artifact vs. natural kind question. The scientist would stare the clone in the eye and say, "I have created you." The value of the clone would be artifactual, not already given, commanding recognition and respect. An artifact's value is purely instrumental and attributed. Thus, the very notion of intrinsic human dignity would be radically threatened. And with it, our whole system of morality, founded upon respect for intrinsic dignity, would be threatened.

In another sense, of course, a cloned human being brought to birth would have intrinsic dignity. While born out of the natural course, perhaps suffering from genetic disorders associated with that manner of coming into being, the clone would still be a member of the human natural kind. Clones are not created from scratch-from a soup of nucleotides and DNA polymerase. Somatic cell nuclear transfer depends on the pre-existence of members of the human natural kind from which the clones would be derived. A human clone brought to birth would be picked out as falling under the extension of the human natural kind. While quite likely to be genetically defective, such an individual would still have a developmental history traceable back to a human embryo. Such an individual would still obey most of the law-like generalizations that characterize the human natural kind. Thus, such an individual would be a member of the human natural kind and would still have intrinsic dignity.

Given the way in which the individual came into being, however, the real and acute worry would be that this individual's intrinsic dignity would be open to question, because the individual might be considered an artifact and not a member of a natural kind, and might therefore be considered to have only attributed and not intrinsic value. And when the intrinsic value (the intrinsic dignity) of any member of the human natural kind is threatened, the moral system that characterizes us as a kind is threatened.

A theory of dignity that explains the common intuition that the bringing to birth of a cloned human being would be a transgression against dignity is a robust theory of dignity. This suggests that the concept of dignity is not irrelevant to bioethics but, rather, extremely important.

The proper care of persons suffering from the Permanent Vegetative State and related neurological conditions has become a highly contentious bioethical topic in the Western world. Even the name of the condition has become a matter of controversy. Although a good biologist or philosopher who has studied Aristotle knows that the term "vegetative" is purely descriptive and not pejorative, many persons, sadly, have abused the term and have called patients who suffer from the condition "vegetables." Because of this, the Australian term, "post-coma unresponsiveness" may be the most descriptive name one can use for this condition and may also be the least liable to misinterpretation. Accordingly, "post-coma unresponsiveness" is the term I will use to describe the condition of persons who initially become comatose after anoxic or traumatic brain injury, but gradually develop into a state in which they are able to open their eyes, have intact brain stem functions and are able to breathe and exhibit sleep-wake cycles, but never recover signs of cognitive awareness or conscious interaction with their environments.

One line of argument in bioethics suggests that such individuals have lost all dignity and therefore should either be euthanized, experimented on, or denied access to life-prolonging therapies. The conception of dignity presented in this essay provides a basis for understanding that this line of argument cannot be sustained. That is because such arguments are based solely on an attributed sense of dignity.

Human beings suffering from post-coma unresponsiveness (PCU) have not undergone an ontological change. Such patients have not become some other kind of thing. We pick them out as members of the human natural kind as a precondition for our judgment that they are severely ill. Even an argument, for example, for euthanizing such patients, based on their profound loss of attributed dignity, presumes, as I have argued, that they are members of the human natural kind and still have intrinsic dignity. All duties to build up or to create conditions conducive to a patient's possibilities for inflorescent dignity depend upon respect for intrinsic dignity. Likewise, any perceived duty to build up diminished attributed dignity also depends upon respect for intrinsic dignity. Respect begins with recognition, and recognition does require an act of attribution, yet this attribution does not create the value. Rather, recognition is best described as an act of attributing correctly, an acknowledgement of the intrinsic dignity of the patient that cannot be eliminated even should it go unrecognized. The dignity here acknowledged is an objective value that presents itself as worthy of respect. Before we can attribute any additional values to human beings, whether sick or well, and call those values "dignities," we must first recognize and respect them as bearers of intrinsic dignity. Those suffering from PCU may represent a limiting case. They have severely diminished attributed dignity, and extremely limited possibilities for inflorescent dignity. Yet it is only by virtue of having first picked them out as members of the human natural kind and having recognized their intrinsic value that we concerned about either their attributed or their inflorescent value. Those who strive to build up the attributed dignity of patients suffering from PCU have already conceded that there is such a thing as intrinsic dignity by the very fact that they show concern for these patients. While extraordinarily impaired, these individuals still have intrinsic dignity by virtue of being the kinds of things that they are- members of the human natural kind. Therefore, according to the moral duties that follow from a fundamental duty to respect intrinsic dignity, someone suffering from PCU cannot be euthanized or experimented upon without consent (P-VI).

Such individuals have an intrinsic dignity that also demands equality of treatment. Accordingly, such individuals cannot be denied access to care that other ill human beings would be afforded merely on the basis of their medical conditions. Treatment might be refused, but treatment must be offered. Comfort, care, and respect must never be abandoned. As discussed above, this duty to provide care is limited by the individual's physical, psychological, social, spiritual, and economic resources in his or her particular circumstances as well as the availability of a given society's resources. The diagnosis of PCU itself, however, must never be the basis for unilaterally withholding or withdrawing care that would be rendered to others.

It is undeniably true that such individuals are extremely restricted in their ability to flourish as the kinds of things that they are. They are incapable of expressing courage, or honor, or even understanding their predicaments. Thus, their capacities for inflorescent dignity are profoundly restricted. No one wishes to be in such a state. Therefore, respect for equal intrinsic dignity also ought to assure such persons the same rights as others to withhold or withdraw life-sustaining treatments that are futile, or more burdensome than beneficial.

The conception of dignity presented in this essay thus also has concrete implications for understanding how to care for individuals suffering from post-coma unresponsiveness. This gives further evidence of the critical importance of a serious consideration of dignity in debates about pressing issues in bioethics.

In this essay, I outlined three ways the word "dignity" has been understood in the history of Western thought and explained how these three senses of dignity-the attributed, the intrinsic, and the inflorescent-are still at play in contemporary bioethical debates. I offered two arguments about why the intrinsic sense of dignity is the most foundational-the Axiological Argument and the Argument from Consistency. In so doing, I stressed the importance of the conception of natural kinds to all three senses of dignity. I then outlined several general moral norms that specify what it means to respect dignity. Finally, I applied this theory of dignity and its associated moral norms to a variety of pressing ethical questions in contemporary bioethics, showing how this conception of dignity is extraordinarily powerful in helping us to understand how we ought to proceed in answering these questions. Space has precluded a fuller explication of this theory or a full consideration of counter-arguments. However, it seems clear that if this is what dignity means, then dignity is anything but a useless concept.

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i. There is a third logical possibility that I will not discuss, although some nihilists accept it-namely, that human beings have no dignity.

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1. Daniel P. Sulmasy, "Death, Dignity, and the Theory of Value," 9 (2002): 103-118, reprinted in , ed. Paul Schotsmans and Tom Meulenbergs (Leuven, Belgium: Peeters,
2005), pp. 95-119.

2. Ruth Macklin, "Dignity is a Useless Concept," 327 (2003): 1419-1420.

3. Charles Trinkaus, "The Renaissance Idea of the Dignity of Man," in , vol. 4, ed. Philip P. Weiner (New York: Charles Scribner's Sons, 1973), pp. 136-147; Daniel P. Sulmasy, "Death with Dignity: What Does it Mean?" 4 (1997): 13-24.

4. Cicero, I.166.

5. Miriam T. Griffin and E. Margaret Atkins, "Notes on Translation," in (New York: Cambridge University Press, 1991), pp. xlvi-xlvii.

6. Cicero, I.106, trans. Walter Miller (New York: Macmillan, 1913), pp. 106-109.

7. Thomas Hobbes, , chapter 10, ed. Richard Tuck (Cambridge: Cambridge University Press, 1991), pp. 63-64.

8. Immanuel Kant, "The Metaphysics of Morals, Part II: The Metaphysical Principles of Virtue," Ak419-420, in Kant, , trans. James W. Ellington (Indianapolis, Indiana: Hackett, 1983), pp. 80-81.

9. Immanuel Kant, , Ak 434, trans. James W. Ellington (Indianapolis, Indiana: Hackett, 1981), p. 40.

10. Ibid.

11. Thomas E. Hill, Jr., (Ithaca, New York: Cornell University Press, 1992), p. 43.

12. In my essay, "Dignity and the Human as a Natural Kind," included in , ed. Carol R. Taylor and Roberto Dell'Oro (Washington, D.C.: Georgetown University Press, 2006), pp. 71-87, I called this the "derivative" sense of dignity. However, some commentators, especially those who would be counted as using the word this way, have worried that "derivative" sounds less"dignified" than is appropriate.

13. Timothy E. Quill, "Death and Dignity: A Case of Individualized Decision Making," 324 (1991): 691-694.

14. Dónal P. O'Mathúna, "Human Dignity in the Nazi era: Implications for Contemporary Bioethics," 7 (2006): E2.

15. Leon R. Kass, (San Francisco, California: Encounter Books, 2002), pp. 231-256.

16. See Noah M. Lemos, "Value Theory," in , ed. Robert Audi (New York: Cambridge University Press, 1995), pp. 830-831; also Michael J. Zimmerman, "Intrinsic vs. Extrinsic Value," (2004 edition), ed. Edward N. Zalta, available online at http:// plato.stanford.edu/entries/value-intrinsic-extrinsic/. The standard views either distinguish intrinsic from instrumental values, or intrinsic from extrinsic values. The theory of intrinsic value outlined in this essay, however, following Holmes Rolston III, (Philadelphia: Temple University Press, 1988), aligns with the views of Kant, Brentano, Broad, Ross, and others, that whatever is intrinsically good is worthy of being valued in itself.

17. See Sulmasy, "Death, Dignity, and the Theory of Value."

18. Rolston, , p. 116.

19. Credit for initiation of the discussion of natural kinds is usually given to Saul Kripke, in his two essays, "Identity and Necessity," in ed. Milton K. Munitz (New York: New York University Press, 1971), pp. 135-164,
and "Naming and Necessity," in , ed. Gilbert Harman and Donald Davidson (Dordrecht, Netherlands: Reidel, 1972), pp. 253-355. For a good contemporary approach to the concept of natural kinds, see David Wiggins, (Cambridge, Massachusetts: Harvard University Press, 1980), pp. 77-101, and his (Cambridge: Cambridge University Press, 2001).

20. Wiggins, , p. 169.

21. Tom L. Beauchamp, (New York: McGraw-Hill, 1982), pp. 5-21.

22. Aristotle, 1095b, trans. Terence Irwin (Indianapolis, Indiana: Hackett, 1985), p. 7.

23. H. Tristram Englehardt, Jr., (New York: Oxford University Press, 1986), p. 213.

24. Michael Tooley, (Oxford: Oxford University Press, 1983).

25. Raymond G. Frey, "Pain, Vivisection, and the Value of Life," 31 (2005): 202-204.

26. Kant, , Ak 421, p. 30.

27. Richard M. Hare, (New York: Oxford University Press, 1981), pp. 107-116.

28. Thomas F. Hack, et al., "Defining Dignity in Terminally Ill Cancer Patients: A Factor-analytic Approach," 13 (2004): 700-708.

29. Garth Baker-Fletcher, , Harvard Dissertations in Divinity, No. 31 (Minneapolis, Minnesota: For tress Press, 1993), p. 23.

30. J. David Velleman, "A Right to Self-Termination?" 109 (1999): 605-628.

31. Daniel P. Sulmasy, "Dignity, Rights, Health Care, and Human Flourishing," in , ed. G. Diaz Pintos and David N. Weisstub (Dordrecht, Netherlands: Springer, in press 2007).

32. Daniel P. Sulmasy, "Diseases and Natural Kinds," 26 (2005): 487-513.

33. Harriet McBryde Johnson, "Unspeakable Conversations," , February 16, 2003, p. 50. The philosopher was Peter Singer.

34. Judith Jarvis Thompson, "A Defense of Abortion," 1 (1971): 47-66.

35. Robert P. George and Patrick Lee, "Acorns and Embryos," 7 (Fall 2004/Winter 2005): 90-100.

36. Alfonso Gómez-Lobo, "Does Respect for Embryos Entail Respect for Gametes?" 25 (2004): 199-208.

37. Germain G. Grisez, "When Do People Begin?" 63 (1990): 27-47.

38. Robert P. George, "Human Cloning and Embryo Research," 25 (2004): 3-20.

39. Carlos A. Bedate and Robert C. Cefalo, "The Zygote: To Be or Not Be a Peron," 14 (1989): 641-645; Thomas J. Bole, III,"Metaphysical Accounts of the Zygote as a Person and the Veto Power of Facts," 14 (1989): 647-653.

40. Nicanor Austriaco, O.P., "Are Teratomas Embryos or Non-embryos?" 5 (2005): 697-706.

41. The President's Council on Bioethics, (Washington, D.C.: Government Printing Office, 2002), pp. 104-107.

42. National Health and Medical Research Council of Australia, "Post-Coma Unresponsiveness (Vegetative State): A Clinical Framework for Diagnosis," December 18, 2003, available online at http://www.nhmrc.gov.au/publications/synopses/_files/hpr23.pdf.

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5 Understanding Human Dignity in Human Rights

Published: November 2018
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This chapter offers an interpretation of the idea of human dignity that explains how it can play certain valuable roles in human rights discourse. The idea contributes to the articulation of a distinctive set of norms that are universalist and humanist, the justification of specific human rights, the grounding of the great normative force of these rights, the combined generation of both negative and positive duties correlative to them, the explanation of the significance of political struggles against their violation, and the illumination of the arc of humanist justice running from basic requirements mandating people’s access to a decent life to maximal requirements to support people’s access to a flourishing life. The idea of human dignity is articulated through a conceptual network that includes an organic set of more specific ideas. These ideas include status-dignity, condition-dignity, dignitarian norms, the basis of dignity, the circumstances of dignity, and dignitarian virtue.

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> Human Dignity
> The role of human dignity as a constitutional value

Book contents

Frontmatter
Acknowledgements
Table of Cases
Part I Fundamental concepts and sources
Part II Human dignity as a constitutional value
5 Purposive constitutional interpretation
6 The role of human dignity as a constitutional value
7 Three types of model for determining the content of the constitutional value of human dignity
Part III Human dignity as a constitutional right
Part IV Human dignity in comparative law
Bibliography

6 - The role of human dignity as a constitutional value

Published online by Cambridge University Press: 05 February 2015

Three roles of human dignity as a constitutional value

The constitutional value of human dignity has a central normative role. Human dignity as a constitutional value is the factor that unites the human rights into one whole. It ensures the normative unity of human rights. This normative unity is expressed in the three ways: first, the value of human dignity serves as a normative basis for constitutional rights set out in the constitution; second, it serves as an interpretative principle for determining the scope of constitutional rights, including the right to human dignity; third, the value of human dignity has an important role in determining the proportionality of a statute limiting a constitutional right. I shall briefly discuss each of these three roles.

Human dignity as a constitutional value that lays a foundation for all of the rights

The first role of human dignity as a constitutional value is expressed in the approach that it comprises the foundation for all of the constitutional rights. Human dignity is the central argument for the existence of human rights. It is the rationale for them all. It is the justification for the existence of rights. According to Christoph Enders, it is the constitutional value that determines that every person has the right to have rights. This does not mean that human dignity is the basic norm ( Grundnorm ) of the legal system. An important and fundamental constitutional value is one thing; a basic norm is quite another. The basic norm determines the binding nature of the constitution. This is unrelated to human dignity. Furthermore, it should not be automatically concluded that human dignity is the most important value that serves as a key to the solution of all difficult constitutional questions. Human dignity requires study and clarification, and each legal system must ultimately define its own position on this constitutional value.

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The role of human dignity as a constitutional value
Aharon Barak
Book: Human Dignity
Online publication: 05 February 2015
Chapter DOI: https://doi.org/10.1017/CBO9781316106327.009

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Human Dignity and Human Rights: Fostering and Protecting Pluralism and Particularity

Human rights and their universality can lead to restrictions for individuals resulting from duties, which correspond to human rights of all human beings. This characteristic of human rights emphasizes the need for an ethical justification. Addressing the question of how human rights can be justified represents, therefore, an expression of respect for pluralism and particularity. Beyond that, human dignity and human rights lay the foundation for pluralism and particularity as they see all human beings as individuals that are all different and unique, and not as members of a collective. Only human rights protection of the autonomy of each individual allows all human beings to be particular and fosters pluralism. Finally, the concept of “adaptation” contributes to an understanding of the interaction between pluralism and particularity and human dignity and human rights as their foundation by capturing the relationship between human dignity and human rights and religious and worldview-based communities.

1 Respecting Pluralism and Particularity by Justifying Human Dignity and Human Rights

“All human beings are born free and equal in dignity and rights. They are endowed with reason and conscience and should act towards one another in a spirit of brotherhood.” Article 1 of the Universal Declaration of Human Rights of 1948 expresses one of the eight essential characteristics of human rights: their universality. 1 Human rights are universal because all human beings are holders of human rights – always, everywhere and without exception. The phrase “everybody matters” 2 shows that human rights give the necessary protection to all human beings in all essential spheres and elements enabling the survival and the life as a human being.

The universality of human rights underpins the need for an ethical justification of human rights 3 , because human beings demand reasons for why human rights are also applicable to them. They ask for a justification for human rights and their corresponding duties, which might restrict them somehow.

The justifications are therefore pendent between the rights holder and the bearer of duties resulting from these rights. Both sides will only be able to accept a justification if this relation will be maintained and a justification will only seem adequate if it is applied to all persons concerned and will therefore be universal. 4

2 The Justification for Human Dignity and Human Rights Based on the Principle of Vulnerability

The question of how the four statements above can be justified, can be answered with the justification approach based on the principle of vulnerability. The term “vulnerability” 5 encompasses the possibility to be attacked or violated and, at the same time, a lack of ability or means to free oneself from this situation and to protect oneself from violations. 6 The vulnerability originates in the physical and psychological helplessness of human beings towards themselves, fellow human beings, their context and their environment 7 , and their dependence on the world. Human beings are dependent on themselves, other human beings, the context and the environment in so far as they can, on the one hand, be violated by them and, on the other hand, be protected by them from violation. 8 This shows a significant difference between the understanding of vulnerability and the term humiliation used by Avishai Margalit. He only traces humiliation back to human acts or omissions and not to the natural environment. 9 Here, however, environment (understood as human and natural environment) is also meant in its second meaning, namely as a source of vulnerability for human beings, because it can touch upon essential elements and spheres of human existence, and because human beings have various options to deal with it and react to it. For example, human beings that fell victims to a natural disaster should not simply be left to their own devices, but should be supported.

This justification approach for human rights based on the principle of vulnerability contains a first, second, and third step in filtering, which will lead to the emergence of an ethical justification for human rights in general and for specific human rights.

2.1 First Step of Filtering

The justification approach based on the principle of vulnerability starts from the observation that human beings will recognize their own vulnerability – a first element of the principle of vulnerability. 10 For example, the person who is healthy today knows that he or she might become ill tomorrow. Or – while living happily in the present – that he or she could be killed by others tomorrow. In this thought process, the person will go through a process of uncertainty, because he or she is made aware of his or her own vulnerability and, in the last consequence, his or her transience. 11 This possibility of self-awareness is true for all human beings.

Second, an essential part of the principle of vulnerability is the “first-person perspective”. 12 The awareness-building of one’s own vulnerability is a self-recognition process of human beings, the empirical correctness of which is not relevant. It is crucial that human beings are willing to do something about this awareness of their vulnerability, namely, to protect themselves from vulnerability or to find a reasonable way to deal with it. This also affects all human beings.

During this awareness-building process when a human being becomes aware of his or her own vulnerability, he or she recognizes, ex negativo , the first-person perspective . This encompasses the awareness of the human being that he or she as a singular person is a subject of self-awareness through which one can access one’s own vulnerability. On the other hand, the person experiences this basic anthropological situation of vulnerability as a subject (meaning as the first person singular). The acts, decisions, sufferings and the life of a human being originate from a person as subject. Furthermore, he or she interprets this basic anthropological situation of vulnerability as a subject and recognises the self-relation . 13

Third, the vulnerability will be perceived and revealed by humans from their first-person perspective as well as for the first-person perspective itself and the self-relation .

This awareness-building process of one’s own vulnerability and the first-person perspective leads, fourth, to human beings relating themselves to all other human beings. In this process, they realize that the vulnerability does not make them different from other human beings, but that they share this vulnerability with all human beings.

Fifth, the process of realizing their own vulnerability and the vulnerability of all other human beings enables them to realize that they share not only the vulnerability with all other human beings, but also the individual first-person perspective on individual vulnerability and the vulnerability of all other human beings, as well as the individual self-relation : Every human being is subject of his or her own life. Human beings therefore realize that the first-person perspective and the self-relation is a prerequisite for life as a human being.

Based on the perception of vulnerability of their own first-person perspective and their own self-relation , they become aware of the same vulnerability of all other human beings. Human beings, who first and foremost want to survive and live as human beings, become aware that the vulnerability concerns their own survival as well as the survival of all other human beings, and also their own life as human beings and the lives of all others as human beings, because the vulnerability does not stop with the first-person perspective and the self-relation as a prerequisite to human life. Faced with one’s own vulnerability, the human being primarily wants to survive and live a dignified life. Survival and a dignified life should not be allowed to be taken away from human beings. They must be legally enforceable in order to offer real protection and have to be applicable to the various dimensions, because vulnerability can encompass the legal, political, historical and ethical dimension. Based on the above-mentioned high priority they possess, and based on the unpredictability of the vulnerability, survival and a dignified life should be unconditional. Human beings share the desire to survive and live a dignified life with all other human beings equally. This desire is not individualistic, even if it is a concern of an individual, which each individual discovers through his or her first-person perspective and self-relation .

Because, sixth, human beings are aware of their vulnerability, but at the same time do not know if and when this vulnerability will manifest itself and turn into a violation, they are prepared to accord all human beings the first-person perspective and self-relation based on the equality of all human beings, because this presents the most rational and advantageous solution for themselves. Which means, to accord all human beings rights – that is to say human rights – in order to protect themselves and all others, since the vulnerability also contains the first-person perspective and the self-relation . On the one hand, this protection through human rights aims at avoiding the transformation of vulnerability into a concrete violation and, on the other hand, in the case of a possible transformation of vulnerability into a concrete violation, to receive active compensation. Humans are aware that the protection of human rights also encompasses the duties corresponding to the human rights, because they are not exclusive rights, but rights that all human beings are entitled to.

In view of the above-described awareness-building process for human rights, the question may arise as to why human beings should not opt for another form of self-limitation or another form of dealing with this situation (e.g. violence, subordination, etc.). As explained above, human beings are first and foremost interested in surviving and leading a dignified life. Human rights can best support this desire, which speaks in favor of human rights. On the other hand, violence or subordination – meaning alternative forms of protection against vulnerability and violation based on inequality and injustice among people (e.g. the powerful and the powerless, tyrants and subordinates, oppressors and oppressed) – can be excluded as rational and advantageous alternatives in view of the unpredictability of a possible transformation of vulnerability to violation because, due to the unpredictability of a possible transformation of vulnerability to violation, one does not know on which side one stands or will stand.

These six points on the principle of vulnerability explain that, seventh, the vulnerability in itself has no ethical quality, but the principle of vulnerability is normatively charged with the vulnerability, the first-person perspective and self-relation as an ethical claim. The principle of vulnerability affects all human beings and differentiates them from all other living beings. Because of the principle of vulnerability human beings accord each other human rights. Because they agree that, with human rights for themselves and all other human beings, a transformation from vulnerability into a concrete violation can be prevented or active compensation for all human beings would be provisioned in the case of a possible transformation of vulnerability into a concrete violation. It would be a decision by the moral society that human beings assign each other human rights based on the principle of vulnerability and consider all human beings as holders of human rights.

Therefore, human beings are not human rights holders because of their vulnerability, but they are human rights holders because they grapple with their own vulnerability and its relevance. They become aware of the first-person perspective and self-relation of themselves and all human beings, and they get to know the former as a prerequisite for human life. They even recognize the vulnerability of the first-person perspective and the self-relation of all human beings – because of the principle of vulnerability. Human beings differentiate vulnerability based on experiences of injustice and violations, and because of the principle of vulnerability they establish a protection of elements and spheres of human existence with specific human rights. The principle of vulnerability is therefore a starting point for justifying human rights per se as well as specific human rights.

Eighth, it is quite possible that the principle of vulnerability can be the basis for new suffering and experiences of injustice, which, because of their threatening character, will necessitate human rights protection. This necessity demands formulating rights that go beyond the human rights that exist today. The above-mentioned dynamic aligns with this possibility, which leaves human rights open to new opportunities and challenges that might arise. The principle of vulnerability contains an “exploratory function” 14 that leads to the potential for unlimited evolution and differentiation of human rights.

These eight points make up the first step in filtering the justification model based on the principle of vulnerability. Not all elements and spheres of human existence are worth considering for protection through human rights, but only those that are needed due to the principle of vulnerability and are necessary for humans to protect themselves and others.

2.2 Second Step of Filtering

The second step of filtering builds on the considerations above and goes into more detail regarding the areas of protection that all human beings as holders of human rights are entitled to, because the consensus on the protection against vulnerability does not include all elements and spheres of human existence. However, which elements and spheres of human existence should be placed under the protection of human rights? What criteria should inform the selection of these elements and spheres of human existence?

Starting points for discerning these criteria are historical experiences of suffering and injustice, which human beings are or could be exposed to based on the principle of vulnerability. Faced with these historically severe experiences of injustice and violence, and because of the principle of vulnerability, human beings agree to prevent for themselves and all other human beings the transformation from vulnerability to concrete violation and to stipulate active compensation in the case of a possible transformation from vulnerability to concrete violation.

Human rights protection does not apply to all historic experiences of violation. It is necessary to make a selection of historic experiences of injustice that call for human rights protection, which again demands criteria for this selection process. They can be derived from the above descriptions of human beings and the above-described weighting, because it shows what human beings want to protect themselves against. It allows human beings to understand which characteristics must be fulfilled for a historical experience of violence to warrant protection through human rights. First of all, human beings want to survive and live as human beings (fundamentality). Human beings become aware that the vulnerability concerns their own survival and the survival of all human beings as well as their own life as human beings and the lives of all others as human beings (universality), because the vulnerability does not stop at the first-person perspective and self-relation as a prerequisite to human life. Survival and a dignified life should not be allowed to be taken away from human beings (inalienability). They must be legally enforceable (enforceability) and have to be applicable to various dimensions (multi-dimensionality), because vulnerability can encompass the legal, political, historical and ethical dimension. Based on the above-mentioned high priority they possess, and based on the unpredictability of the vulnerability or a possible transformation from vulnerability to violation, survival and a dignified life should be unconditional (categorical character). Human beings share this desire to survive and live a dignified life with all other human beings equally (equality). This desire is not individualistic, even if each individual discovers it through their own first-person perspective and self-relation (individual applicability). Therefore, the following eight criteria determine the choice of those historical experiences of violence and vulnerabilities against which all human beings should be protected through specific human rights: fundamentality, universality, inalienability, enforceability, multi-dimensionality, categorical nature, equality and individual applicability.

The second step in filtering the justification model based on the principle of vulnerability characterizes an inherent openness to new threats, risks, and experiences of injustice, which at present are not yet in the human conscience or imagination or have not yet occurred, as well as an openness for experiences of injustice that occur in different religions, cultures, traditions, civilizations, and world views.

At the same time, the second step of filtering leads to the challenges to apply these eight criteria to historical experiences of injustice, for example the challenges of historical contingency and the universalization of particular experiences of injustice.

2.3 Third Step of Filtering

This step encompasses the application of the above-mentioned eight criteria in order to identify the elements and spheres of human existence that need to be protected by human rights. Human rights per se and all specific human rights can be ethically justified based on the principle of vulnerability. 15

3 Autonomy as Source of Pluralism and Particularity

Relying on their ethical justification, human dignity and human rights constitute the basis for pluralism and particularity by understanding all human beings as individuals that are all different and unique, and not simply members of a collective. Only the protection of human rights in its universality guarantees that all people are self-determined and can take their own positions and that those individual rights must be respected by all. Only this protection of autonomy of each individual allows all human beings to be particular. Therefore, human dignity and human rights take on a constitutive role for cultural, religious, and worldview-based pluralism and particularity, because the human rights-based appreciation of autonomy means at the same time celebrating particularity and, therefore, pluralism. 16 Autonomy furthers – it is even a precondition for – pluralism and particularity, because without autonomy there would be no choice for the individual, which would make it very hard for pluralism and particularity. 17

At the same time, pluralism and particularity are limited by human dignity and human rights of all human beings. 18 The freedom of the individual is protected and simultaneously restricted by human rights (by human rights of all other human beings) because, from a human rights perspective, one always has to accept the opposite as “an entity in a constant process of change; an entity we cannot quite imagine; an apparition in the process of becoming who faces us primarily to discomfort us and renegotiate both herself and ourselves.” 19 Rights and the corresponding duties interact with and restrict the arbitrary freedom of all human beings – for the protection of human dignity and human rights of all human beings.

Cultural, religious, and worldview-based pluralism and particularity go back to these individual rights and freedoms. They are indirectly protected by human rights through the individual human rights of all human beings. 20 At the same time, there is a limit to religious and worldview-based pluralism and particularity, because religious and worldview-based communities have to respect, protect, enforce, and contribute to the realisation of human dignity and human rights inside and outside of their communities. Nevertheless, human dignity and human rights are not about levelling religious or worldview-based plurality. This would go against human dignity and human rights, which protect and promote religious or worldview-based pluralism and particularity indirectly by protecting the corresponding freedoms of the individual. By offering the preconditions and a framework for religious and worldview-based pluralism and particularity, human rights make it possible that difference becomes a reality and pluralism and particularity legitimate, even against resistance. 21 It would, for example, be conceivable that a religious or worldview-based community would deny people, who see themselves as being part of another or no religious or worldview-based community, the right to freedom of thought, conscience, and religion by referring to their own tradition, as well as cultural and religious pluralism and particularity. Therefore, human rights protection is needed for religious and worldview-based pluralism and particularity because it guarantees the autonomy of each human being. Religious and worldview-based communities are free within the human rights framework (which means within the preconditions that also protect their own existence). This means, as a last consequence, that they are free, as long as they respect, protect, enforce, and contribute to the realisation of human dignity and human rights.

In this sense, human dignity and human rights secure a peaceful coexistence in a pluralistic society. Human dignity and human rights can be thought of as a branch on which hang the different religious and worldview-based communities, their peaceful coexistence, as well as religious and worldview-based pluralism and particularity. This branch needs to be respected by religious and worldview-based communities – primarily because of the already established universal validity of human rights inside and outside of religious and worldview-based communities – and the corresponding responsibility of protecting, enforcing, and contributing to the enforcement of human rights must be fulfilled. Otherwise, religious and worldview-based communities are in danger of having their right of existence denied (particularly in contexts where they represent a minority). Also, they would endanger the peaceful coexistence of religious and worldview-based communities, the dialogue between religious and worldview-based communities, as well as religious and worldview-based pluralism and particularity as such and, therefore, saw off the branch they sit on.

The continued wrestling for common understanding between religious and worldview-based communities gets an ethically justified frame of reference 22 in human rights, which promotes respectful dealing with religious or worldview-based differences.

4 Adaptation – a Model for Bringing Human Dignity, Human Rights, and Religious and Worldview-Based Communities Together

In order to understand the interaction between pluralism and particularity and human dignity and human rights as their foundation, the concept of “adaptation” 23 tries to capture the relationship between human dignity and human rights and religious and worldview-based communities. Adaptation sees this relationship as coming together in dialogue, as meeting with reciprocal effect, and as continued interaction, within the limits of human dignity and human rights of all humans. First, adaptation considers the above-mentioned protection that human dignity and human rights indirectly offer to religious and worldview-based communities by protecting all humans in their mental, religious, worldview-based, and spiritual dimension of existence. With this first aspect of adaptation, human rights recognise – and take seriously – religious and worldview-based communities as objects of their protection, but also as duty-bearers.

Second, human dignity and human rights have a direct effect on religious and worldview-based communities, because the power and influence of religious and worldview-based communities also require the responsibility to respect, protect, enforce, and implement human dignity and human rights. Religious and worldview-based communities have a particular responsibility to use their power in accordance to and in favour of human dignity and human rights. All human beings everywhere in the world should know that they are not forgotten as holders of human dignity and human rights – inside and outside of religious and worldview-based communities. The adaptation of human dignity and human rights, therefore, takes religious and worldview-based communities as human rights actors seriously. It expects respect towards human dignity and human rights and contributes towards their protection, enforcement and realisation – it does not spare religious and worldview-based communities in this respect. At the same time, adaptation sees religious and worldview-based communities as partners that make sense of human dignity and human rights from their respective perspectives and that participate in the human rights discourse from their own position. In the course of adaptation, both lead to a greater identification with human dignity and human rights in religious and worldview-based communities, a deeper internalisation of human dignity and human rights, and a stronger ownership of human dignity and human rights. The criticism of religious and worldview-based communities of the human rights discourse and human rights practice and, reciprocally, of other or their own religious and worldview-based communities from a human rights perspective, always stays within the boundaries of human dignity and human rights when using adaptation.

Reciprocal criticism also means having the courage in the course of adaptation to “call human rights problems in religious communities by their name, to not simply accept appalling injustices in religious communities as God-given”. 24 Adaptation succeeds in creating a fertile and constructive foundation, because it sees the opposite not only as recipient of criticism, but also as sender of criticism that is embedded in the discourse depending on his or her self-conception.

The adaptation of human dignity and human rights proves to be dialogical when, during this process, religious and worldview-based communities also critically name developments in the human rights tradition, the human rights discourse, and human rights practice. 25 As such, a religious or worldview-based community could, for example, actively take a stand in the international human rights discourse when one category or generation of human rights is given more importance than another one on an international level and, through this, the principle of the indivisibility of human rights is not adhered to. Other religious and worldview-based communities name human rights violations of state and non-state actors and support victims of human rights violations and human rights defenders when they present their concerns and cases, introduce their perception of abuse and instrumentalization of human rights for other political causes (e.g. by states) into the human rights discourse, and criticise a lack of implementation and realisation of human rights for all people. The respect, protection, enforcement, and realisation of human dignity and human rights could benefit from the fact that religious and worldview-based communities are often very close to the action and witness events because of their institutionalisation and structures, and can report and bear witness to them by using their existing communication channels.

Third, adaptation aims at rendering for people in various contexts human dignity and human rights more tangible as their own human dignity and human rights. Using the word adaptation and not interpretation is deliberate. Because in the case of interpretation a change in content is definitely possible. For example, the Cairo Declaration on Human Rights in Islam of 1990 as an interpretation of human rights changes the content of human rights, inter alia , with article 24: “All the rights and freedoms stipulated in this Declaration are subject to the Islamic Sharia.” This Sharia-reservation has an effect on the understanding of human rights as they are seen to be subordinate to Sharia.

Similarly, the Bangkok Declaration of Human Rights of 1993 also represents an interpretation of human rights because it changes the content of human rights, inter alia , with article 6: “Reiterate that all countries, large and small, have the right to determine their political systems, control and freely utilize their resources, and freely pursue their economic, social and cultural development.” The first part of this article concerning the choice of political system leads to the fact that political participation rights are restricted by the self-determination of the state. A state could, therefore, constitute itself as a dictatorship with reference to this part of article 6. This would mean giving up parts of the political participation rights.

Fourth, adaptation includes translating human dignity and human rights into the language, mindset, terms, concepts, narratives, pictures, and symbols of the respective religion and worldview. In the case of human rights as global consensus, there exists a need “of translating itself into a local project that speaks to peoples lived experiences. The international human rights project has been criticized as abstract in its pronouncements, elitist and alien to those it seeks to help. Largely driven by powerful Western-based NGO s, the international human rights movement has appeared to some in the developing world as a ‘civilizing mission’ that sometimes appears to suggest that local and domestic cultures are backward and at odds with human rights.” 26

Fifth, adaptation incorporates human dignity and human rights into the horizon of belief, knowledge, thinking, and understanding of religious and worldview-based communities. This uncovers the contributions of the respective religious and worldview-based community to the emergence and development of human dignity and human rights. Furthermore, human dignity and human rights are correlated with their specific contents, convictions, teachings, principles, and values of the respective religious or worldview-based community. Human dignity and human rights are also rediscovered as part of one’s own identity. In this way, human dignity and human rights can be related as the own to the own. In theology, in discourse, and in reflection within religious and worldview-based communities, a human rights oriented hermeneutic is used. 27

Sixth, adaptation also encompasses religious and worldview-based justifications for human dignity and human rights. Based on the horizon of belief, knowledge, thinking, and understanding of the respective religious and worldview-based community, the claim that all humans are holders of human dignity and human rights will be justified.

Outside the respective religious and worldview-based community, the relevant justifications for human dignity and human rights based on religion or worldview might be limited. For the respect of human dignity and human rights within the respective religious or worldview-based community and for the perception of human rights duties for the respective religious or worldview-based community and its members, a religious and worldview-based justification for human dignity and human rights, cannot be estimated high enough in its importance, even if there is no necessity for it. No necessity, because an ethical justification for human dignity and human rights and their universality is also binding for religious and worldview-based communities.

The high importance of human dignity and human rights justifications based on religion or worldview stems from the fact that a justification based on religion or worldview is able to show that human dignity and human rights correspond to, for example, God’s love or the love for God. 28 Additionally, an ethical justification for human dignity and human rights is needed so that all humans are offered a plausible and rational justification for human dignity and human rights. The unique and essential importance of religious and worldview-based justifications is based on the reinforcing effect that a religious and worldview-based justification for the validity of human dignity and human rights obtains inside the respective religious and worldview-based community, as well as for the respective religious and worldview-based community itself.

Without this additional religious and worldview-based justification of human rights one could, however, come to the conclusion that human dignity and human rights are something purely secular in the sense that they have no relevance for the respective religious and worldview-based community or its members. This conclusion, however, clearly contradicts the universality of human dignity and human rights.

The importance of this religious and worldview-based justification for human dignity and human rights becomes also obvious in view of the tendency to assume a religious or worldview-based space where human dignity and human rights allegedly do not apply. This tendency is based on the claim that a religious or worldview-based justification should be rejected out of respect for the general public and the secular character of human dignity and human rights. This tendency can only be countered with a justification within their own faith or worldview. Justifications based on religion and worldview give access to human dignity and human rights, in particular when emerging from a specific religion or worldview. According to this perspective, religious and worldview-based communities accept the invitation that was given implicitly during the preparatory phase of the 1948 Universal Declaration of Human Rights to develop various human rights justifications from religious or worldview-based perspectives, in order to respect pluralism and particularity, and to make human rights accessible for members and believers of a religion or worldview. On the one hand, this justification gives human rights the importance that they should have. On the other hand, it opens up the possibility to appreciate or use human rights as an ethical frame of reference in the respective religious and worldview-based community.

Professor of Theological Ethics and Director of the Institute of Social Ethics ISE at the Faculty of Theology of the University of Lucerne, and Research Fellow at the University of the Free State, Bloemfontein (South Africa).

2011–2015 Member of the Board of the Swiss Centre of Expertise in Human Rights. 2011–2017 Member of the Expert-Jury of the Swiss Ethics Award. 2013 Visiting Scholar at the University of Technology Sydney (Australia). 2013–2014 Guest-Professor at the Faculty of Theology and Religious Studies at the Katholieke Universiteit Leuven (Belgium). 2013–2017 Fellow at the Raoul Wallenberg Institute of Human Rights and Humanitarian Law, Lund University (Sweden). 2015–2019 Guest-Lecturer at the Leuphana University Lueneburg (Germany). 2015–2017 Visiting Fellow at Yale University (USA).

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Hörnle , Tatjana : “ Zur Konkretisierung des Begriffs ‘Menschenwürde’ ”, in: Jan C. Joerden / Eric Hilgendorf / Natalia Petrillo / Felix Thiele (ed.): Menschenwürde und moderne Medizintechnik . Baden-Baden : Nomos , 2011 , p. 57 – 76 .

Kirchschlaeger , Peter G. (ed.): Die Verantwortung von nichtstaatlichen Akteuren gegenüber den Menschenrechten ( Religionsrechtliche Studien 4 ), Zürich : Edition NZN bei TVZ , 2017 .

Kirchschlaeger , Peter G. : “ How Can We Justify Human Rights? ”, in: International Journal of Human Rights and Constitutional Studies 4 ( 4 / 2016 ), p. 313 – 329 .

Kirchschlaeger , Peter G. : Menschenrechte und Religionen. Nichtstaatliche Akteure und ihr Verhältnis zu den Menschenrechten . Paderborn : Ferdinand Schöningh Verlag , 2016 .

Kirchschlaeger , Peter G. : “ Human Rights and Canon Law ”, in: Felix Wilfred , Andrés Torres Queiruga , Enrico Galavotti (ed.): Revision of Canon Law [= Concilium 52 (5/2016) ], p. 65 – 77 .

Kirchschlaeger , Peter G. : “ Adaptation – A Model for Bringing Human Rights and Religions Together ”, in: Acta Academica , 47 ( 2 / 2015 ), p. 163 – 191 .

Kirchschlaeger , Peter G. : “ Menschenrechte als kontinuierliche Quelle von Wertegeneralisierung ”, in: Jahrbuch für Christliche Sozialwissenschaften 56 ( 2015 ), p. 227 – 250 .

Kirchschlaeger , Peter G. : “ Das Prinzip der Verletzbarkeit als Begründungsweg der Menschenrechte ”, in: Freiburger Zeitschrift für Philosophie und Theologie 62 ( 1 / 2015 ), p. 121 – 141 .

Kirchschlaeger , Peter G. : Wie können Menschenrechte begründet werden? Ein für religiöse und säkulare Menschenrechtskonzeptionen anschlussfähiger Ansatz . Münster : LIT-Verlag , 2013 .

Kirchschlaeger , Peter G. : “ Religionsfreiheit – ein Menschenrecht im Konflikt ”, in: Freiburger Zeitschrift für Philosophie und Theologie 60 ( 2 / 2013 ), p. 353 – 374 .

Kirchschlaeger , Peter G. : “ Das ethische Charakteristikum der Universalisierung im Zusammenhang des Universalitätsanspruchs der Menschenrechte ”, in: Stephan Ast / Klaus Mathis / Julia Hänni / Benno Zabel (ed.): Gleichheit und Universalität ( ARSP -Beiheft 128 ), Stuttgart 2011 , p. 301 – 312 .

Kottow , Michael H. : “ Vulnerability. What Kind of Principle Is It? ”, in: Medicine, Health Care and Philosophy 7 ( 2004 ), p. 281 – 287 .

Lohmann , Georg : “ Die unterschiedlichen Menschenrechte ”, in: Karl Peter Fritzsche / Georg Lohmann (ed.): Menschenrechte zwischen Anspruch und Wirklichkeit . Würzburg : Ergon Verlag , 2000 , p. 9 – 23 .

Loretan , Adrian : “ Menschenrechte in den Religionsgemeinschaften ”, in: Peter G. Kirchschlaeger et al. (ed.): Menschenrechte und Wirtschaft im Spannungsfeld zwischen State und Nonstate Actors . Bern : Stämpfli Verlag ( Internationales Menschenrechtsforum Luzern IHRF , 2 ), 2005 , p. 51 – 59 .

Margalit , Avishai : The Decent Society . Cambridge : Harvard University Press , 1998 .

Marie , Jean-Bernard : “ De l’universalité des principes à l’universalité des pratiques des droits de l’homme ”, in: Avancées et confins actuels des droits de l’homme aux niveaux international, européen et national. Mélanges offerts à Silvio Marcus Helmons . Brüssel : Bruylant , 2003 , p. 219 – 229 .

Ong-Van-Cung , Kim Sang : “ Reconaissance et vulnérabilité ”, in: Archives de Philosophie 73 ( 2010 ), p. 119 – 141 .

Perry , Michael J. : “ ‘The Morality of Human Rights’. A Nonreligious Ground? ”, in: Emory Law Journal 54 ( 2005 ), p. 97 – 150 .

Raz , Joseph : The Morality of Freedom . Oxford : Clarendon House , 1986 .

Runggaldier , Edmund : “ Deutung menschlicher Grunderfahrungen im Hinblick auf unser Selbst ”, in: Günter Rager / Josef Quitterer / Edmund Runggaldier (ed.): Unser Selbst – Identität im Wandel neuronaler Prozesse . Paderborn : Ferdinand Schöningh , ² 2003 , p. 143 – 221 .

Ruteere , Mutuma : Bridging Valleys. Harnessing the Power of Religious Movements for and Human Rights. A Briefing Paper for the Raoul Wallenberg Institute for Human Rights and Humanitarian Law . Turkey , 2014 [unpublished].

Sauer , Hanjo / Riedl , Alfons : Die Menschenrechte als Ort der Theologie. Ein fundamental- und moraltheologischer Diskurs . Frankfurt a. M. : Peter Lang , 2003 .

Schroeder , Doris / Gefenas , Eugenijus : “ Vulnerability. Too Vague and Too Broad? ”, in: Cambridge Quarterly of Healthcare Ethics 18 ( 2009 ), p. 113 – 121 .

Tasioulas , John : “ On the Foundations of Human Rights ”, in: Rowan Cruft / Matthew S. Liao / Massimo Renzo (ed.): Philosophical Foundations of Human Rights . Oxford : Oxford University Press , 2015 , p. 45 – 70 .

See in more detail Kirchschlaeger, Charakteristikum der Universalisierung , p. 301–312.

Appiah, Der Kosmopolit , p. 174.

Perry, Human Rights , p. 97–150; Tasioulas, Human Rights , p. 45–70.

Lohmann, Menschenrechte , p. 10.

Kirchschlaeger, Wie können Menschenrechte begründet werden , p. 241–267; Kirchschlaeger, Das Prinzip der Verletzbarkeit ; Kirchschlaeger, Justify Human Rights .

Schroeder/Gefenas, Vulnerability , p. 113–121; Kottow, Vulnerability , p. 281–287.

Ong-Vang-Cung, Reconaissance et vulnérabilité , p. 119.

Butler, Le pouvoir , p. 77.

Margalit, The Decent Society , p. 9–10.

See in more detail Kirchschlaeger, Wie können Menschenrechte begründet werden , p. 231–267.

Hoffmaster, Vulnerability , p. 42.

Runggaldier, Grunderfahrungen , p. 143–221.

Honnefelder, Menschenrechtsbegründungen , p. 171 et seq.

Habermas, Menschenwürde , p. 18.

Kirchschlaeger, Wie können Menschenrechte begründet werden , p. 290–335; Kirchschlaeger, Das Prinzip der Verletzbarkeit , p. 121–141.

Kirchschlaeger, Menschenrechte und Religionen ; Kirchschlaeger, Die Verantwortung .

Raz, Morality of Freedom , p. 395–399.

Marie, De l’universalité des principes , p. 225.

Gozdecka, Rights , p. 177.

Kirchschlaeger, Religionsfreiheit , p. 353–374.

Hoeffe, Rechtsprinzipien , p. 135–150.

Kirchschlaeger, Wie können Menschenrechte begründet werden ; Kirchschlaeger, Menschenrechte und Religionen .

Kirchschlaeger, Adaptation .

Loretan, Menschenrechte , p. 58 et seq.

Sauer/Riedl, Menschenrechte , p. 202–204.

Ruteere, Valleys , p. 5.

Kirchschlaeger, Human Rights , p. 65–77; Kirchschlaeger, Menschenrechte als kontinuierliche Quelle , p. 227–250.

Raz, Morality of Freedom , p. 31 et seq; Assmann, Exodus .

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Why Human Dignity is Important

What is Dignity?

Dignity is the quality of being honourable, noble, excellent or worthy. With a human regarded as the most supreme living creature, dignity, in its appealing sense, is better referred to as human dignity. It is the conceptual basis for the formulation and execution of human rights and is neither granted by the society nor can it be legitimately granted by the society. An imperative implication of human dignity is that every human being should be regarded as a very invaluable member of the community with a uniquely free expression of their right to life, integrated bodily attributes and their spiritual nature (Chapman, Audrey R, 2010).

Human dignity is a sense of self-worth. Therefore, dignity is a sense of pride in oneself that a human being has with them. This conscious sense makes them feel that they deserve respect and honour from other human beings. Many scholars argue that if a human being is in a humiliating or compromising situation then this is a major threat to their dignity. However, other human persons may still assert that they have dignity even though they find themselves in such situations. All in all, humans deserve dignity not because of their lifelong achievements but by the fact they are already human beings (TerMeulen Ruud, 2010).

Three Perspectives of Human Dignity

The question of human dignity has hit the headlines world over in the recent past. The pre-colonial period has been used as the base reference for crimes against humanity and abuse of human dignity, thence redefinition of the term human dignity by international law courts and the United Nations. Human dignity has been defined from the philosophical, religious and legalistic perspectives.

The deep philosophical roots of the term human dignity were articulated by Emmanuel Kant, a great philosopher of the famous late Enlightenment. He is considered as the source of the now contemporary concept of human dignity. He holds that the fundamental principle behind moral duties of human beings is a categorical imperative. According to Kant, imperative means that it commands us to exercise our wills in a particular way. As a result, human beings with respect for human dignity should not possess any irrational wills against their fellow human beings and the generally acceptable societal norms and values.

And according to Emmanuel Kant, the only thing we should will about is our happiness as human beings. Once we have happiness we’ll be able to enjoy good health and nourish proper relationships (Sensen Oliver, 2011). Human dignity should operate on the basis of volitional principles or maxims. Hence, the basic rational requirements and morality should be the primary demands that apply to these maxims which motivate all our actions.

Human dignity has also been developed along the lines of religious, theological and ethical perspectives. Christian and Islam views make up this perspective at large. According to the Christians, the Bible reveals that God not only created the human nature but also endowed man with unique qualities after creating man in His own image and likeness (Genesis 1:26). It is from this basis that we can deduce that the human nature deserves a very inherent dignity.

According to the Russian Orthodox Church’s basic teaching on the issue of human dignity, God has endowed all human beings in a very generous manner by distributing His gifts equally such that His showing of human dignity, nature and abundance of His unending grace remains undisputable. Owing to the fact that Jesus Christ offered His life as a ransom for sin and the sinful nature of human beings, human dignity was lifted at its best, hence it should be respected. The Bible also asserts that life according to the desires of the flesh that don’t withstand respect for other human beings is loss of and abuse of human dignity.

The Islam Texts Society puts forth the idea that human dignity is the basis of human rights. Several references are drawn from the Holy Quran which indicates that a human being deserves dignity as a result of their physical and spiritual nobility. The Quran says that God’s love for humanity is immense, the sanctity for human life immeasurable, the necessity for freedom a prerequisite thus restating the need for human equality and accountability for all acts done to humanity (Kamali, H, M, 1999) .

For this reason, Sharia Laws have been developed to help in protecting human dignity and also promote a high level of social interaction. Since God has honoured mankind by His great love, human beings should also reciprocate the same and show their love and respect for their fellow human beings. In other words, dignity is not earned by the meritorious conduct which is an expression of the favour and grace of God towards human beings.

The legal perspective of the concept of human dignity was coined at the end of the Second World War. It has been regarded as the central perspective that discourses human rights. The Universal Declaration of Human Rights states that all humans have been born with equality in dignity and rights. For this reason, they are endowed with enough reason and pure conscience, hence should acts towards one another with a deep spirit of brotherhood. In its preamble, the Universal Declaration of Human Rights seeks for recognition and respect for the inherent dignity as well as the equal and inalienable rights of every member of the human dignity despite where they come from, their religious beliefs or background history.

Drafters of this perspective add that the human person possesses many rights because of the fact they have been born as a person, wholly, a master and manager of oneself in many aspects (Frame Tom, 2007). Therefore, all human beings deserve to be treated with utmost dignity. International Law, in pointing out the contempt of and disregard for human dignity says that abuse of human rights has resulted in numerous barbarous acts that have completely outraged the pure conscience of mankind. Digging deep the question of human dignity has led to the coining of and questions in aspects of human liberty, equality and fraternity because many people died and suffered in the hands of their fellow human beings during the war.

Case Analysis of Human Dignity

In March 28, 2010, Conor McBride brutally murdered his fiancée before turning himself to police. As a result, nobody sought a death penalty. Several issues emanate from his ordeal: justice and several elements of justice, deterrence and forgiveness. However, of concern to us now is the question of human dignity by the murderer.

The death penalty for all crimes has been abolished in Australia. The major question that arises is whether we should use justice to arrive at human dignity and justice. Is punishment a means to attaining justice? First of all, McBride hasn’t respected the dignity of his fiancée by killing her. Nonetheless, killing him would be a disregard for his dignity as well.

Several arguments arise from the death penalty for someone who has shown contempt to human dignity. The most obvious one is the fact that a murderer loses their dignity by performing this act. Therefore, they also deserve to lose it in the same manner. The other argument says that by killing another person, a murder can only retain their human dignity by being put to death as well. The last argument says that a murder’s human dignity should be respected hence they shouldn’t be put to death (Perry, Michael J, 2005).

In the case of Oscar Pistorius who participated in the 2012 Olympic Games, a powerful thought and question on human dignity has been put forward. He became the first man with a disability to participate in the able-bodied competition. He was amputated on both legs at birth. This raised tough questions as to whether he should participate in the able-bodied Olympics or in the Paralympics for those with disabilities. He insisted that he wanted to participate in the normal-bodied Olympics. However, others argued that he had an undue advantage because he runs on blades.

Later on, a question as to whether technological advancements should be allowed to take toll in the issue of human dignity arose. This is clear because without the blades, Oscar Pistorius couldn’t have participated in the able-bodied Olympics. The arguments put forward in three perspectives say that human dignity actually places limits on the enhancements of individuals. Others say that it encourages human dignity while the last group argues that those who dispute that enhancements actually threaten human dignity are those who cannot benefit from such enhancements (Kurt Bayertz, Human Dignity, 1996).

In April 1986, an unidentified university lecturer from Belfast was practically seized by some Muslim gunmen in Beirut, Lebanon. After about 5 years, Brian Keenan was a free man once again. He had survived a painful incarceration, chained to some walls of a very tiny cell. To add insult to injury, he’s a blinded musician.

Everybody thought he was actually dead but after being released, he wished to travel the whole world, eat all the food in the world and make love possibly with all the women in the world as he had said. Silently, he began recording his ordeal on tape in an attempt to make sense of his life.

This ideally meant that his dignity had been abused and he never felt as though a human being. It deeply reminded him of the ancient times of slave trade when human beings haggled the price of their fellow human beings in attempt to claim supremacy and gain access to mighty riches. As a learned man, Keenan had been taken hostage to and work as a prisoner for the Jihad in Patagonia, Chile.

Brian was captured at Belfast as a man with full vision but after about five years, he came back blind. Why did this happen? Well, he was blinded by an attack of smallpox. He actually felt that he was better dead than alive at that time. This perhaps is the greatest disregard for human dignity when people you are offering services involuntarily and free of charge can’t even treat you so that you live as a human being just like them.

Brian Keenan, in an interview with The Guardian, a British newspaper, says that he wasn’t prepared for such an endeavour. He wasn’t a musician or historian but he found himself buried in those works of art. To this day, he can’t tell how he started playing the harp yet he wasn’t a musician. That’s why he said that when one ends up spending a lot of time in some small dark place, some strange people and ideas end up visiting you. He attributes all these as an attempt to recover one’s lost dignity. Anderson Duff Attorney

As a university lecturer before his capture, Brian Keenan could actually exercise his freedom of speech and movement and even do whatever he wanted but this didn’t turn out the same when he was captured. When he was a free man, Keenan never highly regarded those who visited him. However, he found himself being very grateful to those who visited him in what he describes as a cell without a wall. This he attributes to the fact that he was surrounded by conditions beyond his wish, conditions that he didn’t perceive to be good.

It is clear from various case studies that the question of human dignity brings out a lot of questions in the areas of justice and equality in the society. It affects societal norms and generally accepted principles. For instance, no society allows a human being to kill a fellow human being.

Critically looking at all the three perspectives from whence the issue of human dignity arises, it is important to look at all of them because without one perspective, several factors surrounding human dignity cannot be properly articulated. Therefore, all the three perspectives should be used depending on the situation bringing the issue of human dignity to question.

Chapman, Audrey R, Inconsistency of Human Rights Approaches ot Human Dignity with Transhumanism, The American Journal of Bioethics 10, no. 7 (2010): 61 – 63.

TerMeulen, Ruud, Dignity, Posthumanism, and the Community of Values, The American Journal of Bioethics 10, no. 7 (2010): 69 – 70

Frame, Tom 2007, The Legacy of Ronald Ryan’s Last Day, Quadrant Magazine51, nos. 1-2 (2007): 53-60.

Kamali, H, M 1999, The Dignity of Man: An Islamic Perspective, 2nd edn, Ismalic Texts Society

Perry, Michael J, Capital Punishment and the Morality of Human Rights, Journal of Catholic Legal Studies 44 (2005): 1–36.

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Sensen, Oliver 2011, Human Dignity in Historical Perspective: The Contemporary and Traditional Paradigms, European Journal of Political Theory, 10:1, 71-91.

Kurt Bayertz, Human Dignity: Philosophical Origin and Scientific Erosion of an Idea, (Sanctity of Life and Human Dignity, ed. Kurt Bayertz [Dordrecht: Kluwer Academic, 1996], 73-90)

Mary Ann Glendon, The Bearable Lightness of Dignity, (First Things, May 2011, 41-45)

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v.26(6); 2021 Sep

Exploring the perceptions of dignity among patients and nurses in hospital and community settings: an integrative review

Mandu stephen ekpenyong.

Research Association, Department of Nursing, Manchester Metropolitan University, UK

Mathew Nyashanu

Health and Social Care/Public Health, Nottingham Trent University, UK

Chioma Ossey-Nweze

Coronary Care Unit, Russells Hall Hospital, UK

Laura Serrant

Head of Department of Nursing, Department of Nursing, Manchester Metropolitan University, UK

Patients have a right to be treated with dignity. However, reports have continually identified concerns regarding the quality of care and dignity in hospitals. Undignified care can have unfavourable impact on the patient’s recovery such as leading to depression and loss of will to live. The aim of this study was to explore dignity as perceived by patients and nurses within hospital and community environments.

An integrative review methodological approach was adopted. Nine databases including Medline, CINAHL plus with full text, Web of Science, Embase, Pubmed, Psycinfo, Scopus, Nursing and Allied Health Source, and Science Direct were systematically searched for relevant articles using a predetermined set of inclusion criteria. Articles were included if they were primary empirical studies, peer reviewed, published between 2008–2019, assessing patients’ or nurses’ perception of dignity outside the end-of-life context, conducted in one of the European countries and written in English. Included papers were analysed using constant comparative analysis. The preferred reporting system for systematic review and meta-analysis (Prisma) flow diagram was used for quality appraisal and review.

Fourteen relevant articles were included in this review. Four overarching themes and 10 subthemes were identified as impacting on patient dignity. Overarching themes include autonomy, healthcare delivery factors, organisational factors and the meaning of dignity, whilst subthemes include dependence/independence, choice, staff attitudes, communication, privacy, structure of services, staff shortages, physical environment, respect and person-centred care.

There are a wide range of factors impacting on patient dignity. Adopting evidence-based interventions supported by adequate theoretical backing can help to enhance patient dignity in hospital and community settings.

Introduction

Respect for human dignity is a core value of human interaction ( Mann, 1998 ) and is desired by most people irrespective of their condition (Ebrahimi et al., 2012; Jacelon et al., 2004 ). The respect of human dignity constitutes the foundation on which human rights are based hence, the Universal Declaration of Human Rights states that all humans are equal in dignity and rights ( United Nations War Crimes Commission, 1948 ). Accordingly, the World Health Organization (1994) in a declaration on the promotion of patients’ rights in Europe states that ‘patients have the right to be treated with dignity’. Dignity has been shown to have an important influence on the patient’s care journey. For example, Williams and Irurita (2004) found that care believed to be dignified provided emotional comfort which in turn enhanced recovery. Conversely, undignified care can have an unfavourable impact on the patient’s recovery such as leading to depression, loss of will to live ( Chochinov et al., 2002 ) and feelings of worthlessness ( Jacobson, 2009 ). This can further lead to complaints and sometimes negative media interest ( Tadd et al., 2011 ).

The importance of dignity in nursing is highlighted by the centrality of dignity in various nursing codes of practice across the world. The International Council of Nurses' (ICN, 2012 ) code states that ‘Inherent in nursing is respect for human rights, including cultural rights, the right to life and choice to dignity and to be treated with respect’. Furthermore, ICN (2012) identified maintaining human dignity as an ethical goal of nursing. In the UK, stipulations in the Nursing and Midwifery Council (NMC, 2018) code posited that nurses should act with integrity and honesty when caring for all patients, and must treat patients fairly and give them autonomy. However, it is worthy of note that codes of practice are only relevant if clearly understood. In a European wide study, Tadd et al. (2006) found that nurses had a poor understanding of their professional codes and often relied on personal values and experiences. Furthermore, despite its glaring significance, it is often unclear what dignity means or how it should be defined. Therefore, it can be argued that any requirement to uphold patient dignity is of little help if the meaning of dignity is not understood ( Barclay, 2016 ).

Scholars have described the concept of dignity as complex ( Leung, 2007 ; Tranvåg et al., 2015 ), vague ( Høy et al., 2016 ), abstract ( Guo and Jacelon, 2014 ) and confusing. A review of the theoretical literature suggests that dignity exists in two interdependent yet separate forms. Despite philosophical and disciplinary differences researchers conceptualise dignity as dualistic ( Tranvåg et al., 2015 ) using various terminologies to describe it including objective dignity versus subjective dignity ( Gallagher, 2004 ), basic dignity versus personal dignity ( Leung, 2007) , dignity of stature and dignity of merit ( Nordenfelt, 2004 ), absolute dignity versus relative dignity ( Edlund et al., 2013 ) and human dignity versus social dignity ( Jacobson, 2009 ). Whatever terminology is used, most authors suggest that one type of dignity is inherent/inborn and cannot be reduced or influenced while the other type of dignity is subjective and changeable often influenced by external factors ( Tranvåg et al., 2015 ). This latter form of dignity is of most relevance in the healthcare context as the care we provide can promote or undermine dignity (Nordenfelt and Edgar, 2005). However, despite plentiful research and rich discourse about dignity in care there is no general agreement on what it means ( Barclay, 2016 ).

Several UK reports have identified concerns regarding the quality of care and dignity in hospitals. The Parliamentary and Health Service Ombudsman (2011) identified failings in the basic standards of care such as assistance with feeding, cleaning and comfortable environment, availability of drinking water, and communication. Another report by the Care Quality Commission (2011) on dignity and nutrition of older people identified several indignities including not gaining informed consent, treating patients disrespectfully and discussing patient’s personal information in open areas. Mid Staffordshire NHS Foundation Trust Public Inquiry ( Francis, 2013 ) presented horrifying levels of indignity suffered by patients in the care of the hospital as recounted by patients and their family. It has been established that dignity is important to patient care, however evidence suggests that dignity is not always respected and is often undermined. Therefore, there is a need to investigate factors that may impact on a patient’s dignity.

Search method

The search process entailed a systematic approach applying clear procedures and reflective processes as suggested by Harcourt and Rumsey (2004)in identifying and reviewing articles. Articles were searched for in a systematic manner between January and March 2019. A comprehensive search of the literature was undertaken as suggested by Dixon-Woods et al. (2005) and Walsh and Downe (2005) as this enables the researcher to find every relevant piece of literature which meets the predetermined inclusion criteria, in order to avoid omitting key research whose omission can bias the study.

The following keywords were used in the search: ‘dignity’, ‘perception’, ‘nurse’, ‘patient’, ‘community’ and ‘hospital’. Words were then first entered individually into specified databases relevant to the topic of study to identify any synonymous words and phrases, alternative terminology, related terms, plurals and variations in word spelling (Cronin et al., 2008). The search was done using the following nine databases: Medline, CINAHL plus with full text, Web of Science, Embase, Pubmed, Psycinfo, Scopus, Nursing and Allied Health Source, and Science Direct. In the first step, the search was carried out according to the purpose of the research and using the selected keywords. While searching, Boolean logical operators such as ‘AND’ and ‘OR’ were used to restrict the search.

Inclusion/exclusion criteria

To be included in the final review, each article was screened for the following inclusion criteria: written in English; published between 2008 and 2019; published in peer reviewed journals; conducted in European countries; studies considering perceptions of dignity from patients and nurses in any context except end of life. Only studies conducted in European countries were included in the study because they have similar geographical and cultural features, and it is believed that the perceptions of dignity in these areas may be more alike.

The reason for excluding studies at end of life is because dignity at end of life has been extensively researched and systematic reviews conducted (Ostlund et al., 2012; Pringle et al., 2015; Johnston et al., 2015; Rodriguez-Prat et al., 2016). While there is a substantial body of evidence exploring patients’ and nurses’ perceptions of dignity outside the context of palliative/end-of-life care, there is a lack of an integrated review of literature analysing and synthesizing this evidence. This study intends to close this gap as it explores this issue in order to advance understanding about this issue and inform practice.

Studies were included if there were more than 50% adults aged over 18 years. One of the inclusion criteria for articles in this study was that at least 50% of their participants were nurses or patients. All primary studies (quantitative, qualitative and mixed methods) were included as they could offer insight into the phenomena under study. Studies not meeting the inclusion criteria were excluded. See Figure 1 for the process of screening the articles to be included in the review.

An external file that holds a picture, illustration, etc.
Object name is 10.1177_1744987121997890-fig1.jpg

Prisma flow diagram.

Data management and strategy

Critical appraisal.

In the current study, all included articles were critically appraised using the Critical Appraisal Skills Programme (CASP) qualitative checklist (Critical Appraisal Skills Programme, 2018) for qualitative studies and Long et al . ’s (2002) tool for quantitative studies.

Data extraction and analysis

Two reviewers (EMS & CO) performed the data extraction. Relevant data such as aims, findings and methods were extracted to a table (see Table 1 for data extraction summary). Data were analysed using constant comparative analysis ( Keenan et al., 2005 ). Using this method all studies identified in the search were read thoroughly and initial codes given to subsets of data ( Thomas and Harden, 2008 ). A coding strategy involving descriptive and evaluation coding was adopted. The descriptive strategy involved assigning codes which best described a passage of data while the evaluation coding involved assigning codes based on judgement of the presence of a concept ( Miles et al., 2014 ).

Data Extraction Table.

Author/date of publication/ Country of study	Research aim/ setting	Method	Participants and sample size	Key findings	Critical Appraisal
(2013). Country of study: UK	To identify characteristics of the ward environment including processes and organization which maintain and challenge dignity in the care of older people. Hospital Ward	Qualitative ethnographic approach Non-participant observation and semi structured interviews. In-depth interviews. Thematic analysis using constant comparison purposive sampling.	40 Recently discharged patients aged above 65, 32 Trust managers responsible for patient experience, 79 Ward staff directly involved in the care of older people includes nurses, OT’s, doctors. Total sample size = 151	A lack of consistency in the provision of dignified care which appears to be explained by the dominance of priorities of the system and organisation tied together with the interests of ward staff and clinicians. The emphasis on clinical specialism meant that staff often lacked the knowledge and skills to care for older patients whose acute illness is often compounded by physical and mental co-morbidities. The physical environment of acute wards were often poorly designed, confusing and inaccessible, and might be seen as ‘not fit for purpose’ to treat their main users, those over 65 years, with dignity	Triangulation of data collection improving quality. Maximum variation sampling to ensure inclusion of all-important elements of the population. Unstructured observations overcoming Apparent bias inherent in individual accounts of actions. Good audit trail: handwritten notes of observations, audio recorded interviews. No consideration of the influence of the Hawthorne effect on staff behaviour Funded research which may influence findings in favour of funding organization
(2014) Netherlands	To explore how Dutch nursing home residents, experience personal dignity and the factors preserving or undermining it Nursing home	qualitative descriptive Methodology In-depth interviews Thematic constant comparison analysis Purposive	30 Dutch nursing home residents recently admitted to selected homes long term	Living in a nursing home was not a reason to feel less self-worth, but rather seen as a consequence of functional incapacity. Nevertheless, many residents felt discarded by society and not taken seriously, simply because of their age or illness. Waiting for help, being dictated to by nurses and not receiving enough attention could undermine personal dignity, whereas aspects of good professional care (e.g. being treated with respect), a supportive social network and adequate coping capacities could protect it	Purposive sampling of homes and participants to achieve maximum variation in terms of nature of home, rural and urban, age, gender, religion. Informed consent gotten thus ethically sound. Interviews recorded and transcribed and field notes kept hence having a good audit trail. Data collection and analysis done concurrently until data saturation was reached. The use of a structured framework to analyse and describe findings could limit researcher such that any new themes not included in the framework are missed.
Norway	The aim of the study was to acquire knowledge of what contributes to maintaining and promoting the dignity of intensive care patients Intensive care unit of a hospital	Qualitative phenomenological approach qualitative interviews Giorgi’s phenomenological analysis strategy	7 former intensive care patients previously admitted on the unit for at least 5 days in the last year	Being seen and heard and having one’s wishes, and needs attended to are parts of dignified care. Personal and individual nursing was essential, as well as the extra involvement beyond what was expected. Being helpless and having to be cared for was unpleasant and degrading. The experience of being unable to speak could cause demeaning situations. Being met with respect was the essence of having one’s dignity maintained and promoted. The sense of being treated as an object was the essence of experiences that inhibited dignity	Clear and detailed description of analysis process. Discussion between authors until a consensus was reached about themes. Interviews carried out on same day as appointment. Patients may be tired. No information on sampling methods used for facility and participants. No caveat to say that information may be shared if harmful information shared. The thematic conversation guide used for the interview appeared to be leading the patients towards a set of answers
UK	To explore healthcare professionals’ perspectives of dignified care and experiences of providing care. Setting: 4 UK NHS trust	Qualitative in-depth interviews : Thematic analysis	48 health care professionals including nurses = 16	Dignity is enacted by focusing on the ‘little’ things that matter to both professionals and patients; and improving care by making poor care ‘visible’.	Purposive maximum variation sampling. Audio recorded where consent is given and handwritten where consent is not given. Double coding by two authors Audit trail of coding frameworks Researchers maintaining reflexivity through out
UK	To explore and compare the views of residents in care homes for older people, their families and care providers on maintaining dignity. care homes within two areas of London	Qualitative descriptive method Semi structured interviews Framework approach to qualitative Analysis convenience and random sample	33 for managers, 29 care assistants, 18 nurses employed by the homes, 10 community nurses, 16 residents, 15 residents’ family members Total sample size: 121	The most prevalent themes were: “independence,” and “privacy”; followed by “comfort and care,” “individuality,” “respect,” “communication,” “physical appearance” and “being seen as human.”	Combination of random and convenience sampling as unable to achieve maximum variation sampling. Detailed notes taken for participants unwilling to be audio recorded forwarded to them for validation. Data analysed independently by 2 authors Resident participation dependent on home managers determining them as able to take part. (managers may only select residents that will give positive experiences of dignity)
Hoy (2016). Sweden, Norway, and Denmark	To illuminate the meaning of maintaining dignity from the perspective of older people living in nursing homes. nursing homes in 3 Scandinavian countries; Sweden, Norway, and Denmark	Qualitative phenomenological-hermeneutic approach in-depth individual interviews phenomenological-hermeneutic analysis purposive sample	28 nursing home residents in 3 Scandinavian countries who had lived in a home for at least 2 months	Three themes impacting on dignity were generated. This included: being involved as a human being, being involved as the person one is and strives to become, and being involved as an integrated member of the society	Aim stated. Type of purposive sampling not stated. No attempts to achieve maximum variation. Sample mostly female (21 females-7males). Only participants with mental capacity involved. Ethical approval gotten. Participants allowed to speak freely Audio recorded interviews Interviews carried out by different researchers which may affect results as each person has different interviewing styles. One collector promotes a consistent approach to data collection
Ballie . (2009). (RCN survey) UK	To understand the perspectives of nurses, healthcare assistants and students regarding the maintenance and promotion of dignity in everyday practice emailed questionnaire to current RCN members	Survey questionnaire containing open free text and closed questions Excel spreadsheet package and thematic analysis	1,110 participants comprising nurses, nursing students and health care assistants who were members of the Royal College of Nursing (RCN).	Respondents perceived that the physical environment and organisation influenced the provision of dignified care Dignity is promoted through thoughtful planning, sensitive communication, preserving privacy and promoting choice.	Large sample size. Focuses exclusively on the perception of nurses Research design very unclear Use of survey style questionnaires despite qualitative approach. No note on ethics. Lack of detailed explanation of how free text data was analysed.
UK	To understand the meaning of patient dignity, threats to patients’ dignity, and how patient dignity can be promoted, in acute hospital settings acute general hospital	qualitative triangulated single case study design Unstructured interviews and participant observation Thematic framework approach purposive sampling	24 patients who had stayed on the ward for at least 2 days were interviewed. 13 Nurses were interviewed 6 senior nurses were interviewed. 26 nurses and health care assistants were observed.	The environment, staff behaviour and patient factors impacted on patient dignity. Lack of environmental privacy threatened dignity. A conducive physical environment, dignity-promoting culture and other patients’ support promoted dignity. Staff being curt, authoritarian and breaching privacy threatened dignity	Data collection methods were pilot tested. Reflective diaries were kept to ensure researcher aware of on biases One researcher collected all the data and did the coding and analysis which may have been influenced by own biases. No variation in sample. All participants white.Interviews in hospital not audio recorded but written up. The researcher may have missed important points. Use of observations but no attempt to mitigate the Hawthorne effect.
UK	To investigate the lived experiences of older patients who had been in hospital, to explore their views on dignity and the factors which promote dignity District general hospital	Qualitative descriptive phenomenological approach Semi structured interviews Colaizzi’s framework of analysis Purposive sampling	10 older patients aged 73–83 who recently had an unplanned admission lasting longer than 72 hours.	Respondents report that factors that promote dignity include privacy for the body, cleanliness, independence and being able to exert control, sufficient time from staff, attitudes to older people and communication.	Manen’s approach was used to identify researcher’s potential bias. More than 72 hours stay to be able to have gained insight into hospital Use of an interview guide which was appropriate for the research question. Close interview dates upon discharge to allow fresh memory. Clear eligibility criteria. Detailed explanation of data analysis No explanation on how decisions regarding design were made. No caveat about full confidentiality
UK	To explore patients’ expectations regarding the factors that contribute to the maintenance of their dignity while in hospital. 3 Acute hospitals in the east midlands	Design: Qualitative phenomenological hermeneutic approach in-depth interviews Data analysis: Content analysis using a phenomenological approach Convenience sampling	102 patients admitted to sampled wards.	Six key themes that contribute to the preservation of their dignity were identified – privacy; confidentiality; communication and the need for information; choice, control and involvement in care; respect and decency and forms of address.	Ethical approval gotten, Clear aims Use of convenience sampling did not ensure information rich sources No idea when interviews occurred before or after admission. Length of interviews quite short. Data analysis process unclear as method used not stated
Italy	To explore inpatients’ perception of dignity in an Italian General Hospital setting Italian General Hospital	Descriptive cross-sectional design questionnaire statistical analysis using STATA program. Purposive sampling	100 patients hospitalized for more than 3 days	The frequency of positive or negative answers was statistically significantly related to the preservation of dignity according to the following questions (p < 0.005, multivariate logistic regression): “privacy to use the bathroom” and “respectful interaction”, as protective factors and “maintaining of body privacy”, “involvement in the care process”, “correct communication” as risk factors	Adopted a measureable approach to assessing dignity Clear aims Sample size small. Approach to sampling unclear. Methods of data analysis unclear
Heijkenskjö ld, Ekstedt and Lindwall (2010) Sweden	To understand how nurses experience patients’ dignity in Swedish medical wards 3 medical units in central Sweden	qualitative hermeneutic approach Flanagan’s critical incident technique Hermeneutic text interpretation	12 nurses working in medical units in Sweden	The findings show that the nurses who wanted to preserve patients’ dignity by seeing them as fellow beings protected the patients by stopping other nurses from performing unethical acts. They regard patients as fellow human beings, friends, and unique persons with their own history, and have the courage to see when patients’ dignity is violated.	Acknowledging authors preconceptions prior to analysis, detailed analysis process No double coding, self-report text hence respondents may only report what they believe the researcher wants to hear
UK	To explore inpatient and staff views on dignity The larger dignity study ran on 17 wards at a large London acute healthcare organisation across three hospital sites. Six wards were medical specialty wards, three were acute admission wards, four wards were surgical, three were older person wards (two medical and one surgical), and one was oncology ward.	Qualitative Recorded semi-structured interviews Pragmatic thematic analysis purposive and snowball sampling method	13 patients and 38 healthcare professionals 13 nurses, 9 doctors,4 occupational therapists, 3 pharmacists, 3 physiotherapists, 3 student nurses, 2 healthcare assistants, 1 ward administrator Total sample size: 51	The meaning of dignity was broadly agreed on by patients and staff. Three broad themes were identified: the meaning of dignity, staffing level and its impact on dignity, and organisational culture and dignity. Registered staff of all healthcare discipline and student nurses report very little training on dignity or care of the older person.	Attempt to ensure maximum variation of participants by selecting wards of different specialities. Detailed inclusion and exclusion criteria, use of an interview guide, confidentiality caveat well understood and acted on by research team where bad care was reported. Attempts to ensure comfort by conducting interview where participants felt most comfortable however this risked their confidentiality as some were conducted in the bay
UK	To explore the service user experience of detained care in particular relation to dignity and respect whilst sectioned. mental health trusts	Qualitative recorded semi-structured interviews inductive thematic approach purposive sampling technique	19 sectioned service users	The service users considered their dignity and respect compromised by 1) not being ‘heard’ by staff members, 2) a lack of involvement in decision-making regarding their care, 3) a lack of information about their treatment plans particularly medication, 4) lack of access to more talking therapies and therapeutic engagement, and 5) the physical setting/environment and lack of daily activities to alleviate their boredom	Aim clear, adequate interview guide used, an assuring confidentiality, the caveat about needing to escalate if harmful information was shared was added No allusion to what sort of research design was being used, audio recorded, and no triangulation

Characteristics of included studies

A total of 14 studies met the inclusion criteria and were thus included in this study. The majority (9) of included studies were conducted in the UK, one in Sweden, one in the Netherlands, one in Italy, one in Norway and one conducted across three countries (Sweden, Norway and Denmark). Seven studies considered dignity solely from the patient’s perspective, while five considered dignity from the perspective of both the patient and the healthcare professional, mainly nurses. A further three considered dignity solely from the perspectives of healthcare professionals, mainly nurses. Most studies (10) were hospital-based and hence considered perspectives of dignity within hospital environments, while four studies considered the perceptions of dignity within community settings. The majority of studies which considered dignity from the perspectives of patients had mainly older participants over the age of 60, even though the intention was to include eligible participants over the age of 18. All studies included female and male participants, and this was mostly balanced in included studies. Where studies considered the perceptions of healthcare professionals, nurses made up at least 50% of their study population.

The majority (12) of studies were qualitative in nature while two studies were quantitative. The sample sizes in most of the qualitative studies were small, the smallest ( Moen and Nåden, 2015 ) being seven and the largest ( Baillie et al., 2009 ) 1,110. However, this does not detract from the quality of the studies, as traditional qualitative research does not require a large sample size as the aim is not to generalise but to explore in-depth the nature of a given phenomenon ( Bajwah, et al, 2013 ). Most studies ( Baillie et al., 2009 ; Calnan et al., 2013 ; Chambers et al., 2014 ; Høy et al., 2016 ; Oosterveld-Vlug et al., 2014 ; Tauber-Gilmore et al., 2018 ; Webster and Bryan, 2009 ; Williams et al., 2016 ) adopted purposive or convenience sampling ( Hall et al., 2014 ; Matiti and Trorey, 2008 ). Where a purposive sample was used, three studies ( Calnan et al., 2013 ; Oosterveld-Vlug et al., 2014 ; Williams et al., 2016 ) attempted to achieve maximum variation by including participants or facilities of various characteristics within the sampled population. Data collection methods used in all the included studies include one or a combination of semi-structured interviews, non-participant observation and self-report text and questionnaires. Most studies used a variation of thematic content analysis for data analysis.

Thematic analysis

Themes and overarching themes for this study were generated following careful analysis of the included studies. Four overarching themes and 10 sub themes were developed from the study. Table 2 shows articles from which themes were generated.

Articles from which themes were generated.

Themes Generated	Articles
Independence/dependence	4, 26, 37 40, 43
Choice	4, 9, 21 24, 26, 37, 40, 49, 55
Staff attitudes	2, 4, 21, 24, 43, 49, 55, 59
Communication	4, 21, 24, 26, 40, 43, 49, 55
Privacy	2, 16, 21, 26, 37, 40, 55
Structure of services	2, 4, 7, 49
Staff shortages	2, 7, 9, 43
Physical environment	2, 4, 7, 9, 26, 37, 43
Respect	4, 9, 16, 21, 24, 37, 49
Person-centred care	4, 9, 21, 24, 26

Dependence/independence

Independence was overwhelmingly described as impacting on patient’s dignity in included papers. Studies by Oosterveld-Vlug et al. (2013), Hoy et al. (2016), Moen and Naden (2015) , Baillie (2009) and Matiti and Trorey (2008) suggest that the more dependent a patient, the more vulnerable they are to a loss of dignity, whilst independence was a protector of patient dignity. Hoy et al.’s (2016) study of dignity in nursing homes found a contradictory opinion by patients, with some reporting that being dependent did not threaten their dignity but instead gave them the help needed to improve their quality of life and, hence, their dignity. Dependence with intimate care was the aspect of care most reported as undignifying. In various studies ( Baillie et al., 2009 ; Tauber-Gilmore et al., 2018 ), it was reported that being admitted to the hospital was associated with being susceptible to a loss of dignity as a result of complexity of care provided. The indignity of certain required procedures and the hospital environment were also mentioned as some of the factors contributing to undignified care ( Baillie et al., 2009 ). In contrast, Oosterveld-Vulg et al.’s (2014) study on dignity and factors that influence dignity amongst nursing home residents found that admission to a nursing home did not in itself impact on dignity, but the associated increased dependence did affect dignity. Old age and being fragile were some of the reasons given. In the same vein, Calnan et al. (2013) in their study referred to older age as one stage of the life course where dignity may be threatened due to the vulnerability created by increased incapacity, frailty and cognitive decline.

Feeling powerless due to having no control or choice was reported by patients in several studies ( Chambers et al., 2014 ; Matiti and Trorey, 2008 ; Tauber-Gilmore et al., 2018 ; Webster and Bryan, 2009 ) as impacting on their dignity, while nurses in other studies ( Heijkenskjöld et al., 2010 ; Høy et al., 2016 ; Tauber-Gilmore et al., 2018 ) report promoting dignity by increasing choice and giving patients control wherever possible. Choice and control were commonly promoted in areas of personal care, involvement of family, meals, leisure activities and cultural and religious practices ( Baillie 2009 ; Hall et al., 2014 ; Heijkenskjöld et al., 2010 ). Two studies ( Matiti and Trorey, 2008 ; Moen and Nåden, 2015 ) showed how lack of involvement and choice threatened patient dignity as some patients reported feeling powerless and devalued because of this. Interestingly, whilst most nurses alluded to promoting choice and involvement with their patients, patients in some studies ( Calnan et al., 2013 ; Chambers et al., 2014 ; Hall et al., 2014 ) reported having their choices or preferences ignored due to a variety of factors such as staff shortages, staff attitudes, wanting to reduce work load and environmental or policy constraints.

The complexity of promoting choice whilst ensuring patient safety especially for patients with cognitive impairments was identified by nurses and home managers in two studies ( Hall et al., 2014 ; Heijkenskjöld et al., 2010 ). Hall et al. (2014) note that nurses can find themselves in a dilemma when a patient’s choice is deemed unreasonable or unsafe and attempts to negotiate safer choices are refused. Again, Baillie’s (2009) study found that more dependent patients had less control and choice irrespective of their age, hence making them more vulnerable to a loss of dignity. This is further reiterated by Chamber et al. (2014) who found that sectioned patients reported feeling undignified where physical or chemical restraint was used.

Healthcare delivery factors

Staff attitudes.

Promoting choice and control is closely related to staff attitudes. Where staff were dedicated to promoting choice and control, they exhibited positive attitudes such as listening to patients and taking them seriously (Ooterveld-Vlug et al., 2014), giving patients required attention and being kind ( Webster and Bryan 2009 ). The majority of the included studies ( Baillie, 2009 ; Baillie et al., 2009 ; Hall et al., 2014 ; Heijkenskjöld et al., 2010 ; Oosterveld-Vlug et al., 2014 ; Webster and Bryan, 2009 ; Williams et al., 2016 ; Tauber-Gilmore et al., 2018 ) reported staff attitude as impacting on patient dignity. Across studies, attitudes perceived as rude, inattentive, disrespectful, uncompassionate and insensitive were reported by patients as negatively affecting their dignity.

Specific episodes where nurses’ attitudes made patients feel devalued were described by patients and include offering a bed pan instead of the toilet when asked, peeping through drawn curtains, taking away buzzers to prevent patients from using them, telling patients to open bowels in pads, being bossy, speaking in an abrupt manner and refusing to answer buzzers ( Baillie, 2009 ; Tauber-Gilmore et al., 2018 ). Conversely, staff attitudes such as being treated with respect, acting in a sensitive and compassionate manner with regards to continence and personal care, being present and listening to patients were found to positively impact on patient dignity ( Heijkenskjöld et al., 2010 ). Consequently, Oosterveld-Vlug et al. (2014) and Høy et al. (2016) concluded that good professional care was a protector of patient dignity. Staff acknowledged that procedures carried out with the best intentions can become potentially undignifying if carried out without seeking adequate consent from the patient ( Baillie et al., 2009 ).

Communication

Communication was a key feature of patient and staff descriptions of dignity. For example, in Moen and Naden’s (2015) study, patients described feelings of indignity related to their inability to communicate due to serious illness, which was overcome once able to communicate. Another aspect of communication identified in other studies was the way and manner in which staff communicated with patients. When staff took their time to listen, provided sufficient information, made appropriate use of humour and used the right body language and tone, patients felt more dignified ( Hall et al., 2014 ; Moen and Naden, 2015 ; Webster and Bryan 2009 ). Conversely, poor and inappropriate communication such as talking over and ignoring patients detracted from the maintenance of patient dignity ( Baillie, 2009 ). Among staff, lack of time to adequately communicate with patients or an inability to communicate effectively was identified as infringing on patient dignity ( Heijkenskjöld et al., 2010 ; Tauber-Gilmore et al., 2018 ).

Patients and professionals in the included studies related privacy to dignity. Privacy of body was most referred to by patients when discussing dignity ( Baillie et al., 2009 ; Høy et al., 2016 ; Moen and Naden, 2015 ). Patients in one study ( Webster and Bryan, 2009 ) acknowledged that some bodily exposure and embarrassment were expected in hospital, however nurses’ attitudes were important in enhancing dignity. Staff preserved patients’ privacy by respecting personal space, knocking before entering rooms ( Hall et al., 2014 ) and drawing curtains prior to procedures requiring bodily exposure ( Baillie et al., 2009 ). Conversely, nurses failed to preserve dignity in terms of privacy when they failed to empathise with patients’ embarrassment during bodily exposure and failed to cover up exposed patients ( Ferri et al., 2015 ). A lack of auditory privacy was also identified in two studies ( Baillie, 2009 ; Matiti and Trorey, 2008 ) as threatening dignity.

Organisational factors

Structure of services.

The management and organisation of hospitals and care homes had a huge influence on patient dignity. Working in an organisation which prioritises dignity and dignity-promoting activities was identified by staff as paramount to delivering dignified care; however, where organisations were focused on meeting targets and staying financially afloat, patient care was often relegated to the back burner, in turn negatively influencing patient dignity ( Baillie, 2009 ; Baillie et al., 2009 ; Calnan et al., 2013 ; Tauber-Gilmore et al., 2018 ). Ward staff in two of the studies ( Baillie et al., 2009 ; Calnan et al., 2013 ) described the relentless pressure from management to move patients as quickly as possible in an effort to create beds to meet set targets, without regard to the impact this might have on the patient and their dignity. Patients in another study ( Baillie, 2009 ) recounted how being constantly moved about made them feel less human and just a number on the board.

Good leadership at all levels was also reported as positively impacting on patient dignity ( Baillie et al., 2009 ; Tauber-Gilmore et al., 2018 ). Baillie (2009) described the influence of good leadership on staff behaviours in relation to dignity on the ward since the ward manager was dedicated to ensuring dignified care, and led by example, this becoming evident in the behaviour of all staff. Additionally, nurses reported that an organisational focus on measureable aspects of care can detarct them from aspects of care which are immeasurable, such as the maintenance of patient dignity. This can, therefore, lead staff to focus on those aspects of care which are measureable, again impacting on patient dignity. Additionally, this can also lead to a focus on excessive documentation as opposed to providing actual dignified care ( Calnan et al., 2013 ).

The impact of organisation policies or ward culture can have unintentional consequences for patient dignity. This was highlighted by patients who described instances where choices were restricted and preferences ignored in a bid to follow organisational policies or structures. Such policies could in themselves independently impact on patient dignity as described by Calnan et al. (2013) where patients with infections are isolated in single rooms leaving them feeling dejected and abandoned.

Staff shortages

Nurses identified staffing levels as being of fundamental importance in maintaining patient dignity. Where there were staff shortages and heavy workloads nurses reported feeling unable to provide dignified care due to having to rush care in the limited time available in order to be able to meet the needs of all patients ( Baillie et al., 2009 ; Chambers et al., 2014 ; Calnan et al., 2013 ). Conversely, adequately staffed wards allowed nurses more time with the patients which improved patient dignity. Managers in Oosterveld-Vlug et al.'s (2014) study report having limited funds to employ permanent staff hence a reliance on temporary staff. Sadly, patients in the same study described how being cared for by different individuals threatened their dignity.

Physical environment

Factors related to the environment where care is provided were identified in eight studies ( Baillie, 2009 ; Baillie et al., 2009 ; Calnan et al., 2013 ; Chambers et al., 2014 ; Høy et al., 2016 ; Matiti and Trorey 2008 ; Oosterveld-Vlug et al., 2014 ; Webster and Bryan 2009 ) as influencing patient dignity. Observational findings by Calnan et al. (2013) depicted acute hospitals as confusing, poorly designed and inadequately signed such that patients, especially older patients, found it difficult finding their way which threatened their dignity. This was further corroborated by patients in semi-structured interviews who stated that similar looking wards made them feel confused and lost which took away any semblance of control they had.

Additionally, acute hospitals in included articles were characterised by limited space with care revolving around the patient’s bed space; such limited space can make care episodes, especially personal care, potentially undignifying for patients. Calnan et al. (2013) identified an interesting point with regards to the unavailability of spaces such as day rooms where patients can go for diversionary activities to pass time. Hospital stays with care revolving around the bed can leave patients bored or depressed and slow down recovery therefore threatening their dignity. On the other hand, Chambers et al. (2014) found that well designed wards with the right decoration can have a positive impact on patient dignity since patients reported feeling more relaxed in newly designed wards with better spaces.

Sharing a room or bay with other patients or service user was also identified as impacting on patient dignity, however findings were contradictory. Some studies ( Oosterveld-Vlug et al., 2014 ) found that sharing a room negatively impacted on patient dignity as it limited their privacy while other studies ( Baillie, 2009 ) found a positive influence on their dignity as they got to enjoy meaningful conversations with other patients, enabling solidarity amongst patients who felt comfortable being with other patients in similar conditions.

The meaning of dignity

Staff and patients in seven studies ( Baillie, 2009 ; Chamber et al., 2014 ; Ferri et al., 2015 ; Hall et al., 2014 ; Heijkenskjöld et al., 2010 ; Matiti and Trorey, 2008 ; Tauber-Gilmore et al., 2018 ) conceptualised dignity as being treated with respect. Dignity was mostly described by patients in terms of feelings. For example, feeling respected featured predominantly in patient descriptions of dignity and was frequently associated with being treated as human. Interestingly, only one study associated dignity to an inherent human right ( Baillie, 2009 ). Other terms such as being treated as worthy as opposed to insignificant were also used in their descriptions.

Person-centred care

Receiving care tailored to their specific needs was an essential feature of patient descriptions of dignity ( Tauber-Gilmore et al., 2018 ) however, this was more prominent in staff descriptions with many promoting choice as a way of tailoring care to meet patient needs ( Hall et al., 2014 ; Heijkenskjöld et al., 2010 ). The importance of paying attention to patient's individual preferences is most highlighted by a patient in Høy et al.’s (2016) study who, despite being an ardent baker in her youth, refuses to continue baking despite opportunities to do so. Prominent amongst patient descriptions is the need to continue to present themselves in a way that preserves their body-image or identity ( Baillie, 2009 ; Hall et al., 2014 ; Høy et al., 2016 ); hair styling, shaving, make up and putting on their own clothes were identified as ways of doing this. Helping patients to look well-groomed was also identified by nurses as a method of promoting dignity. Wearing hospital gowns, even though identified as a necessity when attached to certain devices by patients, was identified as negatively influencing dignity. Baillie (2009) in her observations comments on the lack of awareness by nurses on the potential for hospital gowns which are readily put-on patients to threaten their dignity, especially with regards to their design which often leaves patients’ buttocks exposed.

Forms of address were also identified by some patients and nurses as influencing dignity. The use of endearments which made patients feel like children was reported as undignifying ( Chambers et al., 2014 ; Heijkenskjöld et al., 2010 ). Another study ( Baillie, 2009 ) reported that being referred to by their first name was perceived as undignifying by a patient.

The study aimed to explore dignity as perceived by patients and nurses within hospital and community environments. A key finding of this review was that patients and nurses related dignity to respect or being treated as human. Consequently, findings suggest that when patients were treated with respect and treated others including other patients with respect, dignity was perceived as maintained. This finding has been replicated in other studies ( Lothian and Philp, 2001 ; Šaňáková and Čáp, 2019 ). With regards to being treated as human, nurse and patient perspectives indicate that this was an important component of human dignity. As has been popularly reported in the literature, this aspect of dignity is closely related to the intrinsic dignity inherent in every human by mere belonging to the human race ( Jacobson, 2009 ; Edlund et al., 2013 ).

The three overarching themes generated suggest that factors such as autonomy, healthcare delivery factors and organisational factors impacted on patient dignity. It established that autonomy was essential to the maintenance of patient dignity. Individuals have a right to be informed and make decisions for themselves which must not be violated unless it is determined the individual lacks the capacity to make the decision in question (MCA, 2005). Patients highlighted respecting their choices and providing information to enable choice as important to protecting their dignity.

Earlier studies, such as those of Hall et al. (2014) and Lothian and Philp (2001) have also identified the influence of autonomy on patient dignity. Additionally, this study showed that increased dependence due to impaired health negatively influenced patient autonomy and ultimately their dignity. However, Edlund et al. (2013) have argued that to reinstate damaged dignity one must accept the offer of help, accept and adjust to a new situation and allow oneself to be reliant on others through which a new form of dignity can be developed. Despite its importance to the maintenance of patient dignity Barclay (2016) notes that respect for patient autonomy is not synonymous with dignity.

The complexity of respecting patient autonomy whilst ensuring patient safety was identified by nurses in this study. This presents a dilemma where a patient can make autonomous decisions, it therefore becomes a balancing act between managing patient risk and respecting their autonomous wishes ( Jakobsen and Sørlie, 2010 ; Ryan, 2003 ). This is made worse by the increasingly litigious culture propelling staff to ignore patient autonomy in a bid to minimise risk (Dimond, 2016). Mattiasson et al. (2005) have commented on the vulnerability to paternalism experienced by dependent patients even though beneficially meant but harmful to patient autonomy hence dignity. However, nurses have a legal, professional and ethical duty to respect patient autonomy hence, once a patient has the mental capacity to make a decision this must then be respected, since a failure to do so could lead to professional and legal sanctions (MCA 2005; Griffith and Tengah, 2017; NMC 2018). The link between dignity and staff behaviour has been widely reported. This highlights the notion of interpersonal dignity whereby behaviours from others convey feelings of worth ( Jacelon, 2003 ).

This finding has been echoed in the findings of previous studies about dignity with consistency ( Ebrahimi et al 2012 ; Hanson, 2014). For example, Koppelman (2002) found that when nurses did not treat patients as human or referred to them in terms of their primary illness or condition, this amounted to objectifying the patient thus violating their dignity. Lothian and Philp (2001) and Mullen (2019) found that when staff leave patients in a vulnerable position such as incorrect assumptions about patients’ continence, being slow to answer call buzzers and making rude comments when toileting was requested, patients felt devalued. Failings in this most basic of needs were highlighted in the Francis Report (2013) but recent studies continue to show that lessons have not been fully learnt. In other studies, findings indicated that prompt and skilled care earned patient trust in both the professional and their sense of security ( Efraimsson et al., 2001 ; Widäng and Fridlund, 2003 ).

In this study patients' and nurses’ accounts of dignity enhancing communication were similar, both featuring descriptions of instances where the nurse took time to explain treatment, listen to and address patient concerns, and involved the patient where possible. These are all characteristics of effective communication according to Bramhall (2014) . Likewise, earlier studies highlighted the significance of effective communication in the maintenance of patient dignity, for instance Kirk et al. (2004) and Thorne et al. (2013) found that patients and their families expected healthcare professionals to be expert communicators with the ability to initiate conversations and share important information. A patient-centred communication style has been proposed to improve patient understanding of their care ( Robinson et al., 2008 ). Communication styles which use open-ended questions, pay attention to patient concerns and allow time for patients to express themselves have been identified as patient centred ( Howie et al., 2004 ).

The influence of staff shortages on patient dignity was identified by both patients and nurses in this study. Due to poor staffing, nurses reported having heavier workloads and less time to appropriately interact with patients which detracted from their dignity. This supports findings from a previous study by Baillie (2008) where nurses report experiencing moral distress due to an inability to provide dignified care because of heavy workloads and time constraints.

This review found more similarity than differences in patient and nurse perceptions of dignity. A striking difference was the importance of confidentiality in the maintenance of dignity which was mostly prominent in staff descriptions but rarely present in patient descriptions. This may be due to nurses’ awareness of the legal, ethical and professional implications of a breach in confidentiality which may be lost to the patient. Another important difference was in patient and nurse descriptions of care. Even though patients identified and described poor care, nurses rarely described any episodes of poor care. It can only be speculated as to why this was the case; possibly because these incidents were more noticeable to patients or because nurses were unwilling to report such events. The importance of healthcare professionals and patients having a shared understanding of what dignity means is important for ensuring dignified care ( Barclay, 2016 ). Cronican (2017) has also reported how a lack of awareness of dignity-compromising situations or what is perceived as dignified can influence patient dignity via nurse–patient interactions.

Strengths and limitations

No research is flawless ( Harvard, 2007 ). We have systematically undertaken all steps required to review the literature. The researchers acknowledge that this study has various strengths and limitations. Firstly, the study was limited by the methods of literature searching. The search was only conducted using official electronic scientific databases accessible from the authors’ institution. It is possible that some significant articles are indexed in other databases to which the authors had no access. While the study might have been limited by the search strategy applied, this does not diminish the relevance of our findings and the value added to knowledge. The researchers made efforts to ensure all published articles relevant to the study were identified and included. Additional search strategies such as chain referencing were also adopted in order to identify all studies which may have been missed due to the above issues. An additional limitation, relating to identifying all relevant studies, was the fact that no effort was made to identify unpublished studies relevant to the study; this is particularly important as the impact of publication bias is well documented ( Moher et al., 2009 ). It is therefore possible that relevant unpublished work which may have reported contradictory findings was missed. Future studies should therefore endeavour to contact key scholars in the area of study as they may have other studies which are relevant for inclusion.

Secondly, this review was limited to studies conducted in European countries and it is possible that including studies published elsewhere could have resulted in different findings and further illuminated the concept of dignity from other cultural perspectives. Despite these limitations the study has several strengths since much of the literature around dignity has focused on dignity in an end-of-life context.

This study has synthesised knowledge around perceptions of dignity amongst patients and nurses, outside of the context of end of life. Dignity has been shown to have an important influence on the patients care journey. Various factors impact on patient dignity and how it is perceived. This review provides information on dignity from patients’ and nurses’ perspectives in a healthcare setting. The adoption of a person-centred approach may affect positive changes on patient dignity in hospitals. Furthermore, this review provides information for healthcare professionals, especially nurses, on what dignity in care is and how best to promote patient dignity. Preserving dignity is especially important in care for older patients because of their vulnerability. Educational materials should be developed based on the themes and subthemes synthesised in this study.

Key points for policy, practice and/or research

Independence enhanced dignity and confidence.
Choice is key to empowerment of patients and preservation of dignity.
Communication is an essential feature in enhancing a positive and dignified relationship between nurses and patients.
There is a strong relationship between privacy and dignity for both nurses and patients.
Receiving care tailored to specific needs is an essential feature of patient dignity.
The physical environment can impact on care and dignity.

Acknowledgements

We wish to thank the University of Wolverhampton library staff for their assistance with the literature searches.

Mandu Stephen Ekpenyong has researched widely around maternal health including dignity in health and social care among both patients and professionals.

Mathew Nyashanu has undertaken much work around HIV and sexual health, including social justice in health and social care for various social groups.

Laura Serrant has wide experience in sexual health research including dignity in health care. Laura is accredited for developing the Silences Framework a conceptual framework for researching marginalised issues in communities.

Chioma Ossey-Nweze is a specialist heart coronary nurse with a wide range of working with different groups of patients.

Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Ethics: Ethics approval were not needed for this literature review.

Funding: The authors received no financial support for the research, authorship, and/or publication of this article.

ORCID iD: Mathew Nyashanu https://orcid.org/0000-0001-7324-3837 .

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10 Reasons Why Human Rights Are Important

Interest and awareness of human rights has grown in recent decades. In 1948, the United Nations released the Universal Declaration of Human Rights, which has become the most important document of what should be considered the standard for basic equality and human dignity. Why do human rights matter? Here are ten specific reasons:

#1: Human rights ensure people have basic needs met

Everyone needs access to medicine, food and water, clothes, and shelter. By including these in a person’s basic human rights, everyone has a baseline level of dignity. Unfortunately, there are still millions of people out there who don’t have these necessities, but saying it’s a matter of human rights allows activists and others to work towards getting those for everyone.

#2: Human rights protect vulnerable groups from abuse

The Declaration of Human Rights was created largely because of the Holocaust and the horrors of WII. During that time in history, the most vulnerable in society were targeted along with the Jewish population, including those with disabilities and LGBT. Organizations concerned with human rights focus on members of society most vulnerable to abuse from powerholders, instead of ignoring them.

#3: Human rights allow people to stand up to societal corruption

The concept of human rights allows people to speak up when they experience abuse and corruption. This is why specific rights like the right to assemble are so crucial because no society is perfect. The concept of human rights empowers people and tells them that they deserve dignity from society, whether it’s the government or their work environment. When they don’t receive it, they can stand up.

#4: Human rights encourage freedom of speech and expression

While similar to what you just read above, being able to speak freely without fear of brutal reprisal is more expansive. It encompasses ideas and forms of expression that not everybody will like or agree with, but no one should ever feel like they are going to be in danger from their government because of what they think. It goes both ways, too, and protects people who want to debate or argue with certain ideas expressed in their society.

#5: Human rights give people the freedom to practice their religion (or not practice any)

Religious violence and oppression occur over and over again all across history, from the Crusades to the Holocaust to modern terrorism in the name of religion. Human rights acknowledges the importance of a person’s religion and spiritual beliefs, and lets them practice in peace. The freedom to not hold to a religion is also a human right.

#6: Human rights allows people to love who they choose

The importance of freedom to love cannot be understated. Being able to choose what one’s romantic life looks like is an essential human right. The consequences of not protecting this right are clear when you look at countries where LGBT people are oppressed and abused, or where women are forced into marriages they don’t want.

#7: Human rights encourage equal work opportunities

The right to work and make a living allows people to flourish in their society. Without acknowledging that the work environment can be biased or downright oppressive, people find themselves enduring abuse or insufficient opportunities. The concept of human rights provides a guide for how workers should be treated and encourages equality.

#8: Human rights give people access to education

Education is important for so many reasons and is crucial for societies where poverty is common. Organizations and governments concerned with human rights provide access to schooling, supplies, and more in order to halt the cycle of poverty. Seeing education as a right means everyone can get access, not just the elite.

#9: Human rights protect the environment

The marriage between human rights and environmentalism is becoming stronger due to climate change and the effects it has on people. We live in the world, we need the land, so it makes sense that what happens to the environment impacts humanity. The right to clean air, clean soil, and clean water are all as important as the other rights included in this list.

#10: Human rights provide a universal standard that holds governments accountable

When the UDHR was released, it had a two-fold purpose: provide a guideline for the future and force the world to acknowledge that during WWII, human rights had been violated on a massive scale. With a standard for what is a human right, governments can be held accountable for their actions. There’s power in naming an injustice and pointing to a precedent, which makes the UDHR and other human right documents so important.

Do you want to learn more about why human rights are important? Take a free online course on human rights offered by top universities.

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About the author, emmaline soken-huberty.

Emmaline Soken-Huberty is a freelance writer based in Portland, Oregon. She started to become interested in human rights while attending college, eventually getting a concentration in human rights and humanitarianism. LGBTQ+ rights, women’s rights, and climate change are of special concern to her. In her spare time, she can be found reading or enjoying Oregon’s natural beauty with her husband and dog.

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Universal Declaration of Human Rights

The Universal Declaration of Human Rights (UDHR) is a milestone document in the history of human rights. Drafted by representatives with different legal and cultural backgrounds from all regions of the world, the Declaration was proclaimed by the United Nations General Assembly in Paris on 10 December 1948 ( General Assembly resolution 217 A ) as a common standard of achievements for all peoples and all nations. It sets out, for the first time, fundamental human rights to be universally protected and it has been translated into over 500 languages . The UDHR is widely recognized as having inspired, and paved the way for, the adoption of more than seventy human rights treaties, applied today on a permanent basis at global and regional levels (all containing references to it in their preambles).

Whereas recognition of the inherent dignity and of the equal and inalienable rights of all members of the human family is the foundation of freedom, justice and peace in the world,

Whereas disregard and contempt for human rights have resulted in barbarous acts which have outraged the conscience of mankind, and the advent of a world in which human beings shall enjoy freedom of speech and belief and freedom from fear and want has been proclaimed as the highest aspiration of the common people,

Whereas it is essential, if man is not to be compelled to have recourse, as a last resort, to rebellion against tyranny and oppression, that human rights should be protected by the rule of law,

Whereas it is essential to promote the development of friendly relations between nations,

Whereas the peoples of the United Nations have in the Charter reaffirmed their faith in fundamental human rights, in the dignity and worth of the human person and in the equal rights of men and women and have determined to promote social progress and better standards of life in larger freedom,

Whereas Member States have pledged themselves to achieve, in co-operation with the United Nations, the promotion of universal respect for and observance of human rights and fundamental freedoms,

Whereas a common understanding of these rights and freedoms is of the greatest importance for the full realization of this pledge,

Now, therefore,

The General Assembly,

Proclaims this Universal Declaration of Human Rights as a common standard of achievement for all peoples and all nations, to the end that every individual and every organ of society, keeping this Declaration constantly in mind, shall strive by teaching and education to promote respect for these rights and freedoms and by progressive measures, national and international, to secure their universal and effective recognition and observance, both among the peoples of Member States themselves and among the peoples of territories under their jurisdiction.

All human beings are born free and equal in dignity and rights. They are endowed with reason and conscience and should act towards one another in a spirit of brotherhood.

Everyone is entitled to all the rights and freedoms set forth in this Declaration, without distinction of any kind, such as race, colour, sex, language, religion, political or other opinion, national or social origin, property, birth or other status. Furthermore, no distinction shall be made on the basis of the political, jurisdictional or international status of the country or territory to which a person belongs, whether it be independent, trust, non-self-governing or under any other limitation of sovereignty.

Everyone has the right to life, liberty and security of person.

No one shall be held in slavery or servitude; slavery and the slave trade shall be prohibited in all their forms.

No one shall be subjected to torture or to cruel, inhuman or degrading treatment or punishment.

Everyone has the right to recognition everywhere as a person before the law.

All are equal before the law and are entitled without any discrimination to equal protection of the law. All are entitled to equal protection against any discrimination in violation of this Declaration and against any incitement to such discrimination.

Everyone has the right to an effective remedy by the competent national tribunals for acts violating the fundamental rights granted him by the constitution or by law.

No one shall be subjected to arbitrary arrest, detention or exile.

Everyone is entitled in full equality to a fair and public hearing by an independent and impartial tribunal, in the determination of his rights and obligations and of any criminal charge against him.

Everyone charged with a penal offence has the right to be presumed innocent until proved guilty according to law in a public trial at which he has had all the guarantees necessary for his defence.
No one shall be held guilty of any penal offence on account of any act or omission which did not constitute a penal offence, under national or international law, at the time when it was committed. Nor shall a heavier penalty be imposed than the one that was applicable at the time the penal offence was committed.

No one shall be subjected to arbitrary interference with his privacy, family, home or correspondence, nor to attacks upon his honour and reputation. Everyone has the right to the protection of the law against such interference or attacks.

Everyone has the right to freedom of movement and residence within the borders of each state.
Everyone has the right to leave any country, including his own, and to return to his country.
Everyone has the right to seek and to enjoy in other countries asylum from persecution.
This right may not be invoked in the case of prosecutions genuinely arising from non-political crimes or from acts contrary to the purposes and principles of the United Nations.
Everyone has the right to a nationality.
No one shall be arbitrarily deprived of his nationality nor denied the right to change his nationality.
Men and women of full age, without any limitation due to race, nationality or religion, have the right to marry and to found a family. They are entitled to equal rights as to marriage, during marriage and at its dissolution.
Marriage shall be entered into only with the free and full consent of the intending spouses.
The family is the natural and fundamental group unit of society and is entitled to protection by society and the State.
Everyone has the right to own property alone as well as in association with others.
No one shall be arbitrarily deprived of his property.

Everyone has the right to freedom of thought, conscience and religion; this right includes freedom to change his religion or belief, and freedom, either alone or in community with others and in public or private, to manifest his religion or belief in teaching, practice, worship and observance.

Everyone has the right to freedom of opinion and expression; this right includes freedom to hold opinions without interference and to seek, receive and impart information and ideas through any media and regardless of frontiers.

Everyone has the right to freedom of peaceful assembly and association.
No one may be compelled to belong to an association.
Everyone has the right to take part in the government of his country, directly or through freely chosen representatives.
Everyone has the right of equal access to public service in his country.
The will of the people shall be the basis of the authority of government; this will shall be expressed in periodic and genuine elections which shall be by universal and equal suffrage and shall be held by secret vote or by equivalent free voting procedures.

Everyone, as a member of society, has the right to social security and is entitled to realization, through national effort and international co-operation and in accordance with the organization and resources of each State, of the economic, social and cultural rights indispensable for his dignity and the free development of his personality.

Everyone has the right to work, to free choice of employment, to just and favourable conditions of work and to protection against unemployment.
Everyone, without any discrimination, has the right to equal pay for equal work.
Everyone who works has the right to just and favourable remuneration ensuring for himself and his family an existence worthy of human dignity, and supplemented, if necessary, by other means of social protection.
Everyone has the right to form and to join trade unions for the protection of his interests.

Everyone has the right to rest and leisure, including reasonable limitation of working hours and periodic holidays with pay.

Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.
Motherhood and childhood are entitled to special care and assistance. All children, whether born in or out of wedlock, shall enjoy the same social protection.
Everyone has the right to education. Education shall be free, at least in the elementary and fundamental stages. Elementary education shall be compulsory. Technical and professional education shall be made generally available and higher education shall be equally accessible to all on the basis of merit.
Education shall be directed to the full development of the human personality and to the strengthening of respect for human rights and fundamental freedoms. It shall promote understanding, tolerance and friendship among all nations, racial or religious groups, and shall further the activities of the United Nations for the maintenance of peace.
Parents have a prior right to choose the kind of education that shall be given to their children.
Everyone has the right freely to participate in the cultural life of the community, to enjoy the arts and to share in scientific advancement and its benefits.
Everyone has the right to the protection of the moral and material interests resulting from any scientific, literary or artistic production of which he is the author.

Everyone is entitled to a social and international order in which the rights and freedoms set forth in this Declaration can be fully realized.

Everyone has duties to the community in which alone the free and full development of his personality is possible.
In the exercise of his rights and freedoms, everyone shall be subject only to such limitations as are determined by law solely for the purpose of securing due recognition and respect for the rights and freedoms of others and of meeting the just requirements of morality, public order and the general welfare in a democratic society.
These rights and freedoms may in no case be exercised contrary to the purposes and principles of the United Nations.

Nothing in this Declaration may be interpreted as implying for any State, group or person any right to engage in any activity or to perform any act aimed at the destruction of any of the rights and freedoms set forth herein.

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2023: UDHR turns 75

What is the Declaration of Human Rights? Narrated by Morgan Freeman.

UN digital ambassador Elyx animates the UDHR

cards with stick figure illustrating human rights

To mark the 75th anniversary of the UDHR in December 2023, the United Nations has partnered once again with French digital artist YAK (Yacine Ait Kaci) – whose illustrated character Elyx is the first digital ambassador of the United Nations – on an animated version of the 30 Articles of the Universal Declaration of Human Rights.

UDHR Illustrated

Cover of the illustrated version of the UDHR.

Read the Illustrated edition of the Universal Declaration of Human Rights

UDHR in 80+ languages

Watch and listen to people around the world reading articles of the Universal Declaration of Human Rights in more than 80 languages.

Women Who Shaped the Declaration

Mrs. Eleanor Roosevelt, seated at right speaking with Mrs. Hansa Mehta who stands next to her.

Women delegates from various countries played a key role in getting women’s rights included in the Declaration. Hansa Mehta of India (standing above Eleanor Roosevelt) is widely credited with changing the phrase "All men are born free and equal" to "All human beings are born free and equal" in Article 1 of the Universal Declaration of Human Rights.

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DOI: 10.54097/xrdhyh95
Corpus ID: 267352029

The study of structure and function of human cell

Published in Highlights in Science… 29 December 2023
Biology, Medicine

12 References

Er stress and upr in alzheimer’s disease: mechanisms, pathogenesis, treatments, cell death by pyroptosis drives cd4 t-cell depletion in hiv-1 infection, targeting lactate dehydrogenase b-dependent mitochondrial metabolism affects tumor initiating cells and inhibits tumorigenesis of non-small cell lung cancer by inducing mtdna damage.

Highly Influential

Global cancer statistics

Ifi16 dna sensor is required for death of lymphoid cd4 t cells abortively infected with hiv, [emery-dreifuss muscular dystrophy]., treacher collins syndrome: genetics, clinical features and management, diamond-blackfan anemia, molecular cell biology, related papers.

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