Recovering a Christian understanding of 'dignity' in healthcare

Dignity is a word in crisis. It is used often in law, ethics and ordinary conversation, yet despite the ubiquity of the term, and the intuition that it rightly describes an aspect of being human, it remains to be seen whether using the word is - in practice - a helpful means to define the parameters of ethical action.

For some scholars, “dignity” is incoherent rhetoric, a kind of slogan improperly smuggled into bioethics by religious people who oppose moral autonomy and wish to block progress in medical research. “Dignity” - according to these scholars - is nothing more or less than respect for individual autonomy, and so no other words are needed to describe an established principle of bioethics. Dignity is the property of a being who exercises his or her moral preference without undue constraints. This “autonomy paradigm” of human dignity is rooted in Enlightenment philosophical traditions, which have evolved toward materialist and utilitarian worldviews.

For others, every human being without exception possesses an intrinsic, God-given, inviolable dignity which serves as the reliable foundation of human equality and as a safeguard to ensure that scientists respect and serve every human being and not some at the expense of others. This group promotes the “image and likeness” paradigm of human dignity rooted in Judeo-Christian tradition.

One is a dignity grounded on the prerogatives of subjective preferences, where truth is defined by consensus of majorities. The other is a dignity grounded on transcendence, where human beings can discover the truth by responding to the invitation of a personal God to love Him and one another. “Love” is understood as one person taking responsibility for the dignity of another.

The confrontation of these two approaches might be considered the fault line of today’s dignity debates.

The many meanings of “dignity”

Over the course of history, beginning with the first known use of the term - dignus or dignitas - by Stoic philosophers in the 2nd century BCE, uses of the word “dignity” have varied, but they all might exist on a plane defined by three points, or words.

The notion of worth implies the appreciation of an inherent value within a human being. There is something constitutive of an individual which elicits reverence, honour, or special consideration. This point might include Kantian notions of dignity: worth based on the capacity to will our own ends and the duty to make our choices worthy of our unique moral standing. The “image and likeness” paradigm of the Judeo-Christian tradition would also be included here.

The notion of status implies value assigned to the person externally, by a group or society. It is being honoured or honourable. Here we could include Cicero’s stoic conception of dignity linked to the possession of authority; or status conferred by the exercise of power.

Although he never offered a comprehensive treatment of the notion of dignity, Thomas Aquinas’ sporadic references to dignity included senses linked to the status of authority – the dignity of a particular office or role – as well as dignity associated with being in one’s proper place in the cosmos, a hierarchical sense of dignity that could be applied to human persons, animals, and even non-sentient objects. There is a “dignity” to be found in “order”: it belongs to the being that fulfils its proper purpose by being in its proper place.

Thomas Hobbes emphasized the “status” of a human being - his dignity - as completely “dependent upon the need and judgement of another”. The value of a human being for Hobbes is completely relative: it is the arbitrary price that social consensus might set on a particular human life. Your dignity is your “market value”, your “productivity” in society.

The notion of bearing would include the possession of certain external, observable characteristics: a dignified bearing suggests being restrained in one’s behaviour, exhibiting a proper comportment, “stuffiness”, showing no exaggerated emotion. This is dignity as “gravitas”.

Stoic philosophers like Cicero and Seneca rooted dignity in rationality: humans possessed dignity insofar as their actions were guided by reason and reflection as opposed to their impulsive, disordered appetites. Not all men could achieve this, and so for the ancients, dignity was not a universal attribute of every human being, but only of some.

Here we could also include more contemporary notions of dignity founded on capacities: dementia, disfigurement, incontinence, excessive dependency on others might be assessed as a loss of dignity based on loss of dignified bearing, or acquiring discapacities which make us externally unseemly.

Historically, these varied senses of “dignity” seemed to narrow after the massive violations that occurred during the industrial revolution of the late 19th century and under the totalitarian regimes of the 20th century. It was during this time that Catholic magisterial teaching seemed to elevate “human dignity” - expressed through the “image and likeness” paradigm – as a valuable concept for arguing against those abuses. As a term of art, the word “dignity” arrived late to the lexicon of Christian intellectuals, and today, mostly in response to perceived affronts to our special status.

Christian dignity: lived first, then defined

With the arrival of Christianity, a new and very different understanding of the meaning of human existence entered history and gradually drove the shift from a pagan anthropology toward a Judeo-Christian anthropology. This shift was driven by an implicit understanding among believers of what we call today “human dignity”: they affirmed with deeds the infinite value of each and every human being.

From Antiquity to the Renaissance, Christian intellectuals might not have used the word “dignitas” very often, but it is indisputable that early Christians - whether intellectuals or not - thought and acted in ways that reflected a new and distinctive appreciation of the special status of every human being. This was most clearly expressed in their care for the weak and vulnerable, and their refusal to abandon the sick during pandemics, practices which eventually resulted in a more organized system of hospices and hospitals, and in rational scientific inquiry attempting to understand the root causes of diseases affecting humanity. Lacking the more sophisticated scientific understanding of human biology that we enjoy today, they lived out an anthropology of human dignity without calling it that.

The Judeo-Christian notion of human dignity is founded on the rare scriptural references to man as created in the “image and likeness” of God, words that appear only three times in the Hebrew Bible (Gen 1:26-27; Gen 5:1, and Gen 9:6) but are referred to often in the works of early Christian intellectuals.

By “image” we can understand the accurate reflection of a being - a copy, as in a mirror or a photo - and “likeness” as a “re-presentation” of that being, a “re-production”: recognizable but fundamentally inexact.

Because being human implies possession of spiritual faculties - memory, a rational intellect, free will, the capacity to love - every human being is the “image” of God. The relationship between the original and its image expresses the relationship between God and humans: there is no intermediary between them. God participates immediately in the creation of each human being. We reflect or “image” the being of God.

Insofar as humans are images of God, we can re-present the likeness of God in time and space, “enabling” God’s presence in the created world in a way no other creature can, with an active and responsible role, yet inexact and flawed.

Through the proper exercise of reason and freedom, we can add certain perfections to material things, and so it may be said that human beings are – or at least should be - “co-creators” with God in the perfecting of the material order.

Writing over 1500 years ago, Peter Chrysologus, an early Christian intellectual, speaks to us eloquently of human dignity, but never needs to use the word:

...Why then, man, are you so worthless in your own eyes and yet so precious to God? Why render yourself such dishonour when you are honoured by Him? Why do you ask how you were created and do not seek to know why you were made? …

Was not this entire visible universe made for your dwelling? ….

He has made you in his image that you might in your person make the invisible Creator present on earth; he has made you his legate, so that the vast empire of the world might have the Lord's representative.

Then in his mercy, God assumed what he made in you; he wanted now to be truly manifest in man, just as he had wished to be revealed in man as in an image. Now he would be in reality what he had submitted to be in symbol.

In encouraging his audience to view themselves differently, to acknowledge their own dignity, he first points to the image of God which disposes us to re-present God to the cosmos, but then suggests another dimension to dignity: God draws even closer to human beings who may now become more than just an “image” and a “likeness”.

From “image and likeness” to “ipse Christus”

His words echo in more recent documents of the Catholic Church’s teaching authority. Paragraph 7 of Dignitas personae, for example, refers to Gaudium et spes, 22:

In the mystery of the Incarnation, the Son of God confirmed the dignity of the body and soul which constitute the human being. Christ did not disdain human bodyliness, but instead fully disclosed its meaning and value: “In reality, it is only in the mystery of the incarnate Word that the mystery of man truly becomes clear”.

The “image and likeness” paradigm - dignity based on human nature - seems to undergo a decisive shift with the incarnation. We are brought to a very different understanding of who we are capable of becoming.

With the incarnation, the human body becomes a means of divine revelation.

With the incarnation, there also seems to be a shift from the universal sense of “dignity” to a particular “dignity”: all human beings, created in the image and likeness of God, are now redeemed by and transformed to Christ - perfect God and perfect Man - by means of the sacrament of baptism. This sacrament is administered once to particular members of the human species.

All human beings are created by the same God. Some human beings are baptized and others are not. And so we might speak of the particular dignity of the baptized, who are spiritually transformed into “other Christs”, and potentially - we could argue - into “Christ Himself” through the action of the Holy Spirit and the free cooperation of the baptized person.

It is through baptism that God “reinforces” - as it were - the original call to re-present God before creation with the responsibility not only of co-creators, but now of co-redeemers. And with this special, particular dignity comes a greater responsibility before God and before all humanity.

So the particular dignity of a baptized Christian necessarily moves toward the universal: the free and responsible participation of the baptized in the redemption of all mankind and of all creation.

We may be able to properly speak of the baptized as “Christ Himself”, insofar as baptism - in fact - causes the participation of a particular human being in the hypostatic union: the union of divine nature with human nature in a particular human person.

The notion of the Christian as “alter Christus, ipse Christus” has precedence throughout the writings of Saint Josemaría Escrivá (1) who emphasized the universal call to holiness and apostolate; and in the moving, posthumously published writings of Gabrielle Bossis, collected in the book He and I.

So here we might propose an evolutionary step within the “image and likeness” paradigm, expressed as pre- and post-incarnational dimensions of human dignity. A natural and universal human dignity gives way to a supernatural and particular dignity with universal implications. Resemblance to God the Father, becomes identification with Christ. The entire human family is invited to share in this new and exalted dignity through the action of the baptized who cooperate with the action of the Holy Spirit.

Time for action not words?

For many bioethicists today, all this is basically nonsense. We can’t agree on what dignity means because we can’t agree on what it means to be human. Invoking the “hypostatic union” to argue for human dignity probably does not foster consensus, but only serves to entrench and polarize opposing viewpoints. Even though we could reliably trace the empiric, historical development of the “image and likeness” paradigm of dignity over millennia, the metaphysics of this paradigm becomes a stumbling block: our secular-materialist friends have a hard time appreciating a good mystery.

So what good is the notion of “dignity” today? Does it unify or polarize? Perhaps it might be best to set aside the semantics and focus - like the first Christians - on actions rather than words: to break out of our autonomous self-reliance and live for others. In doing so - striving to live up to the dignity of our baptism - we may make the metaphysical - the mysterious - a visible reality in the physical world.  

Adapted from an oral presentation given at the Fall Conference of the Notre Dame Center for Ethics & Culture on November 11, 2021 (1)

(1) Antonio Aranda. El cristiano, “alter Christus, ipse Christus”, en el pensamiento del Beato Josemaria Escriva de Balaguer. Scripta Theologica26: 513-570, 1994 and also Paul O’Callaghan. The inseparability of holiness and apostolate. The Christian, “alter Christus, ipse Christus”, in the writings of Blessed Josemaria Escriva. Annales theologici 16: 135-164, 2002


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