Human Dignity and Bioethics: Essays Commissioned by the President's Council on Bioethics

Chapter 13: Kant's Concept of Human Dignity as a Resource for Bioethics

Susan M. Shell

Is "human dignity" a vacuous concept-a mere placeholder for varying ethical commitments and biases-or has it a useful role to play in bioethics? The former impression is seemingly confirmed by the disparate uses to which "human dignity" is put by opposing sides in contemporary bioethical debates. For the liberal and secular left, it is generally associated with personal "autonomy" and expanded individual choice.ⁱ For the conservative and religious right, it is generally associated with the sanctity of "life" and related limits on such choice. Does the term "human dignity" merely encourage each side to talk past the other, or can it supply fruitful common ground?

The purpose of this paper is to explore Kant's concept of human dignity as a potential resource for contemporary bioethical debates. The name of Kant is frequently invoked in such discussions, but generally only in passing. On the one hand, Immanuel Kant is surely the philosopher who put the concept of human dignity on the map of modern moral discourse. Few thinkers on either the right or left, and whether religious or secular, fail to pay him homage. Prevailing contemporary views concerning patient "autonomy" and informed consent surely reflect a clear Kantian provenance.¹ On the other hand, his thought can appear too rigidly dualistic to offer much practical guidance on more difficult and contentious issues, such as stem cell research and other matters that touch upon the limits of what is and isn't "human." My guiding hypothesis is that a more complete and fully rounded view of Kant's thought can indeed shed useful, non-question-begging light on such liminal questions. Despite his reputation as a rigid dualist, Kant's thought has much to offer bioethical debate in a liberal democratic context. As I hope to show, one need not be a strict Kantian to find many of his arguments helpful in supplying common ground to citizens of otherwise diverse moral and religious views. The key to such a retrieval lies in giving Kant's notion of "humanity" as embodied rationality the attention it deserves.

Dignity and Embodied Rationality

Kant's concept of human dignity has two components: humanity and dignity. "Dignity" ( Würde ) designates a value that has no equivalent-i.e., that which is "beyond price." As he puts it in a famous passage of the Groundwork of the Metaphysics of Morals :

What is related to general human inclinations and needs has a market price ; that which, even without presupposing such a need, conforms with a certain taste.has a fancy price ; but that which constitutes the condition under which alone something can be an end in itself has not merely a relative value, that is, a price, but an inner value, that is, dignity .. Morality, and humanity insofar as it is capable of morality, is that which alone has dignity.²

This manner of speaking has particular resonance in a commercial society like ours, in which almost all goods are commodified or seem capable of becoming so. The concept of "dignity" gains much of its moral force from its insistence upon an absolute limit to the fungibility of human goods. If something has intrinsic worth, or dignity, then not all values are homogenous. Hobbes had infamously insisted that "a man's worth" is the same as his "price," or the "amount that would be paid for the use of his power."³ Kant's concept of human dignity is a direct rejoinder to that claim.

The ultimate basis of that rejoinder is what Kant calls the categorical imperative-the implicit moral command to which the voice of conscience, in his view, testifies. According to the first and most basic version of that imperative, one should act "only according to those maxims [or rules of action] that one could at the same time will to be a universal law." This version of the imperative is often criticized-first and most famously by Hegel-for its empty formalism, and I will not pause here to consider it. Instead, it will be more fruitful to move to a second version, which commands: So act that you use humanity, whether in your own person or in the person of any other, always at the same time as an end, never merely as a means.⁴ Kant derives this second version from the fact that willing requires an end, and in the case of moral willing, an absolute end, or end in itself. Unlike ends that are "to be acquired by our action," and are thus "conditional" in value-either on our desires or on the contingencies of nature-an end in itself has objective value, or "dignity." Kant had earlier claimed that the only thing "good without limitation" that is possible to think is a good will. But a good will must have some objective end if it is not to be utterly empty. If morality is to be possible at all-if a "good will" is to have an objective end-then good will itself, or the rationality that makes it possible, is the only candidate that can fill the bill.

Such are the considerations behind the following exclamation on Kant's part:

Now I say that the human being and in general every rational being exists not merely as a means to be used by this or that will at its discretion; instead he must in all his actions. always be regarded at the same time as an end.⁵

The idea of humanity as an "objective end" refers not to a goal to be achieved by our action (as in the usual meaning of an "end") but to an absolute limit that restricts our other ends and maxims, and the activities they prompt. An "end in itself " is not "an object that we of ourselves actually make our end"; it is, rather, in Kant's words, the "objective" end that serves as a "supreme [limiting] condition" upon whatever ends we have.⁶

The most clear-cut cases of Kantian "respect" for humanity involve not using others in ways whose ends they cannot formally share-i.e., by not acting on them without their own consent. The moral impermissibility of false promising (along with "assaults on the freedom and property of others") follows directly and unproblematically, in Kant's view, from this formula.⁷ It is easy to see the attractiveness of Kant, from a liberal political perspective, given the congruence between his moral thought and traditional liberal insistence on the right to life, liberty, and the pursuit of property and/or happiness. The peculiar force and influence of Kantian principles in contemporary arguments for patient choice and informed consent is especially apparent.⁸

If matters rested here, it would be easy to conclude, with Macklin, that appeals to "human dignity" as such could be abandoned without much loss. Autonomy, in the sense of choice, and the deference that in her view it commands, would indeed suffice. Whatever adults consent to (with a somewhat hazier provision for children and other "dependents") would set the bioethical standard.

But Kant indeed has more to say. Duties toward oneself (and toward others in matters where consent is impossible or otherwise has no immediate bearing) are more complicated but no less essential to a full understanding of what the claims of "human dignity," in his view, require of us. One is obliged on Kant's account to treat humanity in oneself, no less than in others, as an "end in itself."⁹ But to fully appreciate this point, one must turn from the second term in "human dignity" back to the first.

What, then, does Kant mean by "humanity"? Scholars, it must be said, differ on this point. For Christine Korsgaard, it is the sheer capacity to set ends;¹⁰ for Allen Wood, it is that capacity joined with an ability to think systematically.¹¹ Kant himself seems to speak of it in two ways. On the one hand, humanity is the "subjective" side of rational nature-the way in which rational nature in us immediately and unmistakably impinges on our consciousness. Every human being "necessarily represents his own existence" as an end that needs no further justification. Every human being, in other words, naturally regards himself as his own center of reference, in terms of which all other goods express their value. Humanity, one might say (echoing Nietzsche) is the natural capacity of a being to think in terms of value-a capacity, so far as we know, that belongs to man alone of all earthly creatures. But humanity, as the "subjective" side of "rational nature," also points beyond itself. Man can regard his own existence as something that has objective value only through recognition of a law that applies equally to others.¹² Only to the extent that he gives full weight to that law (by "respecting humanity") can he rationally regard his own existence as worthy of "esteem." Humanity is thus the capacity that both enables us to think in terms of value at all and orients us toward (without physically necessitating) full-fledged moral autonomy-and its realm of objective worth or dignity.ⁱⁱ Respect and esteem are at once distinct and intrinsically related to one another.

This consideration helps explain Kant's otherwise puzzling separation, in Religion within the Boundaries of Bare Reason , of "reason" from moral personality proper. Kant there asks us to imagine our human "endowments" as three-fold: physical, "human" (or "rational" in a strictly instrumental sense) and moral. A rational animal without a conscience-without an awareness, however primitive, of the moral law-is a thinkable possibility; but it is not us . Even human infants, in their crying-counterpurposive, Kant thinks, if one regards the end of humanity to be mere physical survival-"immediately announce" their "claim to freedom (an idea possessed by no other animal)." Although absent in the newborn, that idea is already present in some way by the time infants are capable of "crying":

The newborn child certainly cannot have this outlook. But the tears that accompany his screaming a few months after birth reveal that his feeling of uneasiness comes, not from physical pain, but from an obscure idea (or a representation analogous to it) of freedom and its hindrance, injustice; they express a kind of exasperation when he tries to approach certain objects or merely to change his general position, and feels himself hindered in it.-This impulse [ Trieb ] to have his own way [ seinen Willen zu haben ] and to take any obstacle as an affront is marked, especially by his tone, and manifests ill nature that the mother sees herself required to punish; but he retaliates by screaming even louder. The same thing happens when he falls, through his own fault. While the young of other animals play, children begin early to quarrel with one another; and it is as if a certain concept of justice (which is based on outer freedom) develops along with their animal nature, without having to be learned gradually.¹³

I linger over the passage because it touches with unusual directness on the relation between nature and freedom in man, and hence on the "dualism" with which Kant is so often taxed. Unlike Lucretius, who interprets such crying as apprehension on the young infant's part of the "dolefulness" of the life in store for him, Kant sees in it the (possible) irruption into nature of the "idea of freedom" as a genuinely moral cause. To be sure, the immediate consequences are morally doleful: the malevolent wish, expressed even by the young infant, to have one's way without granting similar sway to others. Still, as in Kant's other historical and religious writings, this fall into evil is the path human beings almost inevitably take in their progress toward earthly realization of the moral idea.

The point for our purposes is this: not the specifics of Kant's moral anthropology, but the larger claim about our need to make sense of our existence as embodied rational beings who are in nature but not fully of it. We are driven by our end-setting nature to make sense of the world both in relation to ourselves and as a whole. (Kant sometimes calls this our capacity for a priori principles of judgment.) But all the stories that we tell are riven by (partial) failure, beginning with the infant who angrily discovers that his claim to freedom is not externally supported. Our very efforts to make sense of the (natural) world, in their (initial) failure, orient us toward the demands of moral transcendence.

Whatever "embodied rationality" might mean for other beings elsewhere in the universe (and Kant kept up a lively openness to the possibility of life on other planets), it is inscribed, for us, within an experiential framework that is dialectical in character. The freedom that enables us to reason leads us to make demands upon the world that ultimately devolve upon ourselves if "only we are rationally consistent." Our "dignity" ultimately derives from our capacity to act upon the dictates of our own reason-i.e., from our autonomy as moral agents. The objective value that we claim is one that we ourselves cannot take to be rational, and hence cannot take seriously, unless we grant it to others who are similarly organized.

As this brief and inadequate sketch suggests, Kant's moral anthropology, broadly construed, is well positioned to support a regime of individual rights, or of "equal recognition," as Hegel will later call it. And this, indeed, is the use to which Kant is most often put, as we have seen, in today's bioethical debates. But "humanity," I am claiming, means more for Kant than the reciprocal freedom of consenting adults (or those who might become or might once have been so); it also imposes limits on the uses to which one may put one's own capacities. What, then, are those limits?

Here the story grows more complicated, as Kant himself admits. Still, certain fundamental principles are clear enough. In regarding ourselves as practical worldly agents-in "looking out" upon the world from a pragmatic standpoint-we cannot help thinking teleologically about our own capacities. Contrary to some contemporary accounts of liberal "self-ownership," our bodies are not things we own, items that are indistinguishable, in principle, from other sorts of alienable property. As the site of our own worldly agency, our bodies are at once more emphatically and irreducibly our own than any merely worldly "thing" and less available to manipulation by our arbitrary will. Certain organic necessities cannot be overcome, nor could we wish to do so without seeking to undermine basic feelings (like the difference between left and right, or between pain and pleasure) by which we orient ourselves. Such indispensable feelings, one could say, are the necessary polestars of living beings like ourselves who are (also) self-aware. The pleasant will always affect us differently than the painful, our left foot cannot become our right one. Of course, one can strive to render oneself relatively indifferent to both pain and pleasure; or to compensate, by strengthening one foot, for weakness in the other. But such orienting feelings remain, at least so long as we are in that rough state of organic functionality and wellness that we associate with human sanity.

Attention to our necessary ways of orienting ourselves in the world can help us to avoid certain absurdities to which certain "liberal" models of the self are otherwise all too prone. The sharp distinction between "persons" and "things" that liberalism encourages can, if wrongly applied, lead either to treatment of one's own body and its parts as if they were as "alienable" as, say, a suit of clothes (as in Nip/Tuck , a popular satire on the plastic surgery industry) or, alternatively, to confusion of the body's surface boundaries with those of self-hood proper (as in Andrea Dworkin's portrayal of the female body as a fortress that is, or ought to be, literally impregnable).

In the first case, one may be driven to regard such arrangements as the sale of body parts or maternal surrogacy as no more problematic than any other exchange of goods or services. But even the fiercest champions of untrammeled market freedom in such areas are sometimes brought up short by due recognition of the human consequences-consequences that would ultimately make markets as such impossible.¹⁴ A recent example: our unease with the idea of transplanting faces, even to restore healthy function rather than for the sake of aesthetic "enhancement." As the very term "person" (derived from persona , the Latin word for "mask") suggests, the relation between individual identity and bodily appearance-especially the appearance of one's face-is neither accidental, on the one hand, nor perfectly straightforward on the other. Eighteenth-century physiognomists may have exaggerated the extent to which our inner character can be read in our faces; but that there is some reciprocal relation and effect seems undeniable. The face is a mask that both reveals us and permits us to hide, just as actors' masks allow them to assume, in highly stylized ways, identities other than their own. Still, a world in which faces, and the peculiar expressions that accompany them, were as exchangeable as hats does not seem to be one in which human life as we know it could easily exist.

In the second, admittedly rarer case, the body and the self become confused in such a way as equally to challenge the possibility of human life. In Dworkin's words:

There is a never real privacy of the body that can co-exist with intercourse: with being entered.. The thrusting is persis tent invasion. She is opened up, split down the center. She is occupied-physically, internally, in her privacy. ¹⁵

For Dworkin, for whom all intercourse is rape, the skin, as Jean Grimshaw notes, "is the boundary of the self." If one identifies the body and the self in Dworkin's way, "such that any 'invasion' of the boundaries of the body [voluntary or not] is invasive of the self," it is "difficult to see what space is left for giving an account of sexuality at all."¹⁶ To this one could add that not only is sexuality (and human generation generally) written out of the equation; even basic acts like eating become morally repellent. The body, so construed, is a pure idea, without engagement with the world-life, as it were, without metabolism.

Whatever personal pathology Dworkin's argument may or may not reflect, its conceptual coherence remains, given the impoverished set of categories with which Dworkin, like many of her libertarian counterparts, sets out. Thus there is a singular advantage, if we are to arrive at a satisfactory and comprehensive liberal understanding of the world, in starting (like Kant), not with the abstract distinction between things and persons-a distinction in which human bodies as such disappear-but from our experience as embodied rational beings who make claims on one another and hence also on ourselves. It is that "pragmatic" starting point (as in the infant's own tearful cry-its initial act of worldly self-assertion) that in Kant's view gives rise, when we try to think it through consistently, to the conceptual distinction between things, persons, and a certain thing-like use of persons that falls somehow in between.ⁱⁱⁱ

Kant's pragmatic starting point, which begins with man and his deeds, bears the following fruit. Human consciousness is punctuated from the start by freedom and a related sense of justice and injustice, right and wrong. Our valuations are not only homogeneous but also hierarchical. Pleasure and esteem are related (e.g., in our judgment that those we esteem as just deserve also to be happy) and yet incommensurable. That observation permits us to make a three-fold distinction among human aptitudes: animal, rational (in an instrumental or calculative sense) and moral.^iv The original disposition ( Anlage ) to the good according to Kant, is threefold, consisting in:

1) the Anlage to animality (insofar as we are living beings);

2) the Anlage to humanity (insofar as we are living and also rational beings); and

3) the Anlage to personality (insofar as we are rational and also responsible beings).¹⁷

The usefulness for present purposes of this rank-ordering lies in its relative formality. On the basis of rather minimal assumptions about the character of human life-assumptions roughly congruent with the premises of liberalism itself-one can draw, as I will argue, some significant bioethical conclusions. That one can do so without appealing to the dogmatic claims of a specific religious tradition- claims that cannot fail to be politically problematic in a liberal society like ours-makes Kant's framework all the more promising.

His explicitly "pragmatic" starting point draws on our ordinary notions about health and sickness that are inseparably bound up with our most basic dealings in the world. That such notions have proved relatively immune to the ideological onslaughts of "value relativism" is not accidental. We may be willing to sacrifice our health for what we regard as a greater good; but we cannot regard it with indifference or as wholly arbitrary in its meaning. Kant analogically extends the sort of reasoning we do with regard to health and sickness upward. Pleasure and pain serve as rough yet indispensable guides to health and illness. Pain and pleasure regulate the lives of animals instinctively. Human beings, in our capacity as calculative reasoners, can override the immediate demands of pain and pleasure with a view to maximizing our physical well-being deliberatively. By analogy, human beings can and should orient themselves with a view to moral health, or the subordination of physical well-being to a higher rational purpose.¹⁸ Such an ideal of "moral" or "spiritual" life-an ideal that implies the complete organization of our physical, rationally calculative and moral being-is, admittedly, a construction on our part, that may or may not correspond to anything that we can (fully) realize. But it is not an arbitrary ideal nor one, in Kant's view, toward which we can remain indifferent. And it is an ideal whose formality can encompass, though not from their own point of view replace, moral and religious aspirations of a more traditional sort.

Kant and Bioethics

How might such pragmatically informed reflections bear on contemporary questions of bioethics? Without entering fully into the many complexities involved, a few guiding principles can be educed. First, there is a certain teleological structure to human life that is anchored, at the lower end, by our primary experience of ourselves as worldly agents. By virtue of that experience, we are directed, first, toward physical well-being and, second, by demands upon others and ourselves that can be regulatively understood as the appearance in the world of a higher principle of life. Duties toward oneself seek a combination of physical and moral self-preservation that permits this higher principle to "take root."

Second, organized beings, though susceptible to scientific study, cannot in principle be fully comprehended. No Newton, as Kant famously put it, will ever arise who can explain a blade of grass.¹⁹ By this Kant does not mean that biological inquiry cannot progress indefinitely, but rather that we are compelled to understand ourselves and, by analogy, all other living organisms in ways that ultimately transcend efficient causation. A physician or researcher informed by Kantian principles will thus retain a sense of the ultimate mysteriousness of life-not on dogmatically religious grounds but as an extension of the speculative modesty that flows from a critical awareness of the necessary structure and limits of human cognition. We cannot help but understand our own organs and aptitudes as naturally purposive in a way we are not free to disregard. To be sure, such understanding does not meet the demands of objective scientific knowledge. That the eye is "for seeing" cannot be established on the basis of a mechanical science (or its contemporary equivalent). And yet this assumption is, in Kant's view, the indispensable subjective foundation of any objective scientific inquiry into the processes of vision.²⁰

Man is not a brain in a vat; but he is also not a disembodied spirit free to use the matter in which it happens to be housed any way it chooses. Kant interprets this to mean that one must respect oneself "as an animal being," e.g., by not killing oneself or defiling oneself by lust. It also means that one ought not employ one's body in ways that strike us as counter-purposive: e.g., committing suicide for the sake of pleasure. Some of Kant's arguments in this regard are no doubt idiosyncratic, especially where sexual matters are concerned. Still, the general point seems both valid and of potential bioethical significance. Recognition of the impossibility, in principle, of reducing life to a mere mechanism argues for humility when confronted with new opportunities for genetic or other radical "enhancements" of the human organism. Wherever we strive to exceed the standard set by normal life functions (a standard roughly equivalent to "health"), we risk grave harms that we cannot in principle foresee.^v Ethical compunction here conspires with ordinary prudence to urge the greatest caution in engaging in experiments that exceed what natural functions by themselves support.

A pragmatic orientation in Kant's sense no doubt suggests other ethical limits on uses of one's body-proscribing, for example, sale of organs or of services that drastically impinge on basic bodily processes.²¹ Here fine distinctions may have to be drawn: selling one's hair or small quantities of blood differs from selling a kidney or contracting to become a maternal surrogate. Still the implicit ethical injunction-do not damage the functioning of the whole for the sake of a lesser and/or only partial good-remains.

There is a further way in which Kant's framework can be brought to bear on bioethical issues. From a strictly Kantian perspective, only duties of right are legally enforceable. Breaches of right (as distinguished from ethics) either violate the rights of other human beings or violate positive laws that are duly enacted to protect them. The state may certainly discourage unethical activities-e.g., by not granting licenses to doctors who fail to meet certain ethical standards- but it cannot punish them, unless they involve breaches to right (e.g., practicing medicine without a legal license to do so).

Current federal policy of withholding funding for certain medical procedures and kinds of scientific research that are nonetheless legal calls to mind this Kantian distinction between law and ethics. Present federal policy is designed to discourage an activity that many regard as ethically wrong but that the state cannot lawfully prevent, at least given the current political consensus. According to the weight of that consensus, destruction of an embryo for the sake of in vitro fertilization, or to conduct scientific inquiry into medical potential of stem cells, is not murder, nor should it otherwise constitute a legal crime. Still, in the view of many it is at least morally problematic and in the view of some ought in fact to be illegal.

In the remainder of this paper I should like briefly to consider how Kant's concept of human dignity might shed light on embryonic stem cell research and the political and moral controversy surrounding it. Here two issues come immediately to the fore: the ethical permissibility of allowing one's genetic material to be so used; and the legal or ethical permissibility of damaging or destroying the embryo for purposes of biological (medical) research.

On the first point (and without considering the moral status of the embryo as such): use of one's faculties should not flagrantly contradict its natural organic function, except in cases where a higher purpose (such as a desire to help others) is involved. This supports our ordinary moral intuition that donation of an organ may be permissible where its sale is not. To be sure, faculties related to generation have a peculiar ethical complexity, given the special moral and legal relations to which they may, and normally do, give rise. Extraction of genetic material-for purposes of enhancing one's own fertility or of advancing medical research-would seem to pass Kantian muster. Sale (rather than donation) of one's eggs appears more doubtful.

On the second and potentially more difficult question of the moral standing of the embryo: Kant's pragmatically informed moral teleology suggests a punctuated account of human development that avoids the extremes of granting the embryo full human status on the one hand, and no moral status whatsoever on the other. To be sure, the reflections that follow are highly speculative. Kant never commented directly on the moral status of the fetus or unborn child, though some of his remarks suggest that even newborns in his view may have lacked full moral standing.²²

The traditional "natural law" position afforded complete human status to the fetus only with "quickening," taken for a sign of self-motion and hence "ensoulment." Modern embryology, it is sometimes claimed, shows that development is, in fact, continuous. Hence, the fetus must have either full human status from the moment of conception or none at all. But modern science also shows that the embryo in its earliest stages retains a certain plasticity of form. For the first ten days or so after conception the blastocyst may divide, becoming twins. Such a process is unusual but not abnormal in the sense of indicating the presence of some pathological factor or other defect. The embryo, at this early stage, is not yet a fully individuated human being. It does not yet have a unifying principle of development, a distinct soul (to speak in traditional terms) that is wholly its own. Pragmatically speaking, the moment at which such division is no longer possible thus represents the beginning of a new and qualitatively different stage in human development.

The punctuated character of early fetal development opens a window for potential uses of the fetus that might be juridically or ethically precluded at later stages. Embryonic stem cell research would seem to be one obvious candidate. One might still, for religious reasons, regard the blastocyst as fully human. But it becomes harder to make the case either on strictly philosophic grounds or on grounds of ordinary common sense.

What, then, of the limits that might apply to such uses? The blastocyst is (or must be viewed by us as) purposively directed toward fuller human development. It is not a mere "collection of cells" that we can injure or dispose of trivially.^vi Use of such embryonic cells for medical research-i.e., to enhance human health-may be permitted where other uses (e.g., for purely cosmetic purposes) are not. A new cure for cancer is one thing; an enhanced shade of lipstick is another. One can respect the human potential of the blastocyst in certain determinate ways, in other words, without granting it the status of a moral person.

None of this speaks directly to the contentious question of abortion and the moral status of the fetus more generally. But it does permit a helpful "bracketing" of the issue of embryonic stem cell research as such. Such considerations also suggest the wisdom of revisiting current federal policy. According to the most recent scientific findings, embryonic stem cells appear to have unique properties (e.g., with respect to longevity) that adult stem cells cannot duplicate. The federal government could support embryonic stem cell research more fully while preserving a sense of its ethical complexity and without begging the question of later-term abortion. Such a stance would not satisfy those for whom destruction of an embryo is murder. But current federal policy (and, indeed, most of our ordinary cultural and legal practices) does not so treat it.

In sum: human beings have dignity, for Kant, because they are capable of acting morally. But this capacity is only realized dialectically, through our pragmatic dealings with the world. A richer understanding of "humanity," informed by Kant's moral and pragmatic reflections, might offer fuller and politically more useful guidance to contemporary bioethical debates than that provided by the usual image of Kant as a rigid dualist. Kant's conception of human dignity draws primarily not on metaphysical abstractions but on the necessities that inform our everyday efforts to lead an effectual and morally decent life. As such it offers potential common ground in a field of contest where it is often all too rare.

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FootNOTES

i. Thus Ruth Macklin has urged that the concept be abandoned as "useless" on the grounds that it adds nothing to that of "autonomy," which itself suffices. See Macklin, "Dignity is a Useless Concept," BMJ 327 (2003): 1419-1420.

ii. In the Metaphysics of Morals Kant defines humanity as "the capacity to set oneself an end-any end whatever," a capacity unique to rational beings. See Metaphysics of Morals 6: 392; translation in Kant, Practical Philosophy , trans. Gregor, pp. 522-23.

iii. This category particularly pertains to marriage law, where bodies are in some sense reciprocally "owned" (see Metaphysics of Morals 6: 276-284; 357-362). However disagreeable Kant's infamous legal description of marriage as a mutual possession of sexual faculties, there is surely something to his insistence that sexual uses of the body have, at least potentially, a personal and moral significance different in kind from other uses. On the meaning of "pragmatic," see Anthropology from a Pragmatic Point of View 7: 119-122: "Physiological knowledge of man investigates what nature makes of him: pragmatic knowledge investigates what man as a free agent makes, or can and should make, of himself." For Kant, our practical knowledge of the world has a formally teleological character that ultimately points us toward moral purposes.

iv. To be sure, Kant's formalism here is not theoretically innocuous. In stressing, as he does, the conditions of experience rather than its particular content, Kant evades the immediate, concrete claims that may correspond to a specific way of life. His formalism here thus reflects a more fundamental difference between his own approach to moral matters and that shared by both classical philosophy and the Bible.

v. One example: according to one very recent study, disabling the cell's "aging" gene-a procedure undertaken in the hopes of extending its life expectancy- proves instead vastly to increase its susceptibility to cancer.

vi. This claim does not depend on an argument that is sometimes made: namely, that nonhuman things (such as giant sequoia trees) may nonetheless have intrinsic value. Kant's argument preserves our sense that the special moral status of the embryo lies in its emerging "humanity."

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EndNOTES

1. For a thoughtful articulation of this point of view, see Onora O'Neill, Autonomy and Trust in Bioethics (Cambridge: Cambridge University Press, 2002); an alternative, non-Kantian argument for "informed consent" and related contemporary practices might be drawn from Plato's Laws 720a-e.

2. Kant, Groundwork of the Metaphysics of Morals 4: 434-435; translation, slightly emended, in Kant, Practical Philosophy, ed. and trans. Mary J. Gregor (Cambridge, Cambridge University Press, 1996), pp. 84-85. Note: I cite Kant's works by volume and page number of the standard German edition, Kants Gesammelte Schriften, edited by the Royal Prussian (later German) Academy of Sciences (Berlin: George Reimer, later Walter de Gruyter & Co., 1900-); these numbers are found in the margins of most translations.

3. Thomas Hobbes, Leviathan , chapter 10.

4. Groundwork 4: 429; Practical Philosophy , p. 80.

5. Groundwork 4: 428; Practical Philosophy , p. 79.

6. Groundwork 4: 431; Practical Philosophy , p. 81.

7. Groundwork 4: 430; Practical Philosophy , p. 80.

8. For a thoughtful exploration of this topic, see Onora O'Neill, op. cit.

9. Groundwork 4: 428; Practical Philosophy , p. 79.

10. Christine Korsgaard, Creating the Kingdom of Ends (Cambridge: Cambridge University Press, 1996), pp. 17, 110; cited in Richard Dean, The Value of Humanity in Kant's Moral Theory (Oxford: Clarendon Press, 2006), p. 6.

11. Allen W. Wood, Kant's Ethical Thought (Cambridge: Cambridge University Press, 1999), p. 119.

12. Groundwork 4: 429.

13. Anthropology from a Pragmatic Point of View 7: 268-269n.; translation in Kant, Anthropology from a Pragmatic Point of View , trans. Mary J. Gregor (The Hague: Nijhoff, 1974), pp. 136-137n.

14. See, for example, Jennifer Roback Morse, Love and Economics: Why the Laissez Faire Family Doesn't Work (Portland, Oregon: Spencer, 2001).

15. Andrea Dworkin, Intercourse (London: Martin Secker & Warburg, 1987), p. 122; cited in Jean Grimshaw, "The Bodily Self: Privacy, Autonomy and Identity," in Liberalism, Citizenship and Autonomy , ed. David Milligan and William Watts Miller (Aldershot, England: Avebury, 1992), p. 194.

16. Grimshaw, op. cit., p. 196.

17. See Kant, Religion within the Boundaries of Bare Reason 6: 26; translation in Kant, Religion and Rational Theology, ed. and trans. Allen W. Wood and George di Giovanni (Cambridge: Cambridge University Press, 1996), p. 74.

18. For an elaboration of this analogy, see Kant's "What it is to Orient Oneself in Thinking" and "On the Use of Teleological Principles in Philosophy."

19. See Immanuel Kant, Critique of Judgment, trans. Werner Pluhar (Indianapolis, Indiana: Hackett, 1987[1790]), §75, pp. 282-283.

20. Kant's argument is most fully worked out in Part Two of the Critique of Judgment.

21. For an alternative approach, based on highly modified Kantian arguments, to the question of body ownership see Deryck Beyleveld and Roger Brownsword, Human Dignity in Bioethics and Biolaw (Oxford: Oxford University Press, 2001), pp. 173-194.

22. See Metaphysics of Morals 6: 327, 336.

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