Neuroethics (2009) 2:35–50
DOI 10.1007/s12152-008-9028-2
ORIGINAL PAPER
Minimally Conscious State and Human Dignity
Jukka Varelius
Received: 27 August 2008 / Accepted: 27 October 2008 / Published online: 4 December 2008
# Springer Science + Business Media B.V. 2008
Abstract Recent progress in neurosciences has
improved our understanding of chronic disorders
of consciousness. One example of this advancement
is the emergence of the new diagnostic category of
minimally conscious state (MCS). The central
characteristic of MCS is impaired consciousness.
Though the phenomenon now referred to as MCS
pre-existed its inclusion in diagnostic classifica-
tions, the current medical ethical concepts mainly
apply to patients with normal consciousness and to
non-conscious patients. Accordingly, how we mor-
ally should stand with persons in minimally
conscious state remains unclear. In this paper, I
examine whether the notion of human dignity could
provide us with guidance with the moral difficulties
MCS gives rise to. More precisely, I focus on the
question of whether we are justified in holding that
persons in minimally conscious state possess human
dignity.
Keywords Human dignity . Impaired consciousness .
Minimally conscious state . Moral problem
J. Varelius (*)
Department of Philosophy, University of Turku,
Turku FIN-20014, Finland
e-mail: varelius@hotmail.com
Introduction
Recent progress in neurosciences has improved our
understanding of chronic disorders of consciousness.
One example of this advancement is the emergence of
the new diagnostic category of minimally conscious
state (MCS). MCS results from severe damage to the
brain. Its central characteristic is impaired conscious-
ness. As distinguished from non-conscious states like
coma and vegetative state, patients falling within this
novel category thus do not altogether lack awareness.
In addition to being of significance in therapeutic
terms, and related to that, the advent of MCS is also
of ethical consequence. Though the phenomenon now
referred to as MCS pre-existed its inclusion in
diagnostic classifications, the current medical ethical
concepts mainly apply to patients with normal
consciousness and to non-conscious patients. There-
fore, those concepts appear inadequate in the case
of MCS. Though controversially, a person’s being
permanently non-conscious is, for example, often
seen to warrant cessation of life-supporting treatment
and harvesting of organs from her. The idea of
allowing such actions in the case of conscious patients
seems alarming even if their degree of consciousness
were rudimentary. However, as persons in minimally
conscious state usually remain far from fulfilling the
criteria of normal agency, it would also not appear
justifiable to grant them the same rights competent
agents have. The morally problematic nature of MCS
36
has been acknowledged in the medical ethics litera-
ture (see, for example, [1]), but how we morally
should stand with persons in minimally conscious
state remains unclear.
The notion of human dignity figures prominently in
many international declarations and the constitutions of
several countries. For example, the preambles of the
three constituents of the so-called ‘International Bill of
Rights’1 maintain that ‘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’ and as its key
point of departure the German constitution declares
that ‘[h]uman dignity is inviolable’. While there are
philosophers who question the significance of dignity
in some of its senses,2 human dignity is also
considered a central value of moral philosophy and
applied ethics especially in Europe but also in, for
example, the United States and Canada. Biomedical
ethics is one of the areas where the concept of human
dignity has gained prominence (see, for example, [3–5].
Accordingly, one might expect that the value could
have important implications in the context of MCS too.
In this paper, I examine whether the notion of human
dignity could provide us with guidance with the moral
difficulties MCS gives rise to. More precisely, I focus
on the question of whether we are justified in holding
that persons in minimally conscious state possess
human dignity.
The Main Concepts and the Main Problem
The existence, definition, and diagnostics of MCS
remain contested. However, as the name of the
category suggests, those who accept it agree that
MCS is centrally about impaired consciousness. For
example, Giacino et al. [6] define MCS as “a
condition of severely altered consciousness in which
minimal but definite behavioral evidence of self or
1
The Universal Declaration of Human Rights, the Internation-
al Covenant of Economic, Social and Cultural Rights, and the
International Covenant on Civil and Political Rights.
2
They usually maintain that the meaning of dignity is
exceedingly obscure or that the notion does not add anything
to the value categories they accept but is only another name for
values like autonomy or respect for persons (see, for example,
[2]).
J. Varelius
environmental awareness is demonstrated” and Fins
([1], p. 22) writes that “the minimally conscious
demonstrate unequivocal, but fluctuating, evidence of
awareness of self and the environment”.3 Patients in
minimally conscious state do not constitute a uniform
group. While the consciousness of some of them is
indeed exiguous, others may utter words or phrases,
gesture, and show evidence of memory, attention, and
intention. Some persons in minimally conscious state
deteriorate into coma or vegetative state, others gain
normal consciousness, and in some cases minimally
conscious state lasts until the patient dies. A person
can remain in a minimally conscious state even for
several years. What all persons in minimally con-
scious state have in common is that they are
conscious to a degree that remains significantly below
that of typical human adults.
According to the Oxford English Dictionary,
‘dignity’ means ‘The quality of being worthy or
honourable; worthiness, worth, nobleness, excel-
lence’. We talk about dignified behavior, dignity
bestowed on one in virtue of one’s having noble
ancestry, the dignity one has on the basis of being an
exceptionally talented person, etc. Besides these kinds
of dignity related to a person’s manner of conducting
herself, her achievements, and her position in a social
hierarchy, we also speak of human dignity. Human
dignity refers to the worth each human being is taken
to have however she acts and whatever her merits or
social position (see, for example, [3, 7, 8]. All human
beings are seen to have it to the same degree. That
degree is usually considered to be higher than, or at
least as high as, the extent to which other (earthly)
beings have value. Thus, it is taken that that, for
example, plants and animals do not merit the same
kind of moral regard that beings possessing human
dignity deserve, other things equal. Furthermore,
though people can be treated in ways that accord
with it and in a manner that is incompatible with it,
human dignity cannot be given to a person and
neither can it be taken away from her by others or by
herself. Below, I call the view that all humans have
such equal basic worth the doctrine of human dignity.
The precise implications of respecting human
dignity are not clear. For example, while some
3
I now sidestep philosophical questions concerning whether
there is a necessary connection between being aware of one’s
environment and being aware of one’s self.
Minimally conscious state and human dignity
philosophers maintain that human dignity grounds the
obligation never to kill humans, others argue that
human dignity is among the central values justifying
voluntary euthanasia and physician-assisted suicide,
and still others hold that human dignity by itself
cannot ground any rights and obligations at all (see,
for example, [9, 10]. Someone might take this to
mean that, instead of there being a single notion of
human dignity, there are several different concepts of
human dignity so that we can speak of human dignity
that may in some cases justify voluntary euthanasia,
human dignity that is against voluntary euthanasia,
human dignity that is compatible with capital punish-
ment, human dignity that is incompatible with capital
punishment, etc. However, instead of accepting that
there is a variety of different notions of human dignity
with even radically different moral implications, I
assume that human dignity refers to a single value of
the kind described above. Accordingly, I take it that
those who disagree on whether or not, for example,
voluntary euthanasia is compatible with human
dignity refer to the same basic notion of human
dignity and debate what respecting it really means.
Despite the controversies regarding the compati-
bility of, for example, respect for human dignity and
voluntary euthanasia, proponents of the doctrine of
human dignity usually maintain that humans’ pos-
sessing the special worth is the basis of our having
such moral obligations towards humans as the duty
not to kill them when other things are equal, the
obligation to take their well-being into account, and
the duty to treat them with respect (see, for example,
[7], p.173). The main moral problems MCS raises
concern similar questions in the case of persons in
minimally conscious state: Do we have a moral duty
to keep them alive in all cases? How, if at all, ought
we to take their wellbeing into account? Should we
respect their wishes (if they have any)? What kind of
respect they deserve? Etc. Furthermore, persons in
minimally conscious state are seldom able to act with
dignity or to accomplish significant things.4 And
though some of them may have noble ancestry it most
probably is not descriptive of persons in minimally
conscious state more generally. Also, whether it is
4
We might of course have actions that are dignified as
compared with how persons in minimally conscious state can
act and achievements in a similar sense. How reasonable that
kind of talk would be is a further example of a philosophical
problem MCS gives rise to.
37
morally permissible to kill a person, to ignore her
wellbeing, and to treat her without basic respect most
plausibly should not depend on her personal achieve-
ments, ancestry, or manner of conducting herself,
other things equal. Therefore, I take it that of the
different senses of dignity referred to above the notion
of human dignity is the most relevant one to deciding
how we ought to treat persons in minimally conscious
state. Accordingly, it is the sense of dignity I focus on
below.
It might be maintained that leaving the precise
moral implications of respecting human dignity
unspecified, as I here do, makes assessing the doctrine
of human dignity impossible. That would, however,
be true only if the only way of evaluating the doctrine
would be in terms of its practical moral implications.
But the doctrine of human dignity can also be
assessed in other terms. Below I will consider, for
example, the problem of how humans who are
incapable of being rational could be taken to possess
human dignity when having human dignity is seen to
follow from one’s being rational. As it concerns the
use or possession of certain psychological capacities
that being rational to a degree that agents typically are
capable of being presupposes, that problem can be
examined without taking a stand on the question of
what exactly respecting human dignity implies.
Though the above characterizations of minimally
conscious state and human dignity are rough, they
suffice, I thus believe, for the purposes of this article.
As human dignity is not the only candidate for
what grounds the moral status of persons in minimally
conscious state, the problem of whether persons in
minimally conscious state have human dignity is not
the same question as whether they have moral status
of one or another kind. Even if it turned out that we
are not justified in holding that persons in minimally
conscious state possess human dignity, it is possible
to maintain that they have moral status because, or to
the extent that, they are sentient, living organisms,
etc. I will, however, not assess these kinds of grounds
for granting persons in minimally conscious state
moral status of one or another kind. I will thus not
examine the more general questions of what grounds
moral statuses of different types and whether it is
justified to hold that persons in minimally conscious
state have moral status in some other sense(s) than
that referred to by the notion of human dignity. My
focus is on the question whether the view that persons
38
in minimally conscious state have human dignity in
the above described sense can be satisfactorily
defended. I will refer to the more general discussion
on moral status only when beings’ having moral
status is taken to imply that they merit moral regard
similar to that which persons’ having human dignity
is taken to deserve5 and the reasons for granting
beings that kind of moral status have not been
discussed in connection with human dignity.
Philosophical discussion directly pertinent to the
human dignity of persons in minimally conscious
state is as yet meager, if not nonexistent. The notion
of human dignity itself and also problems relevant to
justifying it in the case of MCS have, however,
received attention in connection with such topics as
dementia, abortion, euthanasia, and animal rights
(see, for example, [10, 12–15]. Below, I will draw
from those debates.6 Besides those discussions, ques-
tions relevant to the problem of how we ought to deal
with persons in minimally conscious state have been
discussed in connection with, for example, marginal
agency. When the philosophical debate on marginal
agents does not concern the problem of how they count
morally, it usually focuses on how we in practice are to
make moral decisions in cases of marginal agents.
Such debates on surrogate decision-making, advance
directives, etc. are relevant to deciding how we are to
morally deal with persons in minimally conscious
state, but they already presuppose that persons in
minimally conscious state do count in some particular
way. To the extent that the debate on marginal agents
concerns the problem of which marginal agents count
morally and why, these debates are similar to the
discussion on which beings have moral status of one
kind or another and why. As already said above, I will
5
For example, Warren [11] bases the moral status of humans
on moral agency and in the case of humans who are not moral
agents on sentience. As all persons in minimally conscious state
are not moral agents in any plausible sense, on Warren’s view
their moral status would assumedly be based on sentience.
However, it is arguably implausible that mere sentience could
ground the kind of moral regard human dignity is commonly
taken to merit. Accepting that it would, would commit one to
the incredible view that all sentient beings should be treated in
a way that possessing human dignity deserves.
6
Participants of those discussions have however not focused on
MCS. Therefore, whatever they are logically committed to, by
referring to their views I do not mean to posit any stands
concerning the human dignity of persons in minimally
conscious state to them.
J. Varelius
here address one problem belonging to that general
group of questions, the problem of whether we are
justified in holding that persons in minimally con-
scious state possess human dignity.
Is it Self-Evident that Humans in Minimally
Conscious State have Human Dignity?
Someone might maintain that requiring for a justifi-
cation for bestowing humans in minimally conscious
state with human dignity is excessive. Some funda-
mental moral intuitions are in no need of justification
and, a proponent of such a view could maintain, that
all human beings, and thus by implication persons in
minimally conscious state, have human dignity is
among those basic moral points of departure. There-
fore, she might conclude, there simply is no reason to
demand definite justification for the view that persons
in minimally conscious state possess human dignity.
It is indeed plausible that we hold some moral
intuitions with such conviction that requesting for
justification for them would be of purely theoretical
interest. Torturing babies for fun is morally wrong,
making lying promises is typically morally impermis-
sible, etc. are among such intuitions. The view that
typical adult humans have human dignity, or merit the
kind of moral regard beings possessing human dignity
have been taken to deserve, is also among them. The
case with the human dignity of several what may be
called atypical humans is, however, different. That is
demonstrated by the fact that reasonable people can
disagree over the question of whether an embryo, a
person in vegetative state, etc. possesses human
dignity. Persons in minimally conscious state too
belong to that group of human beings. There is no
consensus, or even wide agreement, among compe-
tent moral agents on the issue of whether those beings
have human dignity.
Furthermore, it could be maintained that granting
all and only members of the human species special
dignity is speciesist and, accordingly, morally on a par
with such isms as sexism and racism. There might be
some morally benign forms of sexism and racism. An
aboriginal person’s desire to donate an organ to a
member of his own race and a woman’s decision to
employ women rather than men could be examples
(cf., for example, [16], pp. 249–250). It however
appears implausible that merely belonging to the
Minimally conscious state and human dignity
human species could merit bestowing one with
special moral significance. The morally benign nature
of the above mentioned types of racism and sexism is
arguably best explained in terms of solidarity arising
in the face of a common threat (cf., for example, [17],
p. 53), that of colonialism and patriarchy respectively.
However, nonhuman beings as a class do not pose a
similar threat to all human beings so that favoring the
latter over the former could be justified on similar
grounds. Furthermore, there is no necessary connec-
tion between defending speciesism in terms of
solidarity, on the one hand, and human dignity, on
the other. Therefore, a justification of such favoritism
based on the value of solidarity need not refer to
human dignity at all.
From a different point of view, modern definitions
of the human species usually refer either to humans’
possessing a particular kind of DNA structure or to
their forming an interbreeding population with com-
mon ancestry and progeny. It is unclear how having
that DNA structure or those reproductive relations
could confer a being special moral value (see, for
example, [15], p. 529–530; and also [18], p. 103).
Why precisely is it that all and only beings with that
genetic structure or that reproductive history ought to
be bestowed with special dignity? So far no rationally
persuasive answer has been presented to that question.
Though they are not decisive, the above consider-
ations suffice to show that the intuition that all and
only humans have special dignity does not command
the acceptance of all competent moral agents. There-
fore, it needs reasons for its support.
Is There a Property that Confers Special Dignity
to all Humans?
Religious views have played an important part in
discussion on the grounds of human dignity. Some
philosophers and theologians make it clear that for
them the basis of human dignity is a mystery,
something that is ultimately beyond reason and
rational explanation (see, for example, [19]). Others
suggest that the God they refer to in justifying human
dignity can, at least to a significant extent, be
understood by rational means (cf., for example, [20]).
A central problem with the former approach is that
referring to a mystery is unlikely to persuade the
reasonable persons who do not accept that humans
39
have special dignity. The prospect of its being helpful
in resolving the controversy between the proponents
and the opponents of the doctrine of human dignity is
therefore unpromising. The latter approach is more
auspicious in that respect and also more compatible
with the secular moral philosophical points of
departure of this article. If, for example, it is taken
that belief in absolute moral standards is, ipso facto,
belief in God (cf., for example, [20]) and also that the
moral norms should have rational justification, the
approach’s similarity to (several forms of) secular
moral philosophy is nearing identity. As the
declaredly secular ways of dealing with the issue,
the main task the approach faces is that of formulating
a rationally acceptable justification for bestowing all
human beings with special dignity.
When humans are considered to merit special
moral regard, it is usually by virtue of their having
certain properties (other than merely being human)
that are taken to distinguish them from other beings.
In discussing the morally relevant differences between
humans and other animals, Bernstein remarks that it is
virtually impossible to deliver an exhaustive list of
properties that have been offered to morally differen-
tiate those groups of beings from each other. A
representative list, he continues, consists of the
properties of rationality, autonomy, language use,
and moral agency.7 ([15], p. 525; see also, for
example, [21]) The idea that possessing that kind of
features merits bestowing all humans with special
dignity has been criticized on three main grounds
(see, for example, [15, 22], p. 381).
First, all humans are not rational. Consider, for
example, newborn babies and very young children.
Though they are not rational, we do not consider it
permissible to kill them, we do believe that their
wellbeing ought to be taken into account, and we
think that they ought to be respected as human
beings.8 Second, nonhuman beings can be rational.
7
I will take this list as my point of departure but for the sake of
brevity will speak only about rationality. Unless otherwise
stated, by ‘rationality’ I below refer to all entries of the list.
8
The degree of rationality can also vary significantly among
persons who possess that property. If human dignity is based on
the property of being rational, it can be asked, why would the
more rational always have equal dignity with the less rational
(see, for example, [18])? If it is maintained that a certain degree
of rationality is sufficient for equal human dignity, how is the
level defined? As this problem does not affect the main
argument of this paper, I now put it aside.
40
Several nonhuman animals, such as the great apes,
possess a degree of rationality.9 Future genetic
technology or distant planets may provide us with
highly rational nonhuman beings. That rationality is
not limited to all and only human beings makes
granting special and equal dignity to all and only
humans seem arbitrary.10 Third, it is not clear why
having the property of rationality would confer a
being special moral status. What exactly is it in the
characteristic that grounds granting its possessors
special dignity? It might also be argued that at least
several non-rational beings—such as the newborn, the
seriously ill, and the severely handicapped,—deserve
even more moral regard than those who are rational.
These three criticisms do not seem equally threat-
ening to the doctrine of human dignity. It could be
taken that grounding human dignity on a property that
nonhuman beings can have protects the creed against
an accusation of speciesism. If special dignity were
taken to be based on a property that only humans can
possess critics might maintain that, irrespective of its
apparent concentration on that characteristic, the
doctrine of human dignity is ultimately speciesist.
Despite the air of paradox, that human dignity is taken
to be deserved on the basis of possessing a property
which also nonhuman beings can have might there-
fore even be considered an advantage for the doctrine
of human dignity.11
Furthermore, though it is not altogether clear how
being rational confers one special moral worth and
rational beings do not always deserve more moral
attention than non-rational beings, it is credible that
one’s being rational is highly relevant to determining
9
It is controversial whether nonhuman animals are capable of
moral action or only of ‘pre-ethical’ behavior (see, for example,
[21]).
10
Someone might object that though nonhuman beings can be
rational, human rationality merits special moral regard because
rationality is of more value to humans than it is to nonhumans.
It is however not clear that rationality is of more value to
humans than it is to nonhumans. Furthermore, this objection
appears to give rationality only an instrumental role. At least
until the nature of the ultimate value to which rationality is a
means is explicated, the criticism remains too obscure to be
plausible.
11
For example Lee & George ([7], p. 176) stress that while
membership in the species Homo sapiens is sufficient for full
moral worth it is not “in any direct sense” the criterion of moral
worth.
J. Varelius
one’s moral status. The reason why we, other things
equal, give more moral significance to human beings
than to, for instance, earthworms and stones surely
has something to do with the fact that the former
typically have and the latter lack a degree of
rationality. Accordingly, it seems that a plausible case
for granting rational beings high moral status can be
made (see, for example, [15, 23, 24], though not
necessarily always higher than that of non-rational
beings (see, for example, [25, 26]).
The remaining problem—that not all humans are
rational—appears the most intricate one of the above
mentioned three, especially in the context of MCS.
Making the rather plausible assumption that if
humans are to have special dignity it must be based
on some such property as rationality, proponents of
the doctrine of human dignity need to explain how the
significance of some humans’ possessing that proper-
ty extends to those who do not have it.12 If possessing
human dignity is based on having the property of
being rational, how such humans as persons in
minimally conscious state who are not rational can
possess human dignity?
Is There After all a Sense in Which all Humans are
Rational?
The notion of human dignity has, of course, been much
discussed in connection with Immanuel Kant’s philos-
ophy. The focus there has, however, mainly been on the
dignity of rational beings. And, due to its emphasis on
rationality, Kant’s moral theory is notoriously troubled
precisely by the problem of how to account for the
intrinsic worth of non-rational beings. The ways in
which Kantian moral philosophers have tried to solve
12
Someone might of course want to limit human dignity to all
and only those beings that have the property. If, however, it is
taken that all humans have human dignity and the value is to
help us with the moral problems of MCS, even those humans
who lack rationality need to have the special dignity. Those
who want to defend the view that human dignity does not
extend to nonhuman beings that lack rationality also need to
find out a way of limiting dignity to only human non-rational
beings. But those who only want to focus on MCS and who are
satisfied with extending human dignity to persons in minimally
conscious state whatever other beings it might attain to need not
address that difficulty.
Minimally conscious state and human dignity
this problem can be divided into two. The first kind of
attempts emphasize the fact that non-rational beings are
usually valued by rational beings and/or that treating
non-rational beings badly can have serious repercus-
sions on how we behave towards rational beings. The
second approach loosens the requirements of rationality
that having intrinsic value are taken to presuppose so
that even less than fully rational beings could have
intrinsic worth. Some philosophers combine these two
argumentative strategies.
A full examination of these two types of argument
is beyond the limits of this work. Instead of attempt-
ing anything like it, I will just briefly point out their
main difficulties from the present point of view. The
problem with the first strategy is that it makes the
value of non-rational beings contingent on their being
valued by rational beings and/or the consequences to
rational beings of our treating non-rational beings
badly. A non-rational being would then have intrinsic
value only if a rational being happened to value it
and/or treating it badly would detrimentally affect
some rational being. That is arguably an unsatisfac-
tory account of the intrinsic value of non-rational
beings. For example, if it happened that a person in
minimally conscious state were not valued by any
rational being and/or the ways she would be treated
would not have unfortunate consequences to how
some rational being would be treated, the patient
would not have any intrinsic value.13
The main problem with the second approach is that
the requirements of rationality proposed have, to my
knowledge at least, still been too stringent to be able
to account for the intrinsic value of all non-rational
beings that intuitively plausibly have intrinsic value.
Even if we required only that the persons respected
have at least the capacity to be touched and moved by
considerations of reciprocity and recognition of other
persons as having moral standing (cf., for example,
[27], pp. 71–72, see also pp. 77–78) that would not
13
Someone might object that this problem does not arise if the
Kantian requirement that we must be able to universalize the
maxims of our actions is employed correctly. The question of
what is the correct way of formulating a/the universalization
test is however notoriously difficult, and the debate on whether
there is a plausible test of that kind at all is still continuing. I am
unable to assess that debate here.
41
provide sufficient grounds for granting all persons in
minimally conscious state human dignity. That is
because all persons in minimally conscious state do
not possess the ability referred to.14
The Kantian views are, of course, not the only
ways of trying to explain how persons who lack the
dignity bestowing feature can still have human
dignity. Lee and George, for example, find the
ultimate basis of human dignity in our “natural
capacities” for conceptual thought, deliberation, and
free choice. They maintain that human beings are
rational creatures by virtue of possessing those
abilities and that the capacities, not merely the
potentiality to develop into a rational being,15 are
possessed by every human being. They stress that
having dignity derives from the kind of entity one is,
“a substantial entity with a rational nature”. Therefore
even humans who cannot “immediately exercise”
their rational capacities, such as small children and
unborn human beings, have the capacities and thus
also possess human dignity. ([7], pp. 174, 185, 190;
see also, for example, [30], p. 269-270)16
The main question with this kind of stand is
whether there is a coherent sense in which each
14
The problem of how Kant’s and Kantian moral theory could
satisfactorily account for the intrinsic value of non-rational
beings has recently been discussed especially in connection
with the value of animals. For a review and criticism of the
various attempts to solve the problem see, e.g., Skidmore [28].
Korsgaard [29] has more recently argued that animals’ value is
dependent both on their being valued by rational agents and
their lives’ mattering to the animals themselves. Applying this
conception of the intrinsic value of a non-rational being into the
context of MCS, if it is appropriate to do so, does not provide a
satisfactory result. That is because all persons in minimally
conscious state are not capable of valuing their lives in the
sense that their lives would matter to them and a person in
minimally conscious state need not be valued by any rational
being.
15
In another article Lee ([12], p. 262) makes clear that in his
view potentiality is important because it is an indicator of what
kind of thing is already present.
16
An important part of Lee and George’s defense of their view
consists of criticizing its rivals (see [7], p. 176 ff.). It is not
altogether clear that the views Lee and George argue against are
made less appealing by their objections (cf. [14]). In any case,
the plausibility of the view advocated by Lee and George
presupposes that there is a coherent sense in which all humans
have a rational nature.
42
human can be said to possess a rational nature.17 It
might be maintained that all human beings have
rational nature by virtue of having the genetic
structure of a rational being. That could work in the
case of the human dignity of otherwise normal
persons in minimally conscious state. However, the
genetic constitution of some nonhuman beings, such
as bonobos, can be more similar to the typical genetic
structure of humans, the paradigm rational beings,
than is that of genetically defected humans (see, for
example, [31], p. 110). Therefore, focusing on genetic
constitution would not support the doctrine of human
dignity. If only minor variation from typical human
gene structure is allowed the genetically defected
humans do not have human dignity. If more major
alteration is permissible several nonhuman animals
with significantly lesser capacities for rationality than
humans typically have would have human dignity.
Both of these results are incompatible with the doctrine
of human dignity.
The genetic structure of a rational being would also
not seem to be what Lee and George have in mind.
They maintain that even the severely retarded human
beings, a class of humans lacking the full genetic
constitution of a rational being, have rational nature:
“Were a therapy or surgery developed to correct
whatever defect causes their mental disability, this
would not change their nature”. ([7], p.176) In this
view, a human being who never acts rationally, who
does not possess the psychological capacities rational
action presupposes, and who does not have the
genetic constitution of a rational human being still
possesses the natural human capacity for rationality. It
is difficult to understand how such a being could be
taken to have capacity for rationality even in a
rudimentary sense.
17
At times Lee and George would seem to fluctuate between
the view that all humans have the rational capacity and that all
humans have dignity because they belong to a kind with
rational nature. Saying that human dignity is possessed on the
basis of membership in a kind with rational nature would
however beg the question of why even those members of the
kind who are not rational have dignity. If all members of the
human kind are to have human dignity, all humans must have
rational nature. Unless of course the kind is defined to
encompass all and only those who are immediately able to
exercise their capacity for rationality. Then at least most
persons in minimally conscious state would not have human
dignity.
J. Varelius
Some philosophers stress the importance of such
features as a natural inclination of a human being to
organize herself in such a way as to stay alive and her
possessing a teleological orientation towards growth
into a more developed human ([30], p. 269, see also
[7]) or the varied forms of striving that emerge from
human need ([32], p. 363).18 It is however not clear
that such inclination, orientation, or striving occurs in
the case of all human beings.19 Does, for example, a
lethally ill or a genetically defected human being
always organize herself so as to stay alive and does
she possess a teleological orientation towards growth
into a more developed human being in any relevant
sense? Furthermore, it seems that the striving or
orientation towards growth into a more developed
human of the severely genetically defected humans, if
it exists, need not be development towards, or related
to, rationality. If due to a genetic imperfection a
human being is incapable of developing to a stage in
which it could have even rudimentary rationality,
how could the value of its growth be based on the
importance of rationality?
Someone might maintain that though the geneti-
cally defected humans may not have what it takes to
grow into a rational human being they do at least
possess some of the necessary prerequisites of being
or becoming a rational human being. Resorting to
such conditions appears problematic, however.
Though it is a necessary condition of one’s being
rational, or at least of one’s continued existence as a
rational agent, that one’s body contains a certain
amount of water, it would be counterintuitive to
maintain that something’s containing that amount of
water merits bestowing it with human dignity.20 How
could merely having some such element of a rational
being merit giving its possessor special moral regard?
Coming up with a prerequisite of rationality that is
18
In light of the above considerations relating to the moral
relevance of belonging to the human species, that a need, or a
striving resulting from it, is human would not appear to have
special moral significance. And the grounding of human dignity
is in any case now assumed to be found in rationality.
19
Nussbaum ([32], p. 363) acknowledges this and maintains
that human dignity does not extend to, for example, a person in
a persistent vegetative state or to an anencephalic child.
20
This kind of strategy has been used in arguing that Kant’s
moral philosophy is able to account for the intrinsic value of
non-rational beings (see [33], p. 198; cf., for example, [28],
p. 546).
Minimally conscious state and human dignity
both possessed by all humans and sufficiently closely
related to actually being rational so that it could be
considered valuable appears rather difficult.
A further interpretation of the view that all humans
have rational nature is that all human beings are
potentially rational beings. The standard criticism of
this type of argument is that we should not ascribe a
being with potentiality to something the moral status of
beings that have actualized the potential. A presidential
candidate is a potential president, but merely on that
basis we should not confer to her the rights of a
president.21 This standard objection appears incompat-
ible with the view that having the potentiality to
develop into a rational being bestows non-rational
humans with human dignity. Applied to the case of
human dignity, the objection implies that one’s poten-
tially having the property that bestows its possessor
with human dignity does not mean that one has human
dignity while the potentiality remains non-actualized.
Even if it were accepted that the potentiality for
rationality itself deserves to be morally highly
respected, that could not justify the view that persons
in minimally conscious state possess human dignity.
That is because all of them do not possess such
potentiality in a strong enough sense. As already said
above, some of the persons in minimally conscious
state deteriorate into coma or vegetative state and
some remain in MCS until they die. When there is no
hope of a person’s gaining normal consciousness
again, it would be implausible to maintain that she
still has the potentiality to become rational in any
relevant sense. So, even if the argument from
potentiality succeeded, its significance from the point
of view of justifying human dignity for persons in
minimally conscious state would at best be limited.
21
Focusing on the problem of whether embryos have moral
status, Deckers responses that the line of criticism is implau-
sible as it presupposes that beings with mere potential do not
have moral status. Deckers asks whether one’s not being the
president implies that one lacks moral status and answers: “Not
at all. The question of whether or not a particular human has
moral status is immune from the question of whether or not that
human has achieved a particular contingent status” ([30], p.
264). However, contrary to what Deckers would appear to
assume, the objection does not tie having moral status to some
such position as presidency. It says that one’s potentially
becoming president, or being a potential president, does not
imply that one already has the rights that come with the
position of a president. That does not mean that lack of
presidency implies lack of moral status.
43
Though some of them never regain normal
consciousness, it might be maintained that all persons
in minimally conscious state however have uncon-
scious mental states. Sleeping persons, for example,
do not lose their beliefs and desires, but retain them in
an unconscious or dispositional sense. Similarly,
someone might argue, to the extent that the appropri-
ate neurological configurations are preserved in their
brains persons in minimally conscious state have
unconscious mental states. And dispositional mental
states too can be considered morally relevant. For
example, it is plausible that a person should not be
allowed access to sensitive military secrets if she has
the belief that the government should be violently
overthrown. According to Boonin ([34], p. 68), whose
example this is, what should matter in such cases is
not just whether one has the belief in question as an
occurrent belief, but whether one has it at all.
Similarly, someone might maintain that persons in
minimally conscious state have human dignity be-
cause they have unconscious rational mental states.
That kind of defense of the human dignity of
persons in minimally conscious state is, however,
problematic. To continue with the above example, the
moral relevance of the unconscious belief that the
government should be violently overthrown is mainly
based on the disvalue that would result from the
person’s acting according to the belief. Knowledge
about the person’s having such a belief can affect our
appraisal of her character even if we knew that she
would never act on it. But it is the prospect that she
really would act according to the belief that is morally
the most significant thing here. As many of the
persons in minimally conscious state will never act on
their beliefs and desires, the moral significance of
their unconscious mental states cannot be based on
their (possibly) actualizing their desires. What moral
relevance those mental states have, if they are to have
such relevance, must thus be grounded on our
believing that the persons possessing them would be
rational in some counterfactual world which, for all
we know, will never become real. That can ground at
best a quite weak argument for the stand that they
possess human dignity.
Furthermore, not all of the persons in minimally
conscious state possess rational unconscious mental
states. Consider, for example, MCS in connection
with young children. As opposed to such things as
accidentally having true beliefs, small children are
44
usually incapable of having rational mental states.
They cannot assess reasons in the way that forming
rational beliefs and desires presupposes. When a
small child was unable to have rational mental states
prior to her falling into MCS, she does not have
unconscious rational mental states.22 Therefore, the
special moral worth the doctrine of human dignity
bestows on her cannot be based on her having
unconscious rational mental states.23
In light of the above considerations, a plausible
justification of the doctrine of human dignity cannot
be based on the view that all humans are rational or
have the relevant kind of capacity for rationality. It
might however be maintained that this problem is
merely apparent. Instead of trying to base human
dignity on some property that some humans may not
have, it could be claimed, we should take it that the
doctrine of human dignity is justifiable in terms of a
property that all humans ought to have. It could thus
be maintained that there is a relevant sense of ‘ought’
in which all humans ought to be, for example, rational
(cf., for example, [35]).24 When a person is not
rational, she lacks something that she ought to have,
the property of being rational. In this view, the fact
that some humans lack rationality would then be
irrelevant from the point of view of justifying their
human dignity since the important thing is that all
humans ought to be rational.
However, at least as a defense of equal human
dignity, this line of thinking too confronts problems. It
is difficult to see what could ground the view that all
humans ought to be rational. Usually the idea is based
on a view about human nature which says that it is the
essence, or the function, of a human being to be
rational (cf., for example, [35]). Such claims about
22
This reason also excludes the view that persons in minimally
conscious state have human dignity by virtue of having been
rational agents.
23
If potentiality or dispositionality is defined in such wide
terms that even the genetically defected humans who will never
have normal consciousness are potentially or dispositionally
rational, it is not clear how the view that several non-human
animals too would have human dignity as they in some
circumstances—perhaps with the help of such things as genetic
modification or brain-implants,—could develop into rational
beings.
24
The argument Ramsay [35] puts forward concerns the moral
status of the handicapped, not that of persons in minimally
conscious state.
J. Varelius
what accords with human nature are however notori-
ously hard to prove. Of course, there are senses in
which it would be good if, for example, small
children were fully rational and those in which it is
in the nature of a healthy child to develop into a
rational being under favorable circumstances. But it is
hard to see how it could be reasonably sustained that,
for example, a newborn baby ought to be rational.
Furthermore, though I here have spoken about
rationality on a very general level, there of course are
several competing understandings about what exactly
is rational. According to one popular conception, it is
rational to promote one’s self-interest. Selfishness has
also been seen to be in our nature. Making the rather
plausible assumption that selfishness should some-
times be morally limited, we morally ought not to be
rational in that central sense of ‘rational’.25 As long as
that and similar understandings of rationality are not
shown to be implausible and some sense of rationality
sufficiently coextensive with a credible morality has
not been established, it remains unclear why we
morally ought to be rational or to promote individu-
als’ self-interestedness, other things equal.
Finally, even if it were accepted that we ought to
be rational, providing a coherent justification for the
doctrine of human dignity in terms of the idea that
humans ought to be rational presupposes that a similar
requirement does not apply to nonhumans. Otherwise
nonhuman and non-rational beings too could have
human dignity. But, assuming that humans ought to
be rational, why would it be that only humans ought
to be rational? If rationality is such an important
thing, why exclude other beings from its sphere? The
possible objection that rationality is not in the nature
of others beings than humans can be countered by
referring to the great apes that are capable of a form
of rationality. Of a non-rational great ape it could then
be said that it too has human dignity since it ought to
be rational.26 In the absence of satisfactory solutions
to these problems, the doctrine of human dignity
cannot be justified in terms of the stand that all
humans ought to be rational.
25
For a recent discussion on arguments referring to human
nature in bioethics see, for example, Buchanan [36].
26
Perhaps it could be maintained that even those beings the
typical examples of which are not rational ought to be rational.
I will not now go into that possibility.
Minimally conscious state and human dignity
Is Rationality After all Irrelevant to Human
Dignity?
It could however be maintained that, instead of the
problematic notions of rationality or the capacity
thereof, there are other properties that all humans do
possess and which can provide sufficient grounds for
the doctrine of human dignity. As already suggested by
what was said above, the view that humans merit special
moral consideration simply by virtue of belonging to the
human species faces difficulties.27 Those problems
with the view arguably arise from its attempt to base
the moral justification of human dignity on purportedly
purely factual biological considerations concerning the
characteristic features of the human species. Perhaps
the difficulties could be avoided by grounding the
justification on some notion more intimately connected
to our evaluative concerns? Though it is not the only
possible candidate, the main problems of the suggested
approach to justifying human dignity can be demon-
strated by considering the concept of a person.
There are at least two reasons that make defending
the doctrine of human dignity by saying that all
humans have human dignity by virtue of being
persons unpromising. First, plausible grounds support
abandoning the concept of a person from our moral
discourse (see, for example, [37]). Sometimes ‘per-
son’ is used purely normatively to single out beings
that one wants to bestow with special moral regard.
The problem with that kind of use of ‘person’ is that it
simply does not amount into a justification of granting
some beings with special moral worth. Instead, it
merely reasserts what needs justifying. Usually
personhood is ascribed by virtue of the assessed
object’s having some such property as autonomy or
rationality. However, when that is the case, the
concept of a person, and maybe the notion of human
dignity too, is arguably redundant. Why not leave it
behind and refer directly to the property of autonomy
or rationality, etc. that are doing the important moral
work? And of course, defenses of the doctrine of
human dignity that refer to that kind of grounds of
ascribing personhood face the same problems the
27
In addition to the problem related to the coherence of the
concept of species, it is hard to explain why possessing the
common defining characteristics of species—particular genetic
structure or particular kind of reproductive relations,—should
bestow one with special moral worth.
45
view that human dignity is based on rationality, or the
capacity thereof, was shown to confront above.
Second, even among the philosophers who want to
retain it the concept of a person is highly contested.
Accordingly, there are several different competing
criteria of personhood. If the criterion referred to is
very demanding, some or even several human beings
may not qualify as persons. If it is formulated loosely,
some or even several nonhuman beings may count as
persons. Indeed, some proponents of animal rights,
for example, argue that as many nonhuman animals
are persons too they deserve the same respect as
human persons.28 Justifying the doctrine of human
dignity in this way presupposes that a suitable
concept of personhood that applies to all (and only)
human beings can be found. These considerations do
not show that there cannot be a concept of a person
that applies to all (and only) human beings and
justifies giving them special moral significance. But
they demonstrate that, as things are, trying to justify
the doctrine of human dignity by reference to the
view that only human beings are persons faces serious
difficulties.29
It could however still be maintained that persons
like those in minimally conscious state have human
dignity by virtue of their sharing a culture with us or
because they participate in our way of life. Even this
line of thinking confronts problems, however. Most, if
not all, of the persons in minimally conscious state are
not participants in our culture or way of life. Due to
their severely restricted capacities they do not
intentionally contribute to, or play an active role in,
our lives. Accordingly, they would not have human
dignity when possessing that status is taken presup-
pose participation in our culture or way of life.
28
E.g., Gunnarsson [38] maintains that the great apes are
persons and can sometimes merit more moral regard than
humans. For a useful discussion on the meaning(s) of the
concept of a person see, for example, Barresi [39].
29
Besides the concept of a person, the other possibilities in
terms of which to formulate this type of a justification of human
dignity include the concepts of an individual, a self, a subject,
secular notions of the soul, etc. I am unable to examine them all
here. It however seems that they face problems similar to those
the justification in terms of the concept of a person was shown
to confront above. As they do not, as yet at least, have clear
enough contents, referring to them will rather raise additional
difficulties than be of help in defending the doctrine of human
dignity.
46
It might be objected that participation in a way of
life does not require intentional action from all of the
participants. However, all beings are not of equal
value from the point of view of our culture or way of
life, and some are even of disvalue. Thus, even if
taking particular kind of intentional action was not
necessary for participation in a culture, we have some
criteria for what kinds of things can legitimately be
counted as important parts of our culture. Considering
the fact that relatively much effort is put to avoiding
and curing such states as MCS, is seems safe to say
that minimally conscious state is not a valued part of
our way of life. Though persons in minimally
conscious state can be very important to us their
being in that state is usually considered most
unfortunate. Facing the moral and other difficulties
their cases pose can of course be of instrumental value
from the point of view of such things as developing
moral sensitivity and promoting medical science. But
MCS is not necessary for the enhancement of those
ends. For these reasons, the view that persons in
minimally conscious state should be taken to have
human dignity because they participate in our way of
life, or qua patients in minimally conscious state
constitute a valuable part of it, is not plausible.
Evolutionary Theoretic Reasons for Human
Dignity?
It might be maintained that we should not try to
justify the doctrine of human dignity in terms of some
dignity-conferring feature that all humans have or
ought to have. Whether or not such a property can be
found, a proponent of this view could maintain, we
have reason to favor the members of our own species
by giving them such a special moral status as human
dignity. A source that could be taken to provide
grounds for this kind of view is evolutionary theory.
Deckers ([30], p. 267), for example, writes as
follows30:
30
Also Levy ([40], p. 213, 216), declaring to play the role of a
devil’s advocate, suggests that the rootedness of morality in our
evolutionary history might give us reason to extend the highest
form of moral considerability to members of our own species
and continues that it may be that our moral emotions are
inevitably triggered by conspecifics.
J. Varelius
Speciesism makes good evolutionary sense. The
reason why we should be speciesist is because
we have natural inclinations to favour members
of our own species. Those groups of ancestral
humans that cared more about their fellow
humans than about other species had selective
advantage over other groups of people that put
interests of other species first or on an equal
level. The fact that we evolved into beings with
natural inclinations to care more for our own
kind than for other species is morally significant.
This kind of view about the grounds of granting
humans special moral status31 however raises at least
the following six problems. First, the cases of several
animal rights activists and pet owners, for example,
demonstrate that not all of us are inclined to favor
members of our own species. Though a pet owner
was not a misanthrope, she may put more value on
animals than on human beings.32 That is a coherent
stand at least. Furthermore, even those who want to
prioritize humans over other species need not extend
their concern to all human beings. They may wish to
favor, say, an endangered animal species over persons
in minimally conscious state while still believing that
normal healthy humans have the highest moral status.
Why should such stands be ignored or downplayed in
assessing the plausibility of speciesism in general?
Second, from the point of view of evolutionary
theory the expression ‘fellow humans’ Deckers uses
most plausibly should not refer to the human species
as a whole. Instead, there is good reason to believe
that the evolutionary unit of importance was, and is,
the locally interbreeding population (see, for example,
[31], pp. 115-116). To succeed in the struggle for
survival, it seems that one does best by concentrating
31
Deckers does not speak about dignity but about moral status
that implies meriting relevantly similar moral regard that having
human dignity is usually taken to deserve.
32
Deckers ([30], p. 268) maintains that Greenpeace activists’
risking their life in their campaign to save whales must be
interpreted as a provocative and hyperbolical way of empha-
sizing that whales deserve almost as much moral regard as
humans, not as implying that we should regularly put our lives
on the line for the sake of whales. But why should we see this
case in terms of the dichotomy of provocative emphasizing of
whales’ moral value and our putting our lives regularly on the
line for the whales. Furthermore, the group of such Greenpeace
activists does not exhaust the persons who are not inclined to
favor our own species.
Minimally conscious state and human dignity
one’s efforts on oneself or on a group of beings much
smaller than a species. If the question is about
promotion of one’s own genes, the concentration
should plausibly be on persons who share or may
share one’s genes and the beings that are useful from
the point of view of spreading those genes. Promoting
the survival of such a group of beings could well have
supported activities detrimental to the existence of
competing human populaces as soon as they started to
emerge.
Third, even if at some point in history favoring all
members of our own species would have had
selective advantage, with the ever worsening over-
population it can well become more and more
selectively advantageous for one to favor only some
of one’s conspecifics. In this light, the prospects of
providing evolutionary theoretic grounds for the
human dignity of persons like those in minimally
conscious state seem rather gloom. Why should one
favor such beings that are unlikely to best support one
in one’s fight for survival? It seems that nonhuman
beings, such as those that are used for food, would be
much more valuable in that respect. From a purely
evolutionary point of view it could even be argued
that one should get rid of such extra baggage as
persons in minimally conscious state.33
Fourth, as suggested by the above remarks, even if
we were in some relevant sense “naturally inclined”
to favor our own species that as such does not imply
that we morally ought to be so disposed. Deckers
([30], p. 269) maintains that here the ‘ought’ of
speciesism is discovered simultaneously with the ‘is’
of our finding ourselves to be inclined to favor our
own species. As said above, all reasonable persons are
however not naturally inclined to favor our own
species. So, instead of discovering the ‘ought’
simultaneously with the ‘is’ they do not find the ‘is’
at all. Furthermore, people are said to be naturally
inclined to aggression under certain circumstances;
because of their natural dispositions persons can find
it difficult to remain faithful to their spouses; many of
us want to favor the members of our own families,
etc. However, that does not imply that aggression,
adultery, nepotism, etc. is morally acceptable. On the
contrary, most moral systems include rules to circum-
33
To say that persons like those in minimally conscious state
could be useful as a source of spare parts for the fitter would be
incompatible with bestowing the former with human dignity.
47
scribe those kinds of behavior and, thus, the corres-
ponding natural inclinations. Why, especially in the
light of the suffering and damage humans cause to
other parts of nature, acting in accordance with the
assumed natural inclination to favor our own species
should not be morally restricted?
Fifth, the concept of species itself is highly
contested. There are philosophers who believe that a
coherent concept of species can be formulated (see,
for example, [41]). However, several others believe
that the notion is at best merely a convenient way of
classifying beings for our practical purposes, if even
that (cf., for example, [42]). In the light of evolution-
ary theory, it can be argued, there are no real or
important differences between such species as, for
example, humans and the great apes. If the concept of
species is incoherent, the prospects of justifying
speciesism in its terms are, of course, unpromising.
Sixth, even if there were a plausible way of
defining and applying the concept of a species, it is
still reasonable to ask why that way of classifying
beings would be morally central. Besides species,
assuming that the category is coherent, there are
several other possible classification criteria, such as
being alive, sentient, moral, etc. Why would the
concept of species be the most important one of them
for determining our relationships with others?
As the above remarks suggest, evolutionary theory
is ambiguous and often it can be used to criticize the
same views that resort to it for support (see also, for
example, [43]). What the correct interpretation of
evolutionary theory is and what are its moral
implications remain controversial. The view that all
humans are entitled to such special moral regard as
human dignity needs better reasons for its support
than the above kind of evolutionary theoretic consid-
erations provide.
What does Lack of Rational Justification
for Human Dignity Imply?
To the extent that the above considerations are
plausible, the attempts to identify a property that all
humans possess and which justifies bestowing all
humans with human dignity fail and evolutionary
theoretic grounds for equal human dignity remain
indecisive at best. That suggests that, as things are, we
do not have sufficient reason to believe that all and
48
only humans have special dignity. However, all
philosophers who reject the view that human dignity
is ultimately based on mystery are not willing to draw
that conclusion. Acknowledging that scientific knowl-
edge poses a serious threat to the view that humans
would be morally special, Dennett [44] maintains that
we still should believe in human dignity because of
the value of retaining our belief in it.34
The plausibility of that view presupposes that
believing in human dignity—understood in a sense
in which it is importantly different from other values
such as wellbeing, autonomy, and justice,—is neces-
sary for retaining something we have good reason to
want.35 However, instead of human dignity, it is
possible to justify at least a significant number of our
existing (moral) practices by reference to such values
as health, wellbeing, justice, and autonomy. Further-
more, those who for the above discussed reasons reject
the view that all human beings have equal human
dignity can still hold, for example, that all rational
humans have human dignity by virtue of their being
rational. So, if discarding the belief that all human
beings have equal dignity is to have significant con-
sequences from the point of view of our existing (moral)
practices, human dignity should be the most suitable
value for justifying those practices. Furthermore, the
belief in equal dignity for all should also play an
important role in our dealings with humans who do not
have the dignity-conferring property.
Trying to solve the problem of whether the most
plausible justification of the (moral) practices we have
sufficient reason to hold on to must be in terms of
human dignity is beyond the limits of this work. Here
I must settle for briefly considering the role the belief
in equal human dignity has in our dealings with non-
rational humans. It seems that the belief does not play a
significant part in that context. Firstly, as already said
above, significant philosophical controversies exist on
whether such beings as embryos and the comatose
possess human dignity. To those who believe that they
do not, references to the human dignity of such beings
34
In a similar vein, after acknowledging the fact that all
humans are not rational Sulmasy [45] concludes that instead of
rationality human dignity must then be based on mere species
membership. The problems with that view were already
mentioned above.
35
Dennett understands human dignity in a wide sense in which
it encompasses several of the central values of our “tradition”.
J. Varelius
are meaningless. Second, there is much disagreement
on what respecting human dignity implies. Would, for
example, euthanizing a permanently comatose person
or a person in minimally conscious state accord or
conflict with human dignity? Accordingly, instead of
human dignity, how we solve moral problems the cases
of non-rational humans give rise to is often decided in
terms of values like health, wellbeing, justice, and
autonomy. It thus appears that belief in equal human
dignity is not that central to our moral dealings with
non-rational humans.
The value of retaining that belief could then be
taken to depend on its prospects of turning out to be
valuable to us. There is reason to think that those
prospects are not bright. In connection with moral
problems such as those arising in connection with
MCS the value of a belief is usually dependent on the
justification that can be presented for it. At least
outside cases of agreeing to disagree, controversial
moral beliefs are unlikely to be of significant value in
solving moral problems simply because such beliefs
cannot function as a basis of rational moral consen-
sus. In light of the above considerations, it appears
quite difficult to explain how the significance of some
humans’ possessing the dignity-conferring property
extends to the cases of those human beings who lack
it. Accordingly, the belief in equal human dignity is
unlikely to turn out to be very valuable for us in our
dealings with non-rational humans.36
Furthermore, determining whether or not one
believes in equal human dignity purely on the basis
of the belief’s societal significance would make human
dignity an instrumental value only. Understanding
human dignity as an instrumental value would allow
us to ignore it whenever some other means would be
more effective in achieving our ends, whatever they
would be. That would be incompatible with the
doctrine of human dignity whose central purpose is
to protect individuals against violations defended in
terms of such things as greater societal value or the
promotion of the wellbeing of a limited group of
persons. For these reasons, the attempt to justify the
36
Whether it could be of more worth to us than solving the
moral problems in terms of values like health, wellbeing,
justice, and autonomy is a question that cannot be examined
within the limits of this article.
Minimally conscious state and human dignity
doctrine of human dignity in terms of its societal
value does not succeed in establishing the creed.
Conclusion
In this article, I have considered whether the value of
human dignity could help us in solving the moral
problems the advent of the new diagnostic category of
minimally conscious state has brought forth. I focused
on the question of whether we are justified in holding
that persons in minimally conscious state possess
human dignity. I maintained that the view that persons
in MCS possess human dignity is not self-evident but
needs reasons for its support. Human dignity is
usually taken to be deserved on the basis of possess-
ing some such property as autonomy, rationality,
language use, or moral agency. I considered different
ways of explaining how the humans who lack such
dignity-conferring properties could after all have
human dignity presented in recent philosophical
literature and found them unconvincing. Consequent-
ly, in the light of the main argument of this paper, the
view that persons in minimally conscious state have
human dignity lacks sufficient rational grounds. For
those who believe that human dignity is based on a
mystery that is not a problem. But to the more
rationally oriented persons it poses a difficulty. In
order to establish the kind of doctrine of human
dignity that could help with the central moral
problems of MCS, a plausible way of accounting for
the stand that even humans who lack the dignity-
conferring property have human dignity is needed.
Alternatively, some other property than rationality, the
capacity thereof, personhood, or participation in our
way of life that all humans possess and that merits
bestowing them with equal human dignity should be
found. Though both of these tasks appear quite
difficult, that of course does not imply that we should
reject the intuitively plausible view that we can have
moral duties to persons in minimally conscious state.
Besides trying to complete either of them, a further
option is to examine other values that could bring
light to the problem of how we ought to stand with
persons in minimally conscious state. These tasks
must now however be left for future work.
Acknowledgements I thank Juha Räikkä, Susanne Uusitalo,
and an anonymous reviewer of this journal for helpful
comments on an earlier version of this article.
49
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Dr Jukka Varelius works at the University of Turku, Finland. He
concentrates on questions of moral philosophy and applied ethics in
particular.