Christopher Kaczor makes it plain at the outset that his book A Defense of Dignity: Creating Life, Destroying Life and Protecting the Rights of Conscience is a collection of his previously published essays. These essays have been (minimally) revised and arranged as thirteen chapters. Nine of the essays were published in the National Catholic Bioethics Quarterly, two in the journal Christian Bioethics, one in the Linacre Quarterly, several also appeared online and two originally appeared as chapter contributions in edited volumes (though curiously the title of one of the books appears as The Ethics of Organ Donation in Kaczor's book rather than as its actual title The Ethics of Organ Transplantation).
Kaczor says that these essay chapters ‘examine ethical issues related to human dignity’ (p.1). His first chapter sets the scene by justifying human dignity, particularly the dignity that is intrinsic to all human beings, in response to those who argue against the usefulness of dignity or who reduce dignity to the exercise of autonomy. Referring to the three-fold analysis made by Daniel Sulmasy of dignity as attributed, as intrinsic worth and as flourishing (p.5), Kaczor states that these three senses of dignity ‘inform’ the different parts of his book (p.6). His second chapter consolidates his justification of human dignity by arguing through the question, ‘are all species equal in dignity’. Kaczor neatly demolishes arguments that claim appeals to human dignity are a form of discrimination by dissolving the link some attempt to make between speciesim and racism or sexism.
The subsequent chapters demonstrate all too clearly that the book is simply a collection of stand-alone essays. There is no doubt that these essays are clearly argued, and Kaczor's keen intellect gets to grips with opposing views and nuanced arguments. Certainly human dignity is implicit in his discussion. However, the thread of human dignity does not seem to pull the collection together. Chapters 3 to 8 deal with procreation and the immediate beginning of human life. This is discussed in Chapter 3 in terms of equal access to fertility treatments, the welfare of the child and reproductive autonomy where equal respect does not entail a duty to do whatever a person requests. Chapter 4 deals with ‘procreative beneficence’ and the legitimacy of using fertility treatments in such a way as to maximise the likelihood of a child having a good life. Chapter 5 looks at the ethics of embryo adoption and artificial wombs as making ‘the best of an already imperfect situation’ (p.66). In Chapter 6 Kaczor examines the ethics of dealing with persistent ectopic pregnancy, that is where foetal heart beat can still be detected, particularly where there is a commitment to the equal dignity of every human being. Using direct abortion as a reference point, Kaczor argues that in the ‘lively debate’ neither salpingostomy nor the use of methotrexate need constitute direct and intentional killing of the embryo (p.76, p.79). To embed his conclusion Kaczor applies the theory of probablism, that where there are legitimate doubts an opinion can be formed that relies on probable application of the law even when others hold an opposite and also probable opinion (p.85). Chapter 7 deals with the ethics of foetal surgery as well as reduction of twin pregnancy and the problem of twin-twin transfusion syndrome. In the latter case Kaczor admits the difficulty about coming to a just conclusion especially where foetal dignity is at issue and this leads him on to a sharp critique in Chapter 8 of Judith Thomson's famous violinist argument defending abortion even where the foetus is considered to be a person. In these chapters on the beginning of life certainly human dignity, particularly the dignity of the foetus, is implicit however the focus seems to fall more on the moral duties of parents or physicians to unborn children (p.29; p.39; p.90; p.105).
Kaczor then moves onto problems at the end of life in Chapters 9 to 11. The tone of Chapter 9 on faith, reason and physician-assisted suicide is markedly different in that Kaczor brings Scripture and the thought of St Thomas Aquinas as well as modern philosophers into the discussion. His analysis of the situation of the ‘pvs patient’ and Bl. Pope John Paul II's address on the subject is primarily concerned with the authority of the papal teaching, whether this teaching is in the longstanding christian tradition of distinguishing ordinary and extraordinary means of treatment, and whether artificial nutrition and hydration is required for pvs patients. An example of how Kaczor treats dignity as merely implicit in the discussion occurs in Chapter 11 on organ donation, where he says that the human dignity of the donor must be respected but the discussion is primarily about determining death. Similarly, although Kaczor deals thoroughly and decisively with vexing questions of conscience protection and conscientious objection in Chapters 12 and 13, dignity is mentioned but it is linked to autonomy and freedom (p.154–155; p.174). Given that much of the debate on physician-assisted suicide centres on interpretations of dignity in dying, and that the whole premise of the papal address rests on an understanding of the intrinsic dignity of all patients including the most profoundly disabled, it would have been useful if Kaczor had used his considerable analytical skills to explore dignity as attributed, as intrinsic worth and as flourishing in these situations.
Whether or not the reader agrees or disagrees with Kaczor's conclusions, Kaczor does make a strong case for his positions in each of these essays. However in this collection the essays would perhaps benefit from a stronger connection to the issue in question: human dignity. More seriously perhaps is that in common with most books on bioethical issues problems are grouped in terms of the beginning of life, the end of life and questions of conscience. The rest of life and in particular disability is either merged with the beginning and genetic testing or hovers around dying and death. It is in the area of disability that we need a truly robust defence of human dignity in all its aspects of attributed, intrinsic and flourishing.
