• Autonomy
• Clinical Ethics
• Decision-making
• Ethics
• Human Dignity

I am very grateful to Charlie Camosy and Richard Huxtable for their acute but gracious commentaries. They have made me reflect hard and sometimes painfully. Those reflections have made me wish that I'd made things clearer, but have not made me rewrite my basic thesis.

Huxtable poses three daunting questions. One of them embodies the gist of Camosy's criticism.

Huxtable first asks me ‘what moral steer does (Fosterian) dignity provide?’ He notes my view that ‘every human has dignity, no matter what’, and suggests that I risk ‘seeing dignity everywhere, which arguably threatens the normative power he generally believes the concept to possess.’ He makes his criticism more concrete by observing, rightly, that I see dignity at work in the rulings of both the majority and the minority of the House of Lords in R v Brown1 (about the lawfulness of sadomasochistic acts). Assuming that my account of dignity is being used and rightly understood by the House, he implies, the fact that opposing sides can each recruit it must mean that the account has insufficient normative power to be useful.

It's a potent argument. Indeed it is an argument I used myself in the book when, in criticising another account of dignity, I observed that human dignity has been used both to insist on and to denounce the death penalty and to contend for and against a right to abortion. But in the Brown context the argument has more rhetorical than substantive force. I say expressly and repeatedly in the book that my (or any) definition of dignity won't in itself solve any problems at all. We need, in addition to a workable definition, an explicit and practical model for its deployment. I provide that model. I refer to it as a ‘transactional model’—by which I mean a …