Institute ol So<:lely,Ethics and the Ufe Sciences
Volume 2, Number 5 : November, 1972
Indicators of Humanhood:
A Tentative Profile of Man
It 's time to spell out the "which " an d "what" and "when "
M by JOSEPli FLETCHER
ark Twain c.omplained that peo•
pie are always talking about the
weather but they ne"'r do anything
ubout it. The same is true or the
humanhood agenda. In biomedical
ethi cs writers constantly say that we
need to explicate humanness or
humaneness, what it means to be a
t,uly human being, but they new:r
follow their admission o f the need
with an actual inventory or profile. no
matter how ten tatively offered . Yet
this is wha1 must be done, or at Jeas1
attempted.
Synthetic concepts such as human
and man and person require opera•
tional terms, spelJing out the which
and what and when. Only in that way
can we- get down to cases- to nom1a-
tive decisions. There arc- always some
people who prefer to be visceral and
affective in the ir moral choices, with
no desire to have any rationale for
what they do. But ethics ls precisely
the business of rationa1>critical rcflec•
tion (eneephalic and not merely vis-
ceral) about the problemsof the moral
Dr. J()$eph Rtt cht r is Vi#ting Profdso,
of Medical E thics ot the Uniwn ity of
Virginia Schoo l of Medicine. Excerpted
from a (JQPN presented o, the Nalio,,aJ
Co.nfeun.c« on the Tuchlnz of Mtdi<ol
Ethia. co-sp<>nsortd
by the Jnt1it111e1111d
Columbi,a University College of Ph)'•
.ri.CUuu
and Swgr:om.
agent-in biology and medicine as
much as f.n law, government,education
or anything else.
To that end, then. fOf the purposes
of bio,nedic;al ethics, I am suggestinga
··profile of man" in concrete and
discrete terms. As only one man's
reflection on man, it 'NiUno doubt
invite adding and subtracting by
others, but thi$ is the road to be
followed if we mean business. As a dog
is said to '\1-•orry" a bone, ltt me
worry out loud and on paper, hoping
for some agreement and. at the least,
consldernlio11.There is space only to
itemize it , not to enlarge-upon ii, but I
have fifteen positive propositions and
five negative propositions. Let me set
them out, in no rank order at all , and
as hardly more than a ti.st of criteria or
indicators, by simple title.
Positil·e Human Criteria
Minimal intelligtncc. Any indivi-
dual of the species Jiomosapienswho
falls below the I.Q, 40-mark In a
standard Stanford-Binet test, amplified
if you like by other tests, is question•
ably a person; below the 20-mark, not
a person. Homo is indeed sapiens. in
order to be home. The ratio, in
another tum of spc<ch, is what makes
a person of 1.hevita. Mere biological
life, before minimal intelligence is
achieved or after it is lost irretrfovably,
is without pcrSQr'la l status. Th.is has
bearing, obviously, on decision n1Wng
in gynecology, obstetrics and pedfa,
tries> as Y.
'ell as in general surge{yand
medicine.
Self -awareness. Self-consciousne-ss,
as wt know, l.$ the quality we watch
developing in a baby; w, watch it. with
fasdnation :md glee. Its es.ential role
ln personality development is a basic
datum of psychology. Its existence or
function in animals at or below the
primate levtl is debatablt; it is clearly
absent in the lower vertebrates., as well
as In the nonvtrtebrates. In psyc.J10-
lher-apynon-self-awareness is patholog•
ical; in medicine, unconsciousness
when it is incorrigible• at once- poses
quality-of-life j udgments- for example,
in neurosurgical cases of irreversible
damage- to the brain cortex.
Self-eontrol. If an individual is not
only not controllable by others (unless
ALSO IN TH IS ISSUE:
The Other Drug Problem,
by Pet er St e lnfe ls
The DIiemma or a
Prison Doctor, by Frank
Rund le, M.D.
That Virginia 'Brain Deatll'
Case, by Rob ert M . Veatch
Page 2
by force) but not controliJlble by the
Individual himself or herself, a low
level or life is reached about on a par
v.'lth a paramecium. If the c.on<Ution
cannot be rectified medicaUy. so that
means-ends behavior is out of the
question, the individual is not a per-
son- not ethically, and certainly not in
the eyes. of the law- just as a fetus is
not legally a person.
A sense of time. Time conscious-
ness. By th.is is meant clock time or
chronos, not timeliness or kairos. i.e.,
not the "fulnes.s of time" or the
pcegnant moment (rcmc-mber Paul
Tillich?). A sense, that I$, of the
passage-of time, A colleagueof mine at
the University of Virginia. Dr.Thomas
Hunter, remarked recently. " Life is
the allocation of time." We can dis•
agJeelegitimatt ly about how relatively
impOrtant this indicator is1 but it is
hard to understand why anybody
would minimize it or eliminate it as a
trait of humanneS:S.
A seose of futw-ity. How "truly
human' ' is any man who cannot realize
there is a ti'me yet to comt as well as
the present? Subhuman animals do not
look forward in time; they live only on
what we might ca.II\·isccral strivings,
appetites. Philo$0phical anthropologies
(one recalls William Temple's, for
instance) commonly emphasize pur •
posiveness as a key to humanness.
Chc.stcron once remarked th.at we
would never ask a puppy-what manner
of dog it wanted to be when it grows
Hastings Center Report
623 Warburton Avenue
Has lings on-H udso n, N'f 10106
4
8,uc♦ Hilton. Editor
HA STINGS CENTt:A STAFF
Admini1tr•tion : Oaniel Callahan, d i--
rector ; Willard Gayli n, president ;
Lyn Brydson , Leslie Hendric::ks
Behavlo, Control: Robe rt C, NevUle,
Helen Blatte, Raye Ann Gaski ns
Gtnttiet: Marc Lappe: Tabitha M.
Powledge, Marguerite Robinson
Human.idea: Peter Stelnrels, Helen
O'Sulli van
lnformalion: Bruce Hilton, Martha
Bush, Svsan Travers
Population: Daniel cauahan, Robert
M. V&atc
h, Sharmon Sollitto
Death :Robert M. Veatch, Rosalie
MIiter
copyr,gM $} 1911 or '"- k>-SIJh,,. o,
C011,..,.1'$
SK<l!lr . Elffv<C4
otJO Ir.., l!!CI SCA-IICCl
5 Communication. Utter alienation
up. The assertion here Is that men are
typically teleological. although oer-
tainly not cschatological.
A ,en,e of the past. Memory. Un-
like other animals, men as a species
have reached a unique level of neuto·
logic development, particutarty the
cerebrum and especiallyits neo-<:ortex.
They arc linktd to the past by
conscious recall- not only, as with
subhuman anUTU1ls , by conditioning
and the reactivation of emotions (reac•
tivated , that is, externally rather than
autonomously). It is this trait, in
particular, that makes man, alone
among all species, a cultural instead of
an instinctive creature. An existential-
ist focus on •·nowness" truncates the
natute of man.
Gf he capability to relate to othm.
Inter-personal relationships, of the~ •·
ual-romantic and friendship kind, are
of the greatest importance for the-
folness of what we ideallu as being
truly personal. (Medical piety in the
past has always held its professional
ethics to be only a one•to-one, phy-
slcian•patient obligation.) However,
there are also the more diffuse and
comprehensive social rtlations of our
vocational. economic and political life.
Aristotle's characterization of man as a
social animal, zoon politikon, must
surely figure prominently in the-invcn•
tory. It is true that even insects live in
social systems, but the cohesion of all
subhuman societies is based on in-
stinct. Man's society ic. based on
culture- that is, on a conscious know-
ledge of the system and Qn the
exercise in some real measure of either
consent or opposition.
Concern for others. Some people
may be skeptical about our capacity to
care about others (what in Christian
ethics is often distinguished from
romance and friendship as "neighbor
love'' or '~neighbor concern°) . The
extent to whkh this capacity is actu•
ally in play is debatable. But whether
concern for others is disinterested or
inspired by enlightened self-interest ii
seems plain that a conscious extra-ego
orientation is a trait of the species:the
absence of this ambience is a clinical
indication of psychopathology.
or disconnection from others. if it is
it is a
sense of the past
which n1akes man,
alone a,nong species,
a cu/ruralcreature
ineparablc, is de-humanization.This is
not so much a matter of not being
disposed to receive and send mes..0
sages" as of the inability to do so. This
criterion comes into question in
patients who cannot hear, speak, feel
or see others; it may come about as a
result of mental or physjc.al trauma.
infection., genetic or congenital disor-
der, or from psychological causes.
Completely md finally isolated indivi-
duals are subpersonal. The problem is
perhaps most familiar in terminal
illnesses and the clinical decision.mak-
ing required.
Control of existence. It is of tJ1e
nature of man that he is not helplessly
subject to the blind workings o f
physical or pi,ysiQlogical nature. He
has only finite knowledge, freedom.
and initiative~but what he has of it is
real and effective. Invincible ignorance•
and tot.al helplessnessare the antithesis
of humanness, and to the degree that a
man Jacks control he is not responsi-
ble, and to be irresponsible is to be
subpersonal. This item in the agenda
applies directly, for example, in
psychiatric medicine, especially to
severe cases of toxic and degenerative
psycho~,.
Curiosity. To be without affect,
sunk in anomie, is to be not a person.
lnd.iflerence is inhuman. Man is a
learner and a knower as y,,el( as a tool
maker and user. This raises a question_,
therefore, about demands to stop
some kinds of biomedical inquiry . For
examph), an A.M.A, committee re•
cently called a halt on in vitro rep(O·
duction and embryo transplants on the
gJound that they are dangerous. But
dangerous ignorance is more dangerous:
than dangerous knowledge. It is de-
humanizing co irnpOse:.. moratorium
on research. No doub t this issue arises,
or v.ill arise> in many other phases of
medical educatioo and practice.
Change and changeabilit y. To the
extent that an individual is unchangc•
able or opposed to change he denies
the creativity of personal beings. Jt
means not only the fact of biological
and physiologicalchange, which goes
on as a condition of life, but the
capacity and disposition for changing
ones mind and conduct as well.
Biologically> human beings are de1, ·el-
opmental: birth, life, health, and death
are processes, not events, and are to be
understood epigeneticaJly,not episodi·
cally. All human existence is on a
continuum, a matter of becoming. In
this perspective. are we to regard
potentials als ob, as if they were
actual? I think not. The question arises
prominently in abortion ethics.
Balanae of rationality and feeling.
To be " truly human," to be a
whoJcsome person, one canno, be
either ApolJonian or Dionysian. As
human beings we are not '"coldly''
rational or cerebral, nor a.rewe merely
creatures of feeling and intuition. It is
a mauer of being both, in different
combinations fr om one indh·idual to
another. To be one rather than the
other is lodiston the human1.Jm.
GJ dio,ynerasy. The human being is
idiom-0rphous, a distincfi,..cindh•iduaJ.
As Helmut Schoeck has 1hown. even
the function of envy in human behav.
ior is entirely consistent with idiosyn•
crasy. To be a person is to have aJl
identity, to be recognizable aJl d calJ.
able by name. It is this criterion which
lie, behind t.he fear that to replicate
individual$ by scx:allcd "cloning"
would be 10 make. "catbon copies" of
the parent source and thus dehuman-
it e- the. clone by denying it its indl\1·
dualit}'. One or two writets have even
spoken of a "rigt,1•· to a "unique
genotype,'' aod while such talk is
ethically and scientifically question-
able it nonetheless reflects a legitimate
notion of something essential to an
authentic per$0n.
Neo-corticaJ function. In a way.
this is the cardinal i.ndkator, the ooe
all the others are hinged upon. Before
cen::br.ttionis in play, or with its end,
in the absence• of the• synthesizing
function of the cerebral cortex, the
person is non-existent. Such indivi•
duals are objects but not subjects. This
is so no matter how many other
spontaneoo.~or artificially supported
functions pen ist in the heart 1 lungs,
neurologic and vascular&ystems. Such
non-cerebral procts ses are ,wt per-
sonal. Like the Harvard Medical
School'-Sad hoc committee report on
"brain death" the rectnt Kansas stat•
ure on defining death requires the
absence of broi11function. So do the
guidelines recently adopted by the
ItaJian Council of Ministers. But what
i$ definitive in determiningdeath is the
loss of cerebration, not just of any or
all brain function. Personal reality
depends on cerebration and to be dead
"humanly" speak1ngis to be e x-ccre·
brnl. no maucr how Jong the body
temains alive.
Negalh·eHuman Criteria
The five negative points I have C.lJl
be put e\'cn more briefly than lhe l S
positive ones. although I am inclined
to believe that they merit just as much
critical scrut iny and elabora1ion.
Man is not non• or anti,art.ificiaJ.
A$ Gaylin says, men are characterized
by technique, and for a human being
10 oppose technology is "self-hatred."
We are often confused on this score,
attitudinally. A ' 'teSt tube baby:• for
example, although conceived and ges-
tated ex corpo, wouJd nonetheless be
humanly reproduced and of human
value. A baby nu.de artificially, by
deliberate and c:Jreful contrivance,
would be more human than one•
rtsulting fH>rnsexual rouJ.e .uc- -the re-
productive mode of the subhuman
species.
Man is not esscntiall)' parental.
People can be fully personal withou,
reproducing, as the religious vows of
nuns. monks an.d celibate priests of the
past have asserted, as the law has
implied by refusing to annul marriages
because of sterility, and as we see in
the ethos-rC\'CrsaJ of c-Ontemporary
family and population cootrol- and,
more militantly, in the non-parental
rhetoric of women's liberation and a
growing rejection of the "baby ttap" .
Man is not cssentiaJJy~xual. Sex·
uali1y. a btoader and deeper phenom,
enon than sex, is of the fulness but not
of the essence of man. 1t is nol even
neoessary to human species survival. 1
will not try here to indicate the
psychological entailments of this ncga•
tive proposition, but it is bioJOgically
apparent when we look. a l such non-
sexual reproduction as cloning from
somatic cells, and parthenogenetic re•
production by both andr<>genesis and
gynogene$ls.What light does chis biol-
ogy throw on the nature of man; what
does a personistic view of man say
about rile e thics of such biology?
(N .8. I do not refer here 10 personal-
ism, w}tlch has more metaphysical
freight d1an many of us wam to
cany .)
Man i!i no1 a bundle of rights. The
notion of a human namre has servedas
A test-lube haby
would be ll1orehuman
than one resulting
fro,n sexual roulette
a cooceptual bucket, to contain
"human rights" and ~r1ain other
given things, likC "original sin" and
" the sense of oughtness" and ..con-
science." The idea behind this is that
such things are objective, pre-existent
phenomena, not contingent on biologi,
cal or soda! relatlvitle$. People some-
times speak of rights to UYe, to die, to
be healthy, t◊ reproduce. and so on, as
if they were absolute, eternal. intrin-
sic. But as the law makes plain, all
rights are imperfect and may be set
a.~ide if hum3fl need requires it. We
shall have to think through the rela•
tion of rights and needs, as it bears on
dinical medicine'$ decision-makin.g
problems, as well as society's problems
of health care-delivery, One example:
Whal is the "humane" policy if we-
should reach the p<>int( 1 think we
will) of deciding for or against compul-
sory birth control? Or, how are we to
relate rights and needs if. t <.1iak.c only
one example, an ethnic group protests
against mass screening for sickle cell
Page 4
anemia? Or if after genetic counseling
a cou ple elects to proceed with a
predictablydegenerate pregnancy'?
Man is not a worshiper. Faith in
supernatura l realities and attempt s to
be in direct association \\idt them are
choices some-human beings make and
othe rs do not. Mystique is not essen•
ti.al to being truly a person. Like
:sexuality, it may arguably be of the
fulnes.sof humanness but it is not of
the- essence-. This negative proposition
is required by our basic guideline. the
premise that a viable biomedical ethics
is humanistic, whatever reasons we
may have for putting human wellbeing
at the oenter of concern.
More Thinking
How are we to go about testing
such criteria 3$ the$e?And how are we-
to compare and combine the results of
our criticism? How are we to rank
order or gjvc priority to the items in
our mao,hood profile? Which arc only
optimal. which are essential? \li'hatare
the applications of these or other
indicators to the normative decisions
of biologists and physicians'! In my
own list. here, which factors can be
eliminated, in whole oc in part, with•
out lowering individuals and patients
below the personal line1I trust tha1by
this time h is pl3in Lhat I do nol claim
to have produced the pute gospel of
humanness. I remain ope.n to correc•
tion.
The ..nature of man" question is of
such depth and sensitivity tha t it is
bound to raise c.o ntrovc.csy. and our
tas.k is to welcome the contro\·ersy but
try to ,educe it tluough analysis and
synthesis. Said Heraclitus: "Opposi-
tion brings concord. Out of dis.cord
comes the fairest harmony. It is by
disease that health is pleasant; by evil
that good is pleasant; by hunger.
satiety~by weariness,rt$t.''
As a final note, I rathet suspect that
we are more apt to find good ansv.--ers
inductively and empiric.aUy, from
medical science and the cUnicJans.
than by the necessarily syllogistic
reasoning of the humanilies, which
proceeds deductively from abstract
premises. Syllogisms always contain
their conclusjonsin their major or first
premises. Divorced from tht labora·
tnry and the hospital. talk about what
it means to be human could easily
become inhumane. • •
ConfrontingtheOther
G;"D by PETER STEINFEI.S
~ .I., or most people, the "drug prob,
lem" means nodding heroin addlcts,
crime in the st reet. narc squads,
teenage arrests, and debates over Jega1-
iz.ation of matijuana. Although these
shadows occasionaUy passed O\ler the
Instit\lte 's recent Conference- on Con,
trol of Human Behavior Through
Drugs. it was a more subtle but equally
serious "drug problem·• which oc:cu-
pied the participants' attention. Two
days of intense discussions of four
major papers pcoduced more insights
than can be ,educed to a brief sum-
mary~ bul oeaain recurrent themes
v.,,:
re apparent:
1 Drugsand the MediC3IModel. If
lhe1e was any consensus which
emerged from the conference, it was
that tlte potential of drugs for control-
ling b<havior and even determining
life-styles had badly strained- some
wou1d say shattered- the framework
of the "me-dicaJ model." By assuming
an organic <. Xmdltion ovtr which the
patient has little choice and which
must be restored to normal, the
m:dical model is supposed to prevent
physicians from wading deep into the
water of personal preferences. But the
t ra nsf onnat ions possible through
psychopharmacology appear to escape
these bounds and force ethical choices.
Prescribinga drug to restore a bodily
function to normal is one thing.
Knowing that you can alter a dosage
so as to determine whether a patient
become$ a hard•workingstudent bon-
ing for exams or a relaxed drop-out
conternplatl.ng nal'ure (a dilemma en-
countered by one of the conferees) is
evidently something el.se. De. Louis
Peter Stein/els is the lrull'tute's s111f[
Aisodme for Jhe H1mt0ttlrlet. li e wa.<
form er ly Auociate Edtu,, <>f
Commonweal .
Jolyon-West, Chaim1anat the Depart•
men! ofl'sychiatry, UCLA.catalogued
more than twenty potential uses for
hallucinogenic drugs, ranging from
me-dication and behavior reinforce-
ment to self-exploration, symbolic
rite•s of passage. counter-intelligence.
and social cootrol. Dr. Robert Veatch,
the Institute Associate for Medical
Ethics. distinguished at least five dif-
ferent "ethics" detennining individ-
uals' attitudes toward drugs: the "wis·
dom of the body" ethic rejects chemi•
cal intervention; the Protesrantdrng
ethic approves drugs. which facilitate
the pursuit or .,sah·ation•· in a work-
oriented culture, but disapproves of
those which decrease discipline and
produ.ctivlty: the neo -Pro rettan1 drug
ethit: single.mindedJ} • pursues a salva-
tion experience through whatever
chemicals are ne-ccssary and despite
whate.,·errisks~a pro1eanethic experi-
ments with an array of experiences,
moo<is and behaviors from a full
medicine chest ; a therapeutic ethic
aims at reducing disharmonies in life
and achle,•lng equilibrium. The funda,
mental issue in decisio ns to control
behaviOt' , mood or experience through
chemical agents,said Or. Veatch, is the
choice of a life-style or world view;
and here the medical model provides
no special assistance.
The llmitS of th• medical model
wtre also Illustrated hy the discussion
of Dt. Paul Wender'spaper on Minimal
Brain Dysfunction. According to Dr.
Wender, author of Minimal Brain
Dysfunction in Children, this condi•
uon, associattd with teaming disabili-
ties and adjustment problems in chil-
dren of normal intelligence, is accom,
panied in a core group ofhyperkinetic
children by anatomic.aland neurolog-
ical abnormalities. But a larger group
of children, sometimesestimated as up
to one-third of the boys in early
school grades. displays similar b<hav-