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2. God, Humanity, and Human Dignity "Great are you, O Lord, and exceedingly worthy of praise;

your power is immense, and your wisdom beyond reckoning. And so we humans, who are a due part of your creation, long to praise you—we who carry our mortality about with us, carry the evidence of our sin

and with it the proof that you thwart the proud. Yet these humans, due part of your creation as they are, still do long to praise you. You stir us so that praising you may

bring us joy, because you have made us and drawn us to yourself, and our heart is unquiet until it rests in you."

(St. Augustine of Hippo, ca. 397/2012) By Nathan H. White and Valerie De La Torre

Essential Questions

What does it mean to be a human being?

Why does a human being have value?

What is meant by the concept of personhood?

What are the practical implications for the value of human beings within a health care context?

Introduction Humankind’s restless heart is an invitation to be involved with the human endeavor and particularly with those who are sick and dying. In caring for other human beings while loving God, human hearts may feel flooded with the fulfilling praises of God. Those called as nurses can praise God through their hands, bodies, minds, hearts, and spirit and will make decisions that may decide life and death. They may even help others find salvation. St. Augustine writes, "My heart is listening, Lord; open the ears of my heart and say to my soul, I am your salvation" (St. Augustine of Hippo, ca. 397/2012). This chapter will address why nurses carry this care to others based upon the Christian belief that every human being is made in the image of God.

One of the main hallmarks of the medical profession is its interpersonal nature. Medicine is, if nothing else, a very human profession. A nurse gives medicine, offers comfort to a dying patient, educates patients about their diseases, and walks with patients through their medical treatment. Interpersonal caring defines the

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experience of the profession. Throughout history, health care professionals have acknowledged and celebrated the compassionate nature of nursing as its motivation and foundation.

Although the vocation of nursing centers around caring for other human beings, medical professionals often do not stop to ask why they are doing what they are doing or what it is about another human being that warrants the kind of involved and often difficult care that nurses provide day in and day out. In seeking answers to these questions, the inherent value of human beings becomes apparent. Nurses frequently empathize with others and want to do the best for them, and this is to be applauded. Yet, primarily, the Christian belief that human beings are created in the image of God, or imago Dei, undergirds the value and dignity of every human being simply because of his or her existence. This belief suggests certain practical implications in a range of contemporary health care issues, such as abortion, in vitro fertilization, the definition of death, and euthanasia. This chapter will begin to address many of these topics by looking at ways that science, philosophy, and theology have attempted to answer them.

What Does It Mean to Be a Person? While the question “What does it mean to be a person?” may, at first, seem to be a straightforward question, scientists, philosophers, and theologians still debate the answer. Some perceive a person to be only a physical body with a brain dependent on the body. This is called naturalism. Others suggest that each person has a body and a soul. This is termed dualism. Some have more complicated understandings of the human person that identify the significance of characteristics, such as reason and the search for meaning, that separate human persons from other living organisms. Each of these descriptions of a person understands a human being in a different way. In the field of health care, how health care professionals approach what it means to be a person uniquely informs treatment options.

For example, if a physician perceives a human as having an eternal soul, practitioners will craft treatment that involves this spiritual reality. If a person is understood as having only a physical body, treatment will focus entirely on these options. Every nurse already approaches a patient with an idea of what a person is, and the goal of this chapter is to raise awareness of the reality of the personhood that lies within every patient.

At its most basic level, being a person means that an individual has inherent worth. The person possesses moral, ethical, and legal rights that a nonperson does not have. Generally, in the Christian tradition, personhood has been understood as a substantive nature that all human beings possess. A person may also possess certain traits, such as faith, reason, moral capacity, and consciousness, that enable deep mutual relationality with other persons, including God. In the Christian understanding, personhood is inherent to human beings and is not merely based upon recognition of certain capacities, such as reason, moral capacity, and consciousness.

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Worldview and the Question of Personhood

Worldview significantly impacts the understanding of what it is to be human and to be an individual person. Some believe that God or a transcendent source gives human beings value. Alternatively, another may understand humankind as simply being at the top of the food chain, within the closed system of natural selection. Yet an individual who believes in the existence of God would find God's nature to be of primary importance for understanding what it means to be human. On the other hand, an individual who subscribes to the worldview described as scientism would assume that science can completely answer the question of what it means to be human. In each of these cases, the question of personhood is not primarily a scientific one but, rather, a philosophical one.

Additionally, an individual's worldview about personhood directly influences decisions regarding the care and treatment of patients. Nurses and other health care professionals may think that beliefs and actions separate easily into different boxes without mutual interaction. In reality, beliefs and assumptions about the world significantly shape interactions with the world. This is easily seen in health care situations. If belief in God shapes understanding of personhood, a nurse may display his or her faith determining the care that is needed based on personal and professional perception as well as listening attentively to the patient. If a practitioner perceives a person as being only a physical body, personal interaction with patients and health care considerations may remain at the level of basic physical care.

For example, in the context of palliative care, what constitutes a human person may help decide when to withhold or withdraw treatment from a patient. If quality of life is assumed to be the only consideration for care, treatment could be withdrawn too early before other methods of comfort care are considered. Alternatively, the Christian worldview makes it clear that every human being is approached as being made in the image of God and worthy not only of quality care for physical ailments but also of complete care for both body and soul.

The Metaphysical Question: What Kind of Thing Is a Human Person?

The Bible describes the need to reverently consider the mystery of the human person. Some 3,000 years ago, the writer of the Psalms, prayerfully reflecting on the finitude of humanity and the mystery of God's relation to human beings, wrote, "what is man that you are mindful of him, and the son of man that you care for him?" (Psalm 8:4 English Standard Version). Yet the psalmist does not specifically relate what is so special about human beings or what about human nature separates them from other creatures.

In the postmodern health care situation, nurses will find many understandings of the human person suggested by other professionals and patients. For example, some philosophers, such as Hume, have hypothesized that human beings are only a

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collection of perceptions. Some, such as Searle, say humans are the creators of their own reality, while others, such as Wittgenstein, say that human beings might not exist at all. All these viewpoints may exist in the health care setting. Yet within the Christian religious tradition, human beings themselves are inherently deserving of dignity and respect.

Because, in creation, God made human beings in his image, personhood has a transcendent origin; therefore, human dignity should be recognized and valued in all human beings. Practically, the truth of human dignity calls forth respectful treatment from others. For instance, people who consider themselves as having dignity would not let others treat them in a demeaning or degrading manner but, rather, would consider themselves as being worth more than such treatment would suggest. Thus, individuals would look at themselves as being inherently valuable and deserving of proper treatment.

Dignity logically relates to the concept of human rights. People rightly view abuses against human rights, such as genocide, as being among the worst kind of offenses. But the exact nature of these human rights is not clear. The U.S. Declaration of Independence suggests that human rights refer to the right to "Life, Liberty, and the pursuit of Happiness," but others may consider human rights as being more or less than this. For instance, some consider the right to life as the most primary of human rights, while others recently have included access to high-speed internet as a human right (Human Rights Council, 2016). The range of viewpoints is quite staggering. Unless practitioners can determine the source of these rights, whether from God or elsewhere, then there is little reason to ascribe rights to human beings any more than to any other entity.

A medical professional's beliefs about what constitutes a human being significantly impact actions when caring for a sick or dying patient. A person of the Christian faith sees the human being as a creation of God. In the Bible, the psalmist wrote as a prayer to God, "I praise you, for I am fearfully and wonderfully made. Wonderful are your works; my soul knows it very well" (Psalm 139:14a). In the psalmist's view, human beings have a special relationship to their Creator who made them in such an extraordinary way. The relationship of human beings to God and to other creatures is, then, of utmost importance.

Scientific Classification: Human Persons in Relation to Other Species

The scientific classification system, based on the ancient Greek philosopher Aristotle's thought, divides up entities into various categories based upon observed traits. The basic differentiation is between the nonliving or the living, with further differentiation into categories such as animal or plant, vertebrate or invertebrate. In regard to human beings, the species labelled Homo sapiens, such classification labels describe shared characteristics between human beings and other animals. This is helpful to describe what a human being is like, but this does not, in the end, provide an answer regarding what kind of thing a human being is. For instance, it cannot

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explain why human beings have particular characteristics, such as reason, emotion, or spirituality.

In his On The Origin of Species (1872/2009), Charles Darwin, the originator of the naturalistic theory of evolution, attempted to explain human existence without reference to a divine being. Naturalistic evolution has roots in this system of taxonomy and views the law of survival as the driving force behind the onward movement of life itself. Naturalistic evolution, though, fails to answer some questions fully, such as why human beings exist or how nonphysical phenomena, such as consciousness, arose from purely physical origins.

Darwin's Thesis Published in 1859, the full title of Darwin's book is quite telling as to its thesis: On the Origin of Species by Means of Natural Selection, or the Preservation of Favoured Races in the Struggle for Life.

Human beings, in this understanding, are the most advanced form of life on Earth but are not the ultimate end to evolutionary progress. One implication of this viewpoint is that continued human enhancement is not only acceptable but is almost mandated in the onward march of progress. Another implication follows from this: human beings are merely one stop in nature's continuing development in the evolution of living things. Yet if human beings are not different kinds of things than a beetle, then there is little ethical reason that they should not both be treated in a similar manner. If it is ethically justified to kill a beetle, naturalistic evolution provides little justification for not treating other organisms, including human beings, likewise. In their assessment of justified ethical treatment for animals, some secular ethicists, such as Peter Singer (1975), argue animals should receive just as much consideration as humans.

Theistic Evolution Some individuals ascribe to belief in theistic evolution, wherein God is understood to have created all that exists but chose to use the process of evolution to develop the world to what it is today. This approach resolves some fundamental difficulties with a naturalistic account of evolution, but it also may raise other difficulties.

In naturalistic evolution, the existence of phenomena such as the soul, ideas, conscience, and love are either created by physical factors, such as brain chemistry, that assist to aid survival or do not exist at all. For example, philosopher Richard Rorty (1982) wrote,

There is nothing deep down inside us except what we have put there ourselves, no criterion that we have not created in the course of creating a

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practice, no standard of rationality that is not an appeal to such a criterion, no rigorous argumentation that is not obedience to our own conventions. (p. xlii)

Thinking, emotions, faith, and self-awareness, then, come merely as a means of aiding physical survival.

This is a form of reductionism called naturalism in which human persons are treated as nothing but physical material. This reductionism is an implication of scientism, and it has negative effects in health care because it reduces human beings to merely a system of physical phenomena rather than multifaceted beings who should be cared for holistically. In contrast to reductionism, dualism is a viewpoint that sees human beings as complex entities consisting of multiple levels; therefore, dualism offers a foundation for understanding human thinking, emotional awareness, and spiritual reality.

Dualism

The characteristics that differentiate human beings from other living species are nonphysical realities, such as mind, soul, or spirit. Dualism views the human person as being made of both the physical body and nonphysical realities, such as the soul. The soul is intricately connected with the body but is not identical to the body and continues after the physical death of the body. In the history of Christian thought, some thinkers also regard the human person as being comprised of body, soul, and spirit. Theologians and philosophers debate exactly what constitutes the nonphysical reality of human beings, with much debate even about the existence of the human mind. The contents of belief regarding nonphysical phenomena may differ, but that such a reality exists is affirmed by many.

In recent years, empirical research has supported the reality of human transcendent phenomena. Modern research has shown the efficacy of nonphysical, even spiritual, elements in creating beneficial medical outcomes (Koenig, King, & Carson, 2012). Many medical studies have demonstrated that spiritual and religious activities, such as prayer, religious service attendance, and meditation, have positive health outcomes. Alternatively, spiritual maladies, such as unforgiveness and anger, have corresponding negative physical health outcomes. Additionally, other nonphysical phenomena that are not specifically related to spirituality, such as expectation, reappraisal, and worldview, have been shown to have significant effects upon physical outcomes, including the experience of pain (Tracey, 2010; Wiech, Farias, Kahane, Shackel, Tiede, & Tracey, 2008).

Many Christians and other religions believe that a spiritual reality exists beyond the physical; this spiritual reality interfaces with the physical realm, but it is also separate from it. In this understanding, the human being is more than a body, and some part of the human being can survive physical death. As an example, in this view, the human mind is separate from the human brain, though the mind interfaces with and is in some way dependent on the brain; therefore, damage to the human brain can

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influence expression of the human mind, but it does not eradicate or permanently damage the mind, the soul, or the human being.

The Question of Value

Many medical professionals perceive human beings as being inherently valuable and see belief in God as being foundational to their work. They want to ensure the care of other human beings because each person would want to receive such care. This attitude has been summed up in the Golden Rule: "The second is this: 'You shall love your neighbor as yourself.' There is no other commandment greater than these" (Mark 12:31).

Human beings seem to implicitly recognize some aspects of right and wrong, including the inherent value and worth of human beings. For instance, C. S. Lewis, in The Abolition of Man (Lewis, 1944/2001), identifies the reality of consistent moral standards across diverse cultures around the world. Murder, rape, and kidnapping are almost universally regarded as wrong.

Value and ethical judgments such as these seem to indicate that human beings have a different status from other creatures. This suggests that human beings should not be treated in degrading ways. A significant 20th-century example lies in the war crimes the Nazis perpetrated against millions of Jews, Romani, and others they deemed undesirable. In the Nuremberg Doctor's Trial following World War II, Nazi doctors were charged with crimes against humanity for the genocide and medical experiments they conducted on innocent victims. Significantly, the Nuremberg Code that came out of this tribunal set the basic standards for ethical treatment of human beings in medical and research practice. Standard medical concepts, such as informed consent, have their origin in this document. Additionally, in the aftermath of World War II, the United Nations (1948) made a landmark declaration in the history of humanity regarding "recognition of the inherent dignity and of the equal and inalienable rights of all members of the human family" (para. 1).

Holocaust Viktor Frankl (1973), a Jewish psychiatrist who survived the Holocaust, later wrote:

The gas chambers of Auschwitz were the ultimate consequence of the theory that man is nothing but the product of heredity and environment —or, as the Nazis liked to say, “of blood and soil.” I am absolutely convinced that the gas chambers of Auschwitz, Treblinka, and Maidanek were ultimately prepared not in some ministry or other in Berlin, but rather at the desks and in lecture halls of nihilistic scientists and philosophers. (p. xii)

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If human beings are worthy of any dignity and respect, then reasons for arriving at this conclusion must exist. In general, there are two ways of reasoning why human beings have value: a functional view of value and an essentialist view of value.

Functional View of Value

According to the functional view of human value, a person's abilities determine the value of that person. For example, a person who has highly developed rational thinking abilities may be seen as valuable and important to society. Or a nurse's ability to educate patients about diabetes or to comfort dying patients will be understood rightly as making a beneficial contribution.

The problem with functionalism lies in the very logic it uses. By making human worth contingent upon function, it becomes arbitrary. A person with deficits in rational thinking abilities may be thought of as less valuable than the person with these abilities; a person without emotional and social awareness may be perceived as less than other people. Philosophers call this understanding of a person an extrinsic or instrumental perspective because it relies on external criteria for determining a person's worth. For instance, society could decide the value of a person depending on his or her actions, abilities, and contributions, though the assessment of these valuations may change. Alternatively, an intrinsic view of value views human beings as inherently having worth regardless of abilities.

In Nazi Germany, for instance, a functional view of the value of persons led to the extermination of the disabled and handicapped. Yet even insulting and degrading those one disagrees with can also be a subtle form of dehumanization. Others may be seen as impersonal adversaries rather than human beings with feelings, families, and inherent worth. Even considering a patient as a number or a symptom rather than holistically as a human being is itself a type of dehumanization.

Sadly, this extrinsic perspective can be applied to patients without their awareness of this judgment. For example, if a patient goes through an unsuccessful medical procedure that leads to extensive brain damage, his or her family must decide about whether to continue treatment or let their loved one die without intervention. According to the functional understanding, because the patient’s brain functioning is now diminished, it would follow that the patient’s value is also diminished.

In another example, when a fetus appears to have few functional abilities, the value of this fetus may be diminished in the view of the family. This process of perceiving people at any stage of life as valuable based on their level of functionality can lead to dehumanization, in which others see the nonfunctioning person as a thing to be manipulated and even destroyed.

Essentialist View of Value

An essentialist view of human value regards humans as themselves being intrinsically worthy of value. In contrast to an extrinsic view, an intrinsic viewpoint

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regards human beings as having inherent value apart from any external benefits or valuations.

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