Medical humanism: pragmatic or personalist?

Those in health care practice and research must depend on humanism for guidance in making difficult judgments and decisions that involve the individual patient's dignity and value. But what kind of humanism will inform those choices? Pragmatic humanism tends to view dignity in terms of human functioning: One is human because he or she acts, produces, thinks, achieves. The comatose, the insane, the hopelessly senile, fetuses and the newborn may be accorded human dignity as well, but only because society grants it to them. Thus such dignity can be manipulated or diminished in the name of overall human progress or the common welfare. By contrast, personalist humanism holds that human dignity is rooted in "being human" rather than in "doing human things." An individual has full human value simply by being a living person. This humanism suggests that health care providers must use their capabilities even for nonproductive patients. This may be difficult in the face of today's cost-benefit analyses. But if the individual's basic value is not defended, human dignity will vary in direct ratio to a person's social usefulness. And that would be obscene.