Medicine, Health Care and Philosophy

https://doi.org/10.1007/s11019-019-09926-2

REVIEW ARTICLE

Richard Dean: The Value of Humanity in Kant’s Moral Theory

Clarendon Press, Oxford, 2006, pp. x + 267. Cloth, £28.12

Victor Chidi Wolemonwu1

© The Author(s) 2019

Abstract
This is critical review of Richard Dean’ book, The Value of Humanity in Kant’s Moral Theory. Dean’s book was evaluated,
and some of his interpretations of Kant were critiqued. However, it concludes that Dean’s book is illuminating especially, as
regards the distinction he made between consent and informed consent and their roles in biomedical practice.

Keywords  Richard Dean · Immanuel Kant · Autonomy · Informed consent · Dignity · Duty

The Value of Humanity in Kant’s Moral Philosophy is a criti- generally recognized about exactly which characteristic of
cal exploration of the core themes in Kant’s ethics, namely, rational beings Kant means to pick out as the ‘humanity’ that
the notions of humanity, dignity, good will, autonomy and must be treated as an end in itself” (p. 5). The disagreement
end-in-itself. There is no gainsaying that Kant’s humanity is because these scholars believe that the status of humanity
thesis, which is the bedrock for which this book was written, is accorded to all well-informed adult human beings that
appears to stand out among the other two formulations—The possess at least a minimal rationality, which is logically erro-
Universal Law of Nature Formulation and the Autonomy neous. “Humanity, in the sense of the humanity formulation,
Formulation. Most commentators seem to allude to this fact is indeed equivalent to some feature possessed by rational
in that the humanity thesis seems logically attractive and beings, but not by all minimally rational beings. More so,
appeals to our intuitions, and it is the grounds for all norma- ‘humanity’ is Kant’s name for the more fully rational nature
tive theories, especially, in applied ethics. As Richard Dean that is only possessed by a being who accepts moral princi-
points out at the start of this book, the tricky challenge of ples as providing sufficient reasons for action. The humanity
the humanity thesis is the explanation of the moral obliga- that should be treated as an end in itself is a properly ordered
tions it implies (p. 4). Addressing this challenge, therefore, will, which gives priority to moral considerations over self-
demands an apt explication of its logic vis-à-vis our conven- interest. To employ Kant’s terminology, the end in itself is
tional moral intuitions. This, among other things, is a task a good will” (p. 6).
that Dean sets to achieve in this book. Consequently, it is not all human beings that are qualified
Dean begins his analysis with a distinction between the to be enrolled into the college of Kantian humanity. The
meaning of humanity as construed by some contemporary only qualification is that such human being, despite being
interpreters and the actual meaning of humanity. According rational, must give priority to moral considerations over per-
to him, “specialists in Kant’s ethics regard Kantian humanity sonal inclinations and aggrandizements. This interpretation
as some feature possessed by rational beings, and not just as seems problematic on two grounds. First, it seems to sug-
the property of being a member of the human species. This gest that criminals may not be qualified to be accorded the
seems correct to me. But there is more disagreement than is status of humanity, and by extension, may not possess dig-
nity, since their actions are influenced by their inclinations
and appeal to the hypothetical imperative. A closer read-
* Victor Chidi Wolemonwu ing of Kant seems to contradict this Deanian interpretation.
vcwolemonwu1@sheffield.ac.uk Because, Kant equates dignity with humanity, and believes
1 that the possession of dignity and being part of humanity is
Department of Philosophy, University of Sheffield, Sheffield,
United Kingdom not limited to acting in accordance to good will. Moreover,

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to possess dignity does not imply acting in a morally good commitment to act morally even when acting morally
or plausible way. Dignity is a definitive quality that defines requires her to forgo the satisfaction of inclinations (she
the nature of human beings, and it is, according to Kant, a must make the moral law ‘the supreme condition of the sat-
prerogative, which human beings have over all other natural isfaction’ of her inclinations)” (p. 20). This Deanian inter-
beings (Groundwork, p. 4:436, p. 4:438). The implication of pretation seems to give credence to Marcia Baron’s idea of
this is that possessing dignity is independent of our moral over-determinism, in which duty regulates our inclinations
probity. as a secondary motive, without extricating it from the mor-
The second problem is the restriction of the idea of ally active scene. Agents control their inclinations, making
humanity and dignity to only those who are rationally sure that for no reason would their inclinations become the
competent, and the preclusion of marginal cases like little determining factor of his moral action. This act of control
babies, demented patients and those in coma. This interpre- is a moral commitment, which an agent must develop and
tation seems anti-Kantian. Kant views dignity as an inherent master in order to perform actions that can be adjudged mor-
moral worth, which defines the humanity (humanness) of ally justified.
all human beings. The definition of humanity as a status for Another concept which Dean thinks is integral to Kant’s
‘fully rational nature that is only possessed by a being who moral theory is the concept of autonomy. Autonomy is the
accepts moral principles as providing sufficient reasons for underlying principle of all human dignity and it is a defin-
action’, therefore, seems problematic. In his Metaphysics of ing principle of all human nature. It is reason that makes
Morals, Kant believes that what characterizes humanity and autonomy possible. Dean lists three functions of reason in
distinguishes it from animality is the capacity to set ends— Kant’s Philosophy: “…reason is pure self-activity, which
‘any end whatsoever’ (p. 392). Being able to set ends isn’t an makes rational beings fundamentally active instead of pas-
exclusive privilege a of fully rational nature but a privilege sive. In his theoretical philosophy, reason is the faculty that
of all rational nature, irrespective of their degree of maturity. spontaneously and freely provides rules for organizing the
Children or demented patients may not be able to set ends ‘intuitions’ of sense that we passively receive. In his practi-
in an instrumental or practical fashion given some physi- cal philosophy, reason freely and spontaneously provides
ological and psychological inhibitions, that does not suggest the moral principles that present truly self-given reasons
that they lack the capacity to set ends. For those with severe for action, independent of the influence of inclinations (p.
neurological or biological disabilities, they remain perpetu- 227). To be autonomous, hence, is to be a self-legislating
ally inhibited. So, we could say that their capacity to set ends agent, and by extension an end-in-itself. This sort of value-
is inert or latent. laden role ascribed to autonomy stirs an ontological conflict
Dean attacks the interpretation of the notion of good will, between the humanity formulation and the autonomy for-
especially as defined by H. J. Paton and Lewis White Beck. mulation. Which of these formulations underlies morality?
According to him, Paton and Beck view good will as “’… Dean explains that based on Kant’s analysis, autonomy is the
one which acts for the sake of duty…. An action having foundation of dignity. To wit, the possibility of a good will
this motive (the motive of duty) is moral…’. According to depends on whether moral principles that guide our actions
this view, a good will is exactly a will that performs dutiful are autonomously legislated. Without this autonomous leg-
actions because they are required by duty” (p. 19). Dean islation, the actions of human beings may be based on ‘their
believes that it is plausible to argue that an agent possesses strongest desire’. And, their actions would not be different
a good will if his actions are done from the motives of duty, from other beings in nature (p. 228). Moreover, viewing
the will is not a passive possessor but an active possessor autonomy as an end-in-itself does not imply overriding the
of that which is good. The fundamental characteristic of strategic role of good will in the moral scheme. Autonomy
human is the power of choice. A good will, therefore, is and good will complements each other. They are two sides
one that chooses to perform a morally worthy action. The of a moral coin. While a good will is the prerequisite that
idea of good will, thus, according to Paton and Beck seem renders the contingent moral aspirations of an agent morally
oversimplified. valuable, the will itself, must be autonomous in order to
Dean distinguished between two kinds of will: will as choose what is good. The will must autonomously legislate
choice and the will that makes available the practical laws moral principles that are not subject to any inclination but
upon which all choices are based. Whereas the former is are only constrained by moral laws.
referred to as Willkur, latter is referred to as Wille. The Since the postulation of the notion of autonomy by Kant,
morality worthiness of an action depends on the extent to some bioethicists like Gerald Dworkin have appropriated
which Willkur conforms with Wille. When the Wille of an the concept as a normative principle to evaluative doctors-
agent governs his Willkur, we say that such moral agent, patients relationship (1976, p. 23). The concept of autonomy
aside being fully rational, possesses a will that is good. also underlies most biomedical research guidelines, and it
“In order for an agent’s will to be good, she must have a accentuates the ethical imperative that all potential research

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Richard Dean: The Value of Humanity in Kant’s Moral Theory

participants “have a right to choose freely whether to par- The idea of individual autonomy represented by Gerald
ticipate in research” (CIOMS 2016, p. 34), because they Dworkin and also reflected in Biomedical Research Ethics
are intrinsically valuable and morally autonomous. Histori- guidelines have come under attack because of its over-bur-
cally speaking, the idea of autonomy is often invoked as a dened emphasis on the unrestricted right of an individual
reaction against the culture of paternalistic decisions, which to make decisions based on motives, desires and aspira-
underlie the medical profession for several decades, espe- tions, and in protection of their interests and well-being.
cially, in America and several parts of Europe (even though Childress, for instance, contends that the problem of indi-
it is significantly present in medical practices in Africa). vidual autonomy is that it focuses on just one aspect of our
The wrongness of paternalism, as some anti-paternalistic personhood, which is, self-determination, neglecting the
proponents have averred, is that it interferes with the autono- socio-cultural and historical embodiment of our personhood.
mous decisions and actions of individuals (Birks 2018, p. Also, the proponents of individual autonomy do not consider
138). The respect of autonomy seems to imply the respect the possibility of misplaced, ambivalent, or even contradic-
of an individual’s right to self-determine their actions and tory preferences (1990, p. 13). In order cases, some choices
legislate on their preferred choices, without any interfer- may be borne out the motivation to impress the consentee.
ence, whatsoever. However, Dean contends that “… respect For instance, if a well-known clinical researcher goes to the
for autonomy amounts to little more than a demand to let locality where she is well-known to recruit research par-
patients make choices about their medical care or for poten- ticipants, the possibility of recruiting several participants is
tial volunteers to either accept or refuse research participa- very high. But, irrespective of the informed consent rituals,
tion. This emphasis on choice, sometimes to the exclusion of the participants may decide to consent based on the grounds
any other aspect of respect for autonomy, is understandable, of deference to the researcher, even when they would pre-
given the original role of the principle” (p. 199). The empha- fer to choose not to participate when it involves someone
sis on the rights of patient’s autonomy, thus, is to show what else. Childress, and of course, Beauchamp believe that a
could be wrong when patients are excluded in medical deci- better idea of autonomy should be personal autonomy or
sion making about their medical treatment. what Dean calls ‘a Minimalist Self-Deterministic account
The demand that patients’ choices be respected may be of Autonomy’ (MSDA). According to them, personal auton-
morally acceptable, nevertheless, it creates a leeway for blind omy or MSDA entails the capacity to make indivdual deci-
consent, which medical experts often exploit. Therefore, the sion or choose a preferred course of action, which at mini-
respect for autonomy requires a higher demand for rationale mum, is free from controlling influence by others and from
behind all possible alternatives opened to choice. The jus- limitations, such as insufficient understanding that makes
tification for requiring a doctor to make adequate informa- it impossible for the autonomous agent to make meaning-
tion available before obtaining consents from patients to this ful choices (Beauchamp and Childress 2001 qtd in Varelius
end, according to Dean, “allows patients to make choices 2006, p. 377).
that fit with their overall desires, goals, and attitudes. This A significant criterion of personal autonomy as construed
is the real requirement and intuitive force of the principle by Beauchamp and Childress is that in as much as an indi-
of respect for autonomy, and it accords with most explicit vidual possesses a moral capacity to make choices and deci-
formulations of that principle” (p. 200). Dean’s introduction sions, such capacity must not impede certain factors that
of the notions of choice and autonomy gives an illuminating could regulate the decisions he makes (1994, p. 121). Where
insight into consent and informed consent dichotomy, and your choice poses a threat to your attaining desired goals,
their diverse role in biomedical practice. While the idea of other factors external to you must be allowed to act on your
consent creates a possibility of blind choice, informed con- choice so that the desired goal can be attained. A fundamen-
sent opens a more robust ethical requirement, whereby the tal consideration in ascertaining moral grounds for medical
doctor becomes obligated to provide accurate information decision should be based on medical interest. For instance,
which would aid the participant or patient to make choices in the case of a mentally retarded person, “it is irrelevant in
that express their desires and aspirations as self-legislating determining whether treatment is in the patient’s best inter-
agents, and also, refrain from interferences that are gratui- est” (1994, p. 216). There should not be confusion between
tous (p. 203). Importantly, informed consent bids the phy- the value of life for others and the patient’s quality of life. In
sician to make judgements that would be for the patient’s a situation where a patient is incapacitated and incompetent
best interests. The judgments of physicians or biomedical to make decisions as regards his or her health condition, the
researchers, therefore, ought to incorporate the duty of benef- incompetent patient’s best medical interests generally should
icence (obligation to improve the health and well-being of suffice even if these interests’ conflict with the interests of
patients or research subjects and non-maleficence (the obli- the family of the incompetent patient. According to Dean,
gation to ensure a non-deliberate cause of harm). the choice of taking a minimalist stance on autonomy is
to make “autonomous choice the central object of concern

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in the principle of respect for autonomy, instead of assign- acted autonomously if their actions are morally grounded,
ing this central role to autonomy as a property of persons” that is, if their actions are morally justified. If a doctor gives
(p. 204). Nevertheless, this stance of autonomy is problem- a false diagnosis to a patient in order to keep them perpetu-
atic because though it permits a minimal interference on ally and hopelessly in their hospital just for commercial
an agent’s choice if their choice were incompetently made, gains, such a doctor acts immorally and cannot claim to
it restricts interference on “the inconsistent decisions of have acted autonomously as the motivation of the action isn’t
someone halfway in the grip of unusual religious beliefs” (p. good will but self-aggrandizement. While this may seem
204) like an individual who refuses to accept blood transfu- like an abstract moralization, it does not seem to address
sion after childbirth, even when it is clear that not doing so in practical terms some complexities that occur in medi-
would result in her death. More so, if the autonomous and cal practice. For instance, it doesn’t answer the question of
intentional choice is what MSDA seems to promote and pre- whether a doctor acts autonomously when he treats a cancer
serve, Dean believes that it is difficult to see why all choices patient or performs a Cesarean Section on a woman with
shouldn’t be respected, even if it is unreflective. This is not an ectopic pregnancy against the will of the patient. It is
to suggest that Dean supports unreflective choices but to also difficult to see how the good will account of autonomy
point to the inadequacies of individual and personal accounts helps to explain patients or research participants’ decisions.
of autonomy. For instance, it is difficult to see how that account holds a
Kant’s view of autonomy, which is distinct from indi- clinical researcher culpable for recruiting a participant who
vidual and personal autonomy is ‘metaphysically laden’ agreed to participate in a clinical research on the grounds
and morally grounded. It is metaphysically laden because of (monetary or therapeutic) incentives advertised during
he dissociates autonomy from the individual and the per- the recruitment process. If a participant willingly agrees to
sonality of the individual and anchors it on the will. It is participate in such a trial not through coercion but simply to
therefore the will that is autonomous. Kant explains that a enjoy the gains of the advertised incentives (either because
will that is autonomous is that which conforms to the moral they are sick or due to their impoverished conditions), can
law. The will is a kind of causality, which defines all beings we say that they acted autonomously? Or, if a cancer patient
that are part of rational nature. To be human, thus, is to pos- agrees to the decision of doctor to treat her without being
sess a will. The nature of a will depends on the motivations interested in the details, can we say that the cancer patient
that stimulates its willing. A good will, thus, “is not good acted autonomously? The good will account does not offer
because of what it effects or accomplishes, because of its any response.
fitness to attain some proposed end, but only because of its The abstract moralization of autonomy pokes Secker to
volition, that is, it is good in itself and, regarded for itself, is claim that “Kant’s concept of moral autonomy is not a con-
to be valued incomparably higher than all that could merely cept we should attempt to “plug into” bioethics’ principle
be brought about by it in favor of some inclination and of respect for autonomy because of its undesirability as an
indeed, if you will, of the sum of all inclinations” (Ground- ideal and its impracticability in assessment contexts” (1999,
works, p. 4:395 Emphasis is mine). Dean explains that p. 52). Endorsing Secker’s attack on this Deanian-Kantian
because good will is volition-dependent, it is the grounds abstract moralization of autonomy, Saad argues that
for autonomy. According to him, to be autonomous is to
it is unrealistic because many people, especially sick
possess good will. In other words, to be able to perform an
and vulnerable patients, are incapable of the sort of
autonomous action, one must necessarily possess a good
philosophical gymnastics Kant requires. Furthermore,
will, and it is what gives value to the action of a moral agent
because Kant equates acting autonomously with acting
(p. 255). To act on good will is to act morally, but to act
morally, applying Kant’s autonomy to clinical practice
without recourse to good will is “to choose to act immorally
would, in a sense, make doctors arbitrators of patient
in order to satisfy inclinations” (p. 255). So, to perform good
morality. If patients have a duty to act autonomously…
or morally acceptable acts is to act in accordance to auton-
and if doctors are to gauge patient autonomy, the
omy. It also means to act on the grounds or motivation of
patient will be subjected to a physical and moral exam-
reason because only reason and not incentive directs an act
ination before undergoing treatment (2018, p. 130).
to conform to moral law. This idea of autonomy is restricted
to an agent that wills a moral action. It is not relational—it All these criticisms are plausible only because Kant’s
is not expressed in relation to another moral agent. view of autonomy is explored in part.
How would Deanian-Kantian good will interpretation of A broader and practical exploration of Kant’s view of
autonomy address the problems of informed consent and autonomy reveals that while Kant is interested in moral
moral decision-making in medical practice and biomedi- goodness of an agent, he is also interested in how that mor-
cal research? A possible response by Dean would be that ally good agent treats another agent. For instance, Kant
a doctor or a patient, for instance, could be said to have believes that it is morally despicable to tell lies. So, if a

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Richard Dean: The Value of Humanity in Kant’s Moral Theory

doctor lies to a cancer patient that there is no hope for them (Campbell 2017, p. 388). So, scrutinizing our actions in
to get healed just to make the patient stay perpetually in conformity to moral imperatives is vital to autonomy.
their care simply for commercial gains, Kant believes that More specifically, our autonomous will is constrained by
such action is morally despicable because “whatever mili- moral principled to act in the morally plausible way. This
tates against frankness lowers the dignity of man” (Lecture broader account of autonomy views autonomy not as a
on Ethics 1963, p. 231). Kant defines a lie as a “falsiloquim self-deterministic capacity, which is devoid of interfer-
in praejudicium humanitatis - false statement prejudicial ence. This account is based on the capacity of a will to will
to humanity” (Lecture on Ethics 1963, p. 227, translation a good action through rational deliberation. Deanian good
is mine). He however adds that not every statement that is will account of autonomy does not consider this aspect
untrue is a lie. Because “if we were to be at all times punctil- of moral scrutiny or deliberation. But a broader Kantian
iously truthful, we might often become victims of the wick- reading shows that this is very fundamental in Kant’s dis-
edness of others who were ready to abuse our truthfulness” cussion of autonomy.
(Lecture on Ethics, p. 228). A pharmacist who sells vita- There is, therefore, a sense in which Kant’s moral auton-
min C to a drug addict in place of Codeine tablet may have omy sits prominently within an ineluctable pluralistic moral
deceived the drug addict to believe that they have bought a deliberation that is primal to bioethics and medical practice.
psychoactive drug when they have only got a medicine that Kant’s autonomy, just to reiterate, is manifested in a moral
would help boost their body vitamin. Kant does not believe action in which moral duties or obligations are met, and
that the pharmacist has acted in a morally despicable way in which the rights, well-beings and dignity of others are
but in good will. But Dean’s good will account does not respected. This is because, an individual cannot claim to
account for the role lies or truthfulness plays in defining be autonomous when they don’t act in reference to every
moral goodness. other moral agent. So, every human action ought to base on
The concept, which is very central to Kant’s moral “informed reason and autonomously held, principled com-
autonomy, which is missing in the good will account is mitments” (Stirrat and Gill 2005, p. 127). More specifically,
the idea of mere means. To be autonomous is to act in Kant’s view of autonomy “requires that we act only on prin-
such a way that one does not treat the other as a mere ciples that can be principles for all; it provides a basis for an
means. The ‘non-use as mere means’ view suggests that account of the underlying principles of universal obligations
all human beings ought to be treated with respect because and rights that can structure relationships between agents”
they possess intrinsic value. Though Dean situates value- (O’Neill 2002, p. 96). So, autonomy that is based on the
ness in the moral goodness of an action, Kant believes ‘underlying principles of universal obligations’ does not tol-
that irrespective of our moral status, because we are part erate deception, manipulation or coercion. This is expressed
of rational nature, we are intrinsically and unconditionally through “truthful communication, through care not to mis-
invaluable, that is, we possess inviolable dignity. For Kant, lead, through avoidance of exaggeration, through simplicity
“a human being… is not a thing and hence not something and explicitness, through honesty in dealing with others, in
that can be used merely as a means but must in all his a word, through trustworthiness” (O’Neill 2002, p. 98). In
actions always be regarded as an end in itself” (Ground- the field of bioethics and medical practice, Kant’s autonomy
work 1997, p. 38). To act autonomously is to treat others could be expressed, thus, where in a clinical researcher and
as ends rather than as mere means. A will which makes it a research participant, for instance, communicates to each
possible for an agent to treat others as ends is a good will. other truthfully and attempts not to mislead each other. In the
A good will is a will that conforms to the moral principles case of complex moral deliberation, the deliberating agents
of reason. Another way to explain this is to say that an must act in a way that stimulates or promotes trustworthi-
individual performs actions autonomously when they will ness. If, for instance, a patient wishes to accept blood trans-
action that are determined by rational moral principles. fusion but is constrained by some religious belief system,
An autonomous action is distinguished from a heterono- and the doctor believes that is the only way to save her from
mous action. While autonomous actions are motivated by an impeding danger of possible death, it is morally instruc-
practical reason, heteronomous actions are motivated by tive that whatever decision that is arrived at must be such
feelings, inclinations ad pathologies. One cannot claim to that is morally motivated by honesty, trustfulness and care
be autonomous when their actions are controlled by feel- not to mislead.
ings and inclination because the reason for such actions Even though the good will account expressed by Dean is
is illegitimate as well as defective. A captivating way of insufficient to explain how Kant’s view of autonomy could
describing an autonomously willed action is to see it as help to address pluralistic moral issues that arise in bioethics
“the product of a process of deliberation which involves and medical practice, it is, however, necessary. But, to see
scrutiny of the reasons underlying our proposed actions how that account could be applied to bioethics and medi-
to ensure that they meet certain standards of rationality” cal practice, it must to be read in conjunction to the mere

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means principle, in which our obligations to act are informed Dworkin, Gerald. 1976. Autonomy and Behavior Control. The Hastings
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Kant, Immanuel. 1997. Groundwork of the Metaphysics of Morals.
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tive Commons Attribution 4.0 International License (http://creat​iveco​ Cambridge University Press.
mmons​.org/licen​ses/by/4.0/), which permits unrestricted use, distribu- Saad, Toni C. 2018. The History of Autonomy in Medicine from
tion, and reproduction in any medium, provided you give appropriate Antiquity to Principlism. Medical Health Care and Philosophy
credit to the original author(s) and the source, provide a link to the 21: 125–137.
Creative Commons license, and indicate if changes were made. Secker, Barbara. 1999. The Appearance of Kant’s Deontology in Con-
temporary Kantianism: Concepts of Patient Autonomy in Bioeth-
ics. Journal of Medicine and Philosophy 24 (1): 43–66.
Stirrat, G.M., and R. Gill. 2005. Autonomy in Medical Ethics After
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