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The Ontological Argument: an Exploration of Existence and God

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Published: Sep 16, 2023

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Table of contents

1. **historical origins**, 2. **rené descartes and the "clear and distinct" idea**, 3. **gödel's modal ontological argument**, 4. **criticisms and objections**, 5. **contemporary perspectives**, 6. **conclusion**.

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1000-Word Philosophy: An Introductory Anthology

Philosophy, One Thousand Words at a Time

The Ontological Argument for the Existence of God

Author: Andrew Chapman Category: Philosophy of Religion Word Count: 1000

1. God’s Greatness

The Abrahamic conception of God is that he’s awesome —all-powerful, all-knowing, all-good, creator of the universe, self-existent, and a host of other properties that make him not just very, very great, but the greatest that there is or could possibly be.

“This is all fine and good,” say non-theists, “but this is a description of a being whose existence we don’t affirm.” However, a famous and powerful argument for God’s existence known as the Ontological Argument purports to be able to show that God’s being the greatest possible being entails God’s existence: the mere definition of God proves his existence.

This essay introduces this argument. 

2. Anselm’s Ontological Argument

There are different versions of the Ontological Argument, but we will focus on one of the earliest, set forth by St. Anselm (1033-1109). 1

As we’ve already noted, God is the being than which no greater can be conceived . This is Anselm’s somewhat unwieldy description of God, which we can abbreviate as BNGC . By definition, BNGC is the greatest conceivable being. If you think you’re conceiving of God and you can possibly conceive of a greater being, then you weren’t initially conceiving of God. Simple enough.

Now, certainly you can conceive of God. To conceive of something is just to think about it clearly and distinctly; you’ve been doing that since the beginning of this essay. So we know, at least, that God can exist in conception , i.e., can be conceived. Even atheists admit this. What the atheist is denying, and what the agnostic is refusing to affirm or deny, is that God exists in reality . So we have an intuitive distinction between a thing that exists merely in conception and a thing that exists in reality as well as in conception .

Now here’s the argument: Assume that the atheist is right, that God doesn’t exist in reality, but merely in conception. But then there would be another possible being, a God who exists not merely in conception but also in reality as well, who is greater than BNGC. 2 That is, there would be a possible being who is greater than the being than which no greater can be conceived. But no being can be greater than the being than which no greater can be conceived—that’s a flat-out contradiction! So our original assumption, that God doesn’t exist in reality, but merely in conception, must be false, since any assumption that entails a contradiction must be false. Therefore, God must exist both in conception and in reality. Therefore: God exists. 3

The Ontological Argument is remarkable in that it reasons from premises containing only definitions and logical laws to perhaps the grandest philosophical conclusion there is. We can know that God exists merely by reflecting on the concept of God .

Many people, however, have been uncomfortable with the purported fact that we can prove the Almighty’s existence so apparently simply. Numerous critics, theist and non- alike, have criticized different aspects of the Ontological Argument. Let’s look at just two of the most influential criticisms: those provided by Gaunilo of Marmoutiers (994-1083) and Immanuel Kant (1724-1804).

3. Gaunilo’s Criticism

Gaunilo was a monk and a contemporary of Anselm’s. In his “Reply on Behalf of the Fool,” 4 Gaunilo has us imagine another really awesome thing: the island than which no greater can be conceived —let’s call it INGC . This island has all the amazing-making properties you can think of: pristine white-sand beaches for lounging, warm water for swimming, and not a tourist in sight. But certainly such an island’s existing only in conception would entail a contradiction, since then there would be a possible thing greater than the INGC, namely, the existing INGC. Therefore, the INGC exists. And, of course, since we have picked island arbitrarily, we can run the same argument for any object: a building, a mousetrap, a horse, whatever you please. 5

What Gaunilo has shown, then, is that, using Anselm’s form of reasoning , we can prove the existence of all sorts of bizarre entities, entities that clearly don’t exist. Accordingly, concludes Gaunilo, there must be something fatally wrong with Anselm’s reasoning. 6

4. Kant’s Criticism

Which do you prefer, coffee or existing coffee ? Notice that this is different from the question of whether you prefer coffee or no coffee at all . No coffee isn’t coffee while both coffee and existing coffee are coffee just the same! If it seems like we’re verging on Lewis Carroll-style nonsense here, you’re right, and this is exactly Kant’s criticism of the Ontological Argument.

According to Kant in his Critique of Pure Reason , what’s gone wrong with Anselm’s argument lies in the distinction between a thing that exists merely in conception and a thing that exists in reality as well as in conception . According to Anselm, there are two different sorts of things : those that exist merely in conception and those that exist in reality as well as in conception. But an existing thing and its non-existing counterpart aren’t two different sorts of thing —one merely exists and the other doesn’t. While it is certainly true that some things exist and others do not, existing does not make a thing a different kind of thing from its non-existing colleague.

The upshot of this, says Kant, is that existence is a very special type of property, one not suited for the type of argument Anselm is running. Since there is no difference between the group of objects falling into the class God and those falling into the class existing God , an existing God can be no better and no worse than a mere God. There’s simply no relevant difference in kind between a God who exists and a God who doesn’t.

5. Conclusion

Of course, Gaunilo and Kant have not had the last word in this debate. Powerful arguments have been mounted in response to Gaunilo’s and Kant’s criticisms of the Ontological Argument. Additionally, increasingly complex versions of the Ontological Argument have been developed and debated. One thing that’s certain is that the Ontological Argument, whether sound or unsound, is a fascinating and powerful attempt at a proof for the existence of God.

1  Two other famous formulations of the argument are Descartes’s formulation from the conception of existence as a perfection  (see  Descartes’ Meditations 4-6 by Marc Bobro) and Alvin Plantinga’s so-called Modal Ontological Argument (see Modal Ontological Arguments for the Existence of God by Thomas Metcalf). 

2  Which is greater, a God who exists merely in conception or a God who exists in reality as well as in conception? Think of all the things a God who exists in reality as well as in conception can do that a God who exists merely in conception cannot do: He can create worlds. He can listen to prayers. He can be the ultimate source and ideal form of goodness. He can reward virtuousness and punish vice… Those all seem like great things, and a God who exists merely in conception can do none of them.

3  You may remember this type of argument or proof from your geometry courses where it was called an indirect proof . Philosophers and logicians call this a reductio ad absurdum , or a reduction to absurdity. The strategy, as you have seen, is to assume the opposite of what you are trying to prove, show how that assumption entails either a contradiction or some other form of absurdity, and then to reject the original assumption.

4  “The fool has said in his heart, ‘There is no God.’” (Psalm 14:1)

5  It’s important to note that we’re not merely talking here about the greatest actually existing island, mousetrap, horse…, but the greatest possible island, mousetrap, horse… It is plausible that for any type of existing object, one of the ones that exists is the best one (in terms of whatever makes that sort of thing a good one of what it is). But it is another thing altogether to talk about the greatest possible or greatest conceivable such object.

6  Notice that Gaunilo’s argument is also a reductio ad absurdum:  Assume that Anselm’s reasoning is valid and an absurdity results. Therefore, Anselm’s reasoning must be flawed.

Anselm, St.,  Proslogion , in  St. Anselm’s Proslogion , M. Charlesworth (ed.), Oxford: OUP, 1965.

Descartes, R., Discourse on Method and The Meditations , translated with an introduction by F. Sutcliffe, Harmondsworth: Penguin, 1968.

Gaunilo, “On Behalf of the Fool”, in St. Anselm’s Proslogion, M. Charlesworth (ed.), Oxford: OUP, 1965.

Kant, Immanuel.  Critique of Pure Reason . Trans. Paul Guyer and Allen W. Wood. Cambridge: Cambridge UP, 1998.

Oppy, Graham. “Ontological Arguments.”  Stanford Encyclopedia of Philosophy . Stanford University, 08 Feb. 1996. Web. 27 June 2014.  

Related Essays

The Concept of God: Divine Attributes  by Bailie Peterson

Descartes’ Meditations 4-6  by Marc Bobro

Modal Ontological Arguments for the Existence of God by Thomas Metcalf 

Possibility and Necessity: An Introduction to Modality  by Andre Leo Rusavuk

Modal Epistemology: Knowledge of Possibility & Necessity  by Bob Fischer

About the Author

Andrew Chapman is a lecturer in philosophy at the University of Colorado, Boulder. He holds a PhD in philosophy from the University of Colorado, Boulder, an MA in philosophy from Northern Illinois University and a BA in philosophy and a BM in bassoon and sound recording technology from Ithaca College. He specializes in epistemology, metaethics, and the history of philosophy (especially Kant and the 20th Century Anglophone and Phenomenological traditions). When not philosophizing, Andrew is skiing, hiking, listening to great music, or playing the bassoon. www.colorado.edu/philosophy/people/andrew-d-chapman  

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A Level Philosophy & Religious Studies

Model essay for Ontological arguments

AQA Philosophy model essay

Note that this model essay plan is merely one possible way to write an essay on this topic.

Points highlighted in light blue are integration points Points highlighted in green are weighting points

The ontological argument

The strength of ontological arguments is their a priori nature. They are made independent of experience, so cannot be countered by new scientific knowledge.

Anselm’s ontological argument

• P1. God is the greatest conceivable being
• P2. It is greater to exist in the mind and reality than in the mind alone
• P3. God exists in the mind
• C1. God exists in reality
• Malcolm interprets the idea of the greatest being as God being unlimited, not dependent on anything else for existence. God has no limitation which could possibly cause God’s non-existence. So, God contains the impossibility of non-existence.
• Gaunilo attempts to show Anselm’s logic is absurd by applying it to another case which yields an absurd result.
• Imagine the greatest possible island. If it’s greater to exist then this island must exist.
• This would work for the greatest possible version of anything.
• Anselm’s argument suggests reality would be overloaded with greatest possible things, which seems absurd.
• Gaunilo is attempting to deny that the ontological argument’s conclusion follows from the premises. So he is denying that it really is a valid deductive argument.  
• However, Gaunilo’s critique is not particularly strong.
• There is no self-contradiction arising from Anselm’s logic also proving the existence of a perfect island. At most this seems counter-intuitive, but Gaunilo has not demonstrated actual absurdity, i.e., inconsistency.

Evaluation:

• However, there is a difference between God and an island (and anything else) which explains why the logic works for God but not anything else.
• An island is contingent by definition. It is land enclosed by water, so it depends on a sea/sun/planet for its existence. Everything else in the world is also contingent.
• You cannot use a priori reasoning to prove the existence of a contingent thing, because the existence of a contingent thing is not a matter of its definition. Its existence is a matter of whether what it depends on happens to exist.
• E.g. whether the island exists is a matter of whether the sea/planet/sun it depends on exists. That cannot be determined merely by thinking about the definition of the greatest island. 
• So, the greatest island would still be the greatest island even if it didn’t exist.
• There is nothing in the definition of the greatest being which implies dependence, however, making it necessary.
• Nothing prevents determining the existence of a necessary being by a priori reasoning, unlike contingent beings.
• So, that is why the argument works for God but not anything else.

Kant’s critique that existence is not a predicate

• When Anselm says that if God didn’t exist, God wouldn’t be the greatest being (God), he’s saying that existence is part of what defines God.
• Anselm goes on to conclude that God must exist.
• However, this treats the concept of ‘existence’ like a predicate, like a description of what a thing is, which defines a thing.
• Kant objects that existence is not a predicate. 
• Imagine I was to say ‘the cat exists’. In that sentence, the term ‘exists’ doesn’t seem to actually describe the cat itself. It doesn’t describe a quality that the cat possesses. It simply describes that the cat exists – not the cat itself.
• So, existence is not a predicate. When Anselm says God would not be God if God didn’t exist, Anselm is wrong. God would be just as great/perfect even if non-existent. Anselm can’t go on to conclude that God must exist, therefore.
• Kant’s criticism is stronger than Gaunilo’s because he actually points out the assumption the ontological argument makes rather than pointing to a supposed absurdity.
• However, Kant’s criticism fails for two reasons.
• Firstly, Kant’s criticism fails to attack Descartes’ ontological argument, which therefore seems to be in a stronger position than Anselm’s
• Descartes bases his argument on his rationalist epistemology. He claims that God’s existence can be known through rational intuition. 
• It is not possible to rationally conceive of the most supremely perfect being without existence.
• Descartes’ rejected the aristotelian logic of subject-predicate analysis. So, his argument does not infer God’s existence by assuming that existence is a predicate of God.
• He illustrates with a triangle. You intuitively know that a triangle cannot be without three sides. Similarly, we can intuitively know that God cannot be without existence.
• Descartes does put his argument into standard form however:
• P1. God is a supremely perfect being, which contains all perfections.
• P2. Existence is a perfection
• Secondly, Malcolm defends Anselm and the subject-predicate form of the argument.
• Kant is correct, but only about contingent existence.
• A contingent thing depends on something else for its existence.
• However a necessary being contains the reason for its existence within itself.
• So, necessary existence is a defining quality of a thing, in a way contingent existence is not.
• So necessary existence is a predicate.
• So, both Anselm and Descartes’ versions of the ontological argument succeed against Kant’s criticism.
• Against Anselm, Kant makes the same mistake Gaunilo did – comparing God to contingent beings and thinking the ontological argument fails because it doesn’t work in the case of contingent beings (like cats and coins).

Kant’s critique that existence being a predicate doesn’t establish actual existence

• Kant’s 1st critique is stronger because it doesn’t make the mistake of his other objection of denying that necessary existence is a predicate. 
• Here, Kant argues that even if necessary existence were a predicate of God, that doesn’t establish God’s existence in reality.
• Kant improves on the style of argument Gaunilo was making with his lost island critique.
• Kant is again going to give us a much clearer reason than Gaunilo did for doubting the deductive validity of the ontological argument.
• Gaunilo was trying to argue that we may judge something necessary in our mind, but this doesn’t make it necessary in reality.
• Kant develops this using Descartes’ illustration of a triangle.
• It is necessary that a triangle has three sides. 
• This shows that if a triangle exists, then it necessarily has three sides.
• Similarly, Anselm may have shown that the concept of God necessarily has the predicate of existence.
• However, again similarly, this only shows that if God exists, then God exists necessarily.
• The ontological argument does not show that God does actually exist necessarily.
• Malcolm responds to Kant – he says it makes no sense to say that a necessary being could possibly not exist. Necessary seems to mean ‘must exist’.
• If God is a necessary being then God must exist – it makes no sense to say if a necessary being existed – since a necessary being must exist – there is no if. 
• So, Kant fails according to Malcolm.
• The issue is, Malcolm has only shown that God is a non-dependent being. 
• In his ontological argument, Malcolm argued that if God exists, God exists necessarily because nothing could cause God to cease existing, as God is unlimited and non-dependent. 
• This is what Malcolm established as God’s necessity. But this only establishes that God is necessary in the sense of being non-dependent, not in the sense of must exist.
• A being could be non-dependent and yet not exist. If it existed, then it would be necessary.
• So, the necessity of God’s existence established by the ontological argument only relates to the manner of God’s existence if God exists. 
• Ontological arguments cannot show that God actually exists, then.
• Gaunilo’s illustration of the island fails. However Gaunilo’s main claim was that there is a distinction between judgement and reality. Kant developed this criticism more convincingly:
• “The unconditioned necessity of judgements is not the same as an absolute necessity of things” – Kant.
• The ontological argument can only show that if God exists, God exists with necessity. 

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The Ontological Argument and the Existence of God

An undergraduate essay on the Ontological Proof, drawing the conclusion that while it is fatally flawed as a logical proof, it nevertheless remains valuable as a demonstration of the coherence of the concept of God

Related Papers

CHIBUIKEM CHARLES NNAEME

This article is concerned with how we can know about the existence of God. In attempting to do this, the article will single out two medieval thinkers, Anselm and Aquinas, and will examine their stances on the subject. The former holds, as exemplified in his ontological proof, that human beings can rationally know the existence of God, whilst the latter objects to the former’s claim by proffering that human beings can know God’s existence through effects of God’s creation. Over the years these positions have appealed to people who defend either strand of the argument. Such a followership makes worthwhile my efforts to contribute to the ongoing debate. It is my intention to show the argument of each of these positions and indicate which is more plausible to human beings. It is vital to note that Anselm and Aquinas both accept the existence of God; therefore, the existence of God is not in question for them. The article will only concentrate on where the two thinkers differ in terms of how human beings can know God’s existence. Intradisciplinary and/or interdisciplinary implications: This article challenges idealists’ philosophy that human beings can prove God’s existence from the concept, God, as epitomised by Anselm’s ontological argument. The critique of the argument through the application of Aquinas’s realism exposes the limitedness of the human beings in epistemological conception of the absolute metaphysical reality.

Proceedings of the American Catholic Philosophical Association

Michael Wiitala

Saint Anselm’s ontological argument is usually interpreted either (1) as an attempt to deductively prove God’s existence or (2) as a form of prayer, which is not intended to “prove” God’s existence, but rather to deepen the devotion of those who already believe. In this paper I attempt to find a mean between these two interpretations, showing that while Anselm’s argument is not a deductive proof, it is nevertheless a proof of God’s existence. I argue that Anselm’s ontological argument is analogous to Aristotle’s to elegktikōs apodeixai (retorsive argument) for the truth of the principle of non-contradiction in Metaphysics IV: an argument that does not move from premises to conclusion, but rather demonstrates the truth of its conclusion by showing that its conclusion is always presupposed. I argue that interpreting Anselm’s ontological argument in this way exempts it from the most common objections against it.

The Downside Review

Martin Benson

Anselm of Canterbury’s Proslogion is a Benedictine prayer-exercise that contains a famous argument for the existence of God. This article highlights how the argument is intertwined with the prayer. The article argues that since the understanding of God leads to a joyous affect, the logic of the argument must be causally connected with joy. While much of the secondary literature applies a division between ‘prayer’ and ‘proof’, this article suggests a reading of the Proslogion proof as a prayer-practice, and the prayer-practice is in turn analyzed through the logic of the proof. The result is a description of how contemplation of the argument drives affect, leading to the conclusion that the affect of joy achieves the intended result of the proof: the joy leads the mind to God. The article thus shows that the Proslogion is an intellectual affective prayer-practice.

John D. Wilsey

Luke Arredondo

Edgar Ter Danielyan

I propose that reading 2 and 3 Proslogion as advancing exclusively philosophical arguments and virtually ignoring the context of both the book and its author is untenable. I agree with Smart who identifies a radical misunderstanding of the Sitz im Leben of Proslogion in exclusively philosophical readings of Anselm: 'Anselm's attitude is radically misunderstood if it is thought of as being purely philosophical and theoretical. His real aim is practical, polemical, apologetic. He is engaged in combatting scepticism - the scepticism of the fool who says in his heart, "There is no God”. Against this position Saint Anselm advances the view that not only does God exist, He exists with an absolute necessity which excludes the possibility of His being even conceived correctly as possibly not existing. In pursuit of such a purpose Anselm might legitimately use any order of cognition he thought sound and he might therefore be expected to depend on faith at least in part; only had his end been pure philosophic speculation would such an appeal to the supra-rational have been out of court.' Smart’s view is supported in particular by Anselm’s reply to Gaunilo, where he writes ‘Now my strongest argument that this is false is to appeal to your faith and to your conscience’ - such an appeal being reasonable only if the arguments advanced are not exclusively philosophical.

Scottish Journal of Theology

Sigurd Baark

Shaun Smith

James Cleary

This paper seeks to analyse the metaphysical presuppositions of the word maius in Anselm’s argument. In order to do so, the paper first interprets Anselm and his philosophy and then the Proslogion. Since maius is seldom used in the Proslogion outside the phrase referring to God, the paper recurs to the Monologion for a further interpretation. This then permits the author to analyse maius in the context in which Anselm used the word, focussing both on what it refers to as well as what metaphysical presuppositions the word entails in the phrase id quo maius cogitari non potest. A modified version of this paper was named runner-up to the Marco Arosio Award 2015"

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4 The Ontological Argument

Brian Leftow is the Nolloth Professor of Philosophy of the Christian Religion at the University of Oxford.

• Published: 02 September 2009
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The term “ontological argument” was Kant's name for one member of a family of arguments that began with Anselm of Canterbury. These arguments all try to prove God's existence a priori, via reasoning about the entailments of a particular description of God. The description almost always involves God's greatness or perfection. Where it does not, the argument has a premise justified by God's greatness or perfection. So these arguments might better be called arguments from perfection. This article deals with the main arguments from perfection and criticisms thereof in historical order. It first explicates Anselm's key phrase “something than which no greater can be thought” and then takes up his reasoning, then the question of whether its premises are true.

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Overview – Does God Exist?

A level philosophy looks at 4 arguments relating to the existence of God . These are:

• The ontological argument
• The teleological argument
• The cosmological argument

The problem of evil

There are various versions of each argument as well as numerous responses to each. The key points of each argument are summarised below:

Ontological arguments

The ontological arguments are unique in that they are the only arguments for God’s existence that use a priori reasoning. All ontological arguments are deductive arguments .

Versions of the ontological argument aim to deduce God’s existence from the definition of God. Thus, proponents of ontological arguments claim ‘God exists’ is an analytic truth .

Anselm’s ontological argument

“Hence, even the fool is convinced that something exists in the understanding, at least, than which nothing greater can be conceived. For, when he hears of this, he understands it. And whatever is understood, exists in the understanding. And assuredly that, than which nothing greater can be conceived, cannot exist in the understanding alone. For, suppose it exists in the understanding alone: then it can be conceived to exist in reality; which is greater. […] Hence, there is no doubt that there exists a being, than which nothing greater can be conceived, and it exists both in the understanding and in reality.” – St. Anselm, Proslogium , Chapter 2

Anselm of Canterbury (1033-1109) was the first to propose an ontological argument in his book Proslogium .

His argument can be summarised as:

• By definition, God is a being greater than which cannot be conceived
• We can coherently conceive of such a being i.e. the concept is coherent
• It is greater to exist in reality than to exist only in the mind
• Therefore, God must exist

In other words, imagine two beings:

• One is said to be maximally great in every way, but does not exist.
• The other is maximally great in every way and does exist.

Which being is greater? Presumably, the second one – because it is greater to exist in reality than in the mind.

Since God is a being that we cannot imagine to be greater, this description better fits the second option (the one that exists) than the first.

Descartes’ ontological argument

Descartes offers his own version of the ontological argument:

• I have the idea of God
• The idea of God is the idea of a supremely perfect being
• A supremely perfect being does not lack any perfection
• Existence is a perfection
• Therefore, God exists

This argument is very similar to Anselm’s , except it uses the concept of a perfect being rather than a being greater than which cannot be conceived .

Descartes argues this shows that ‘God does not exist’ is a self-contradiction . Hume uses this claim as the basis for his objection to the ontological argument.

Gaunilo’s island

Gaunilo of Marmoutiers (994-1083) argues that if Anselm’s argument is valid, then anything can be defined into existence. For example:

• The perfect island is, by definition, an island greater than which cannot be conceived
• We can coherently conceive of such an island i.e. the concept is coherent
• Therefore, this island must exist

The conclusion of this argument is obviously false.

Gaunilo argues that if Anselm’s argument were valid, then we could define anything into existence – the perfect shoe, the perfect tree, the perfect book, etc.

Hume: ‘God does not exist’ is not a contradiction

The ontological argument reasons from the definition of God that God must exist. This would make ‘God exists’ an analytic truth (or what Hume would call a relation of ideas , as the analytic/synthetic distinction wasn’t made until years later).

The denial of an analytic truth/relation of ideas leads to a contradiction. For example, “there is a triangle with 4 sides” is a contradiction.

Contradictions cannot be coherently conceived . If you try to imagine a 4-sided triangle, you’ll either imagine a square or a triangle. The idea of a 4-sided triangle doesn’t make sense.

So, is “God does not exist” a contradiction? Descartes (and Anselm) certainly thought so.

But Hume argues against this claim. Anything we can conceive of as existent , he says, we can also conceive of as non-existent . This shows that “God exists” cannot be an analytic truth/relation of ideas, and so ontological arguments must fail somewhere.

A summary of Hume’s argument can be stated as:

• If ontological arguments succeed, ‘God does not exist’ is a contradiction
• A contradiction cannot be coherently conceived
• But ‘God does not exist’ can be coherently conceived
• Therefore, ‘God does not exist’ is not a contradiction
• Therefore, ontological arguments do not succeed

Kant: existence is not a predicate

Kant argues that existence is not a property (predicate) of things in the same way, say, green is a property of grass .

To say something exists doesn’t add anything to the concept of it.

Imagine a unicorn. Then imagine a unicorn that exists . What’s the difference between the two ideas? Nothing! Adding existence to the idea of a unicorn doesn’t make unicorns suddenly exist.

When someone says “God exists”, they don’t mean “there is a God and he has the property of existence”. If they did, then when someone says “God does not exist”, they’d mean, “there is a God and he has the property of non existence” – which doesn’t make sense!

Instead, what people mean when they say “God exists” is that “God exists in the world” . This cannot be argued from the definition of God and could only be proved via ( a posteriori ) experience. Thus the ontological argument fails to prove God’s (actual) existence.

Norman Malcolm’s ontological argument

Kant’s objection to the ontological argument is generally considered to be the most powerful argument against it.

So, in response, some philosophers have developed alternate versions that avoid this criticism.

Malcolm accepts that Descartes and Anselm (at least as presented above) are wrong.

Instead, Malcolm argues that it’s not existence that is a perfection, but the logical impossibility of non-existence ( necessary existence , in other words).

This (necessary existence) is a predicate, so avoids Kant’s argument above. Malcolm’s ontological argument is as follows:

• Either God exists or does not exist
• God cannot come into existence or go out of existence
• If God exists, God cannot cease to exist
• Therefore, if God exists, God’s existence is necessary
• Therefore, if God does not exist, God’s existence is impossible
• Therefore, God’s existence is either necessary or impossible
• God’s existence is impossible only if the concept of God is self-contradictory
• The concept of God is not self-contradictory
• Therefore, God’s existence is not impossible
• Therefore, God exists necessarily

Malcolm’s argument essentially boils down to:

• God’s existence is either necessary or impossible (see above)
• God’s existence is not impossible
• Therefore God’s existence is necessary

Possible response:

We may respond to point 8, as discussed in the concept of God section , that the concept of God is self-contradictory.

Alternatively, we may argue that the meaning of “necessary” changes between premise 4 and the conclusion (10) and thus Malcolm’s argument is invalid. In premise 4, Malcolm is talking about necessary existence in the sense of a property that something does or does not have. By the conclusion, Malcolm is talking about necessary existence in the sense that it is a necessary truth that God exists. But this is not the same thing. We can accept that if God exists , then God has the property of necessary existence, but deny the conclusion that God exists necessarily.

Teleological arguments

The teleological arguments are also known as arguments from design.

These arguments aim to show that certain features of nature or the laws of nature are so perfect that they must have been designed by a designer – God.

Hume’s teleological argument

In Dialogues Concerning Natural Religion , Hume considers a version of the teleological argument (through the character Cleanthes ), which he goes on to reject (through the character of Philo ).

“The curious adapting of means to ends, throughout all nature, resembles exactly, though it much exceeds, the productions of human contrivance; of human designs, thought, wisdom, and intelligence. Since, therefore, the effects resemble each other, we are led to infer, by all the rules of analogy, that the causes also resemble; and that the Author of Nature is somewhat similar to the mind of man, though possessed of much larger faculties, proportioned to the grandeur of the work which he has executed. By this argument a posteriori , and by this argument alone, do we prove at once the existence of a Deity, and his similarity to human mind and intelligence.” – Hume, Dialogues Concerning Natural Religion, Part 2

Hume’s argument here draws an analogy between things designed by humans and nature:

• The ‘fitting of means to ends’ in human design (e.g. the fitting of the many parts of a watch to achieve the end of telling the time) resemble the ‘fitting of means to ends’ in nature (e.g. the many parts of a human’s eye to achieve the end of seeing things)
• Similar effects have similar causes
• The causes of human designs (e.g. watches) are minds
• So, by analogy , the cause of design in nature is also a mind
• And, given the ‘grandeur of the work’ of nature, this other mind is God .

William Paley: Natural Theology

William Paley (1743-1805) wasn’t the first to propose a teleological argument for the existence of God, but his version is perhaps the most famous.

The reason for this is that a watch, unlike the stone, has many parts organised for a purpose. Paley says this is the hallmark of design:

“When we come to inspect the watch, we perceive (what we could not discover in the stone) that its several parts are framed and put together for a purpose , e.g. that they are so formed and adjusted as to produce motion, and that motion so regulated as to point out the hour of the day.” – William Paley, Natural Theology, Chapter 1

Nature and aspects of nature, such as the human eye, are composed of many parts. These parts are organised for a purpose – in the case of the eye, to see .

So, like the watch, nature has the hallmarks of design – but “ with the difference, on the side of nature, of being greater and more” . And for something to be designed, it must have an equally impressive designer .

Paley says this designer is God.

Hume: problems with the analogy

Hume (as the character Philo) points out various problems with the analogy between the design of human-made objects and nature, such as:

• We can observe human-made items being designed by minds , but we have no such experience of this in the case of nature. Instead, designs in nature could be the result of natural processes (what Philo calls ‘generation and vegetation’).
• The analogy focuses on specific aspects of nature that appear to be designed (e.g. the human eye) and generalises this to the conclusion that the whole universe must be designed.
• Human machines  (e.g. watches and cars) obviously have a designer and a purpose. But biological things (e.g. an animal or a plant, such as a cabbage) do not have an obvious purpose or designer – they appear to be the result of an unconscious process of ‘generation and vegetation’. The universe is more like the latter (i.e. a biological thing) than the former (i.e. a machine) and so, by analogy, the cause of the universe is better explained by this unconscious processes of ‘generation and vegetation’ rather than the conscious design of a mind.

An argument from analogy is only as strong as the similarities between the two things being compared (nature and human designs). These differences weaken the jump from human-made items being designed to the whole universe being designed.

Hume: Spatial dis order

Hume (as the character Philo) argues that although there are examples of order within nature (which suggests design), there is also much “vice and misery and disorder” in the world (which is evidence against design).

If God really did design the world, Hume argues, there wouldn’t be such disorder. For example:

• There are huge areas of the universe that are empty, or just filled with random rocks or are otherwise uninhabitable. This suggests that the universe isn’t designed but instead we just happen, by coincidence, to be in a part that has spatial order.
• Some parts of the world (e.g. droughts, hurricanes, etc.) go wrong and cause chaos. Hume argues that if the world is designed , these chaotic features suggest that the designer isn’t very good.
• Animals have bodies that feel pain and that could have been made in such ways that they could have happier lives. If God designed animals and humans, you would expect He would make animals and humans in this way so that their lives would be easier and happier.

These features are examples of spatial dis order – features that wouldn’t make sense to include if you designed the universe.

Hume argues that such examples of disorder show that the universe isn’t designed. Or, if the universe is designed, then the designer is neither omnipotent nor omnibenevolent (as God is claimed to be).

Hume: causation

Hume famously argues that we never experience causation – only the ‘constant conjunction’ of one event following another. If this happens enough times, we infer that A causes B.

For example, experience (ever since you were a baby) tells you that if one snooker ball hits another (A), the second snooker ball will move (B). You don’t actually experience A causing B, but it’s reasonable to expect this relationship to hold in the future because you’ve seen it and similar examples hundreds of times.

But imagine that you take a sip of tea and at the same time your friend coughs. Would it be reasonable to infer that drinking the tea caused your friend to cough based on this one instance? Obviously not. The point is: You cannot infer causation from a single instance.

Applying this to teleological arguments, Hume (as the character Philo) argues that the creation of the universe was a unique event – we only have experience of this one universe. And so, like the tea example, we can’t infer a causal relationship between designer and creation based on just one instance.

Hume: finite matter, infinite time

“Instead of supposing matter to be infinite, as Epicurus did, let us suppose it to be finite and also suppose space to be finite, while still supposing time to be infinite. A finite number of particles in a finite space can have only a finite number of transpositions; and in an infinitely long period of time every possible order or position of particles must occur an infinite number of times.” – Hume, Dialogues Concerning Natural Religion, Part 8

Hume’s objection here assumes the following:

• Time is infinite
• Matter is finite

Given these assumptions, it is inevitable that matter will organise itself into combinations that appear to be designed.

It’s a bit like the monkeys and typewriters thought experiment:

Given an infinite amount of time, a monkey will eventually type the complete works of Shakespeare.

This is the nature of infinity. It’s inevitable that the monkey will write something that appears to be intelligent, even though it’s just hitting letters at random.

The same principle applies to the teleological argument, argues Hume: Given enough time, it is inevitable that matter will arrange itself into combinations that appear to be designed , even though they’re not.

Darwin: evolution by natural selection

Charles Darwin’s (1809-1882) theory of evolution by natural selection explains how complex organisms – complete with parts organised for a purpose – can emerge from nature without a designer.

• Competition for food is tough
• An animal that cannot acquire enough food will die before it can breed and produce offspring
• An animal with a (random genetic mutation for a) neck that’s 1cm longer than everyone else’s will be able to access 1cm more food
• This competitive advantage makes it more likely to survive and produce offspring
• The offspring are likely to inherit the gene for a longer neck, making them more likely to survive and reproduce as well
• Longer necked-animals become more common as a result
• The environment becomes more competitive as more and more animals can reach the 1cm higher leaves
• An animal with a neck 2cm longer has the advantage in this newly competitive environment
• Repeat process over hundreds of millions of years until you have modern day giraffes

The key idea is that – given enough time and genetic mutations – it is inevitable that animals and plants will adapt to their environment, thus creating the appearance of design.

This directly undermines Paley’s claim that anything that has parts organised to serve a purpose must be designed.

Swinburne: The Argument from Design

Swinburne’s version of the teleological argument distinguishes between:

• Examples of order in nature ( spatial order )
• And the order of the laws of nature ( temporal order )

Swinburne accepts that science, for example evolution , can explain the apparent design of things like the human eye (i.e. spatial order) and so Paley’s teleological argument does not succeed in proving God’s existence. However, Swinburne argues, we can’t explain the laws of nature (i.e. temporal order) in the same way.

For example, the law of gravity is such that it allows galaxies to form, and planets to form within these galaxies, and life to form on these planets. But if gravity had the opposite effect – it repelled matter, say – then life would never be able to form. If gravity was even slightly stronger, planets wouldn’t be able to form. So how do we explain why these laws are the way they are?

Unlike spatial order, we can’t give a scientific explanation of why the laws of nature are as they are. Science can explain and predict things using these laws – but it has to first assume these laws. Science can’t explain why these laws are the way they are. In the absence of a scientific explanation of the laws of nature, Swinburne argues, the best explanation of temporal order is a personal explanation.

We give personal explanations of things all the time – for example, ‘this sentence exists because I chose to write it’ or ‘that building exists because someone designed and built it’. Swinburne argues that, by analogy, we can explain the laws of nature (i.e. temporal order) in a similarly personal way: The laws of nature are the way they are because someone designed them.

In the absence of a scientific explanation of temporal order, Swinburne argues, the best explanation is the personal one: The laws of nature were designed by God .

Multiple universes

Hume’s earlier argument (finite matter, infinite time) can be adapted to respond to Swinburne’s teleological argument.

But instead of arguing that time is infinite, as Hume does, we could argue that the number of universes is infinite.

This idea of multiple universes is popular among some physicists, as it explains various phenomena in quantum mechanics.

But anyway, if there are an infinite number of universes (or even just a large enough number), it is likely that some of these universes will have laws of nature (temporal order) that support the formation of life. Of course, when such universes do exist, it is just sheer luck. If each universe has randomly different scientific laws, there will also be many universes where the temporal order does not support life.

Is the designer God?

Both Hume and Kant have argued that even if the teleological argument succeeded in proving the existence of a designer , this designer would not necessarily be God (as defined in the Concept of God section).

For example:

• God’s power is supposedly infinite ( omnipotence ), yet the universe is not infinite
• Designers are not always creators. Designer and creator might be two separate people (e.g. the guy who designs a car doesn’t physically build it)
• The design of the universe may be the result of many small improvements by many people
• Designers can die even if their creations live on. How do we know the designer is eternal , as God is supposed to be?

Cosmological arguments

The Kalam Argument

The Kalam argument is perhaps the simplest version of the cosmological argument in the A level philosophy syllabus. It says:

• Whatever begins to exist has a cause
• The universe began to exist
• Therefore, the universe has a cause

Aquinas: Five Ways

St. Thomas Aquinas (1225-1274) gave five different versions of the cosmological argument. A level philosophy requires you to know these three:

Argument from motion

Argument from causation.

• Contingency argument

Aquinas’ first way is the argument from motion .

“It is certain, and evident to our senses, that in the world some things are in motion… It is [impossible that something] should be both mover and moved, i.e. that it should move itself. Therefore, whatever is in motion must be put in motion by another. If that by which it is put in motion be itself put in motion, then this also must needs be put in motion by another, and that by another again. But this cannot go on to infinity, because then there would be no first mover, and, consequently, no other mover; seeing that subsequent movers move only inasmuch as they are put in motion by the first mover… Therefore it is necessary to arrive at a first mover, put in motion by no other; and this everyone understands to be God.” – Aquinas, Summa Theologica , Part 1 Question 2

A summary of this argument:

• E.g. a football rolling along the ground
• E.g. someone kicked the ball
• If A is put in motion by B , then something else ( C ) must have put B in motion, and so on
• If this chain goes on infinitely, then there is no first mover
• If there is no first mover, then there is no other mover, and so nothing would be in motion
• But things are in motion
• Therefore, there must be a first mover
• The first mover is God

Aquinas’ second way – the argument from causation – is basically the same as the argument from motion, except it talks about a first cause rather than a first mover:

• E.g. throwing a rock caused the window to smash
• C is caused by B , and B is caused by A , and so on
• If this chain of causation was infinite, there would be no first cause
• If there were no first cause, there would be no subsequent causes or effects
• But there are causes and effects in the world
• Therefore, there must have been a first cause
• The first cause is God

Argument from contingency

Aquinas’ third way relies on a distinction between necessary and contingent existence. It’s a similar distinction to necessary and contingent truth from the epistemology module.

Things that exist contingently are things that might not have existed.

For example, the tree in the field wouldn’t exist if someone hadn’t planted the seed years ago. So, the tree exists contingently. Its existence is contingent on someone planting the seed.

So, using this idea of contingent existence, Aquinas argues that:

• Everything that exists contingently did not exist at some point
• If everything exists contingently, then at some point nothing existed
• If nothing existed, then nothing could begin to exist
• But since things did begin to exist, there was never nothing in existence
• Therefore, there must be something that does not exist contingently, but that exists necessarily
• This necessary being is God

Descartes’ Cosmological Argument

Descartes’ version of the cosmological argument is a lot more long-winded than the Kalam argument or any of Aquinas’ .

The key points are along these lines:

• I can’t be the cause of my own existence because if I was, I would have given myself all perfections (i.e. I would have caused myself to be omnipotent, omniscient, etc. In other words, I would have made myself God).
• I can’t always have existed, because then I would be aware of this. Plus, there has to be something that sustains my existence – the fact that I existed a moment ago does not at all guarantee that I should continue existing.
• Whatever is the cause of its own existence is God.
• So, this only leaves option 4: God is the ultimate cause of my existence .

Leibniz: Sufficient reason

Note: This is another cosmological argument from contingency , like Aquinas’ third way above

Leibniz’s argument is premised on his  principle of sufficient reason. The principle of sufficient reason says that every truth has an explanation of why it is the case (even if we can’t know this explanation).

Leibniz then defines two different types of truth:

• Truths of reasoning: this is basically another word for necessary or analytic truths
• Truths of fact: this is basically another word for contingent or synthetic truths

The sufficient reason for truths of reasoning (i.e. analytic truths) is revealed by analysis. When you analyse and understand “3+3=6”, for example, you don’t need a further explanation why it is true.

But it is more difficult to provide sufficient reason for truths of fact (i.e. contingent truths) because you can always provide more detail via more contingent truths. For example, you can explain the existence of a tree by saying someone planted a seed. But you could then ask why the person planted the seed, or why seeds exist in the first place, or why the laws of physics are the way they are, and so on. This process of providing contingent reasons for contingent facts goes on forever.

“Therefore, the sufficient or ultimate reason must needs be outside of the sequence or series of these details of contingencies, however infinite they may be.” – Leibniz, Monadology , Section 37

So, to escape this endless cycle of contingent facts and provide sufficient reason for truths of fact (i.e. contingent truths), we need to step outside the sequence of contingent facts and appeal to a necessary substance. This necessary substance is God , Leibniz says.

Is a first cause necessary?

Most of the cosmological arguments assume something along the lines of ‘there can’t be an infinite chain of causes’ (except the cosmological arguments from contingency ). For example, they say stuff like there must have been a first cause or a prime mover .

But we can respond by rejecting this claim. Why must there be a first cause? Perhaps there is just be an infinite chain of causes stretching back forever.

• An infinite chain of causes would mean an infinite amount of time has passed prior to the present moment
• If an infinite amount of time has passed, then the universe can’t get any older (because infinity + 1 = infinity)
• But the universe is getting older (e.g. the universe is a year older in 2020 than it was in 2019)
• Therefore an infinite amount of time has not passed
• Therefore there is not an infinite chain of causes

Hume’s objections to causation

Another assumption (or premise) of many of the cosmological arguments above (not so much the contingency ones) is something like ‘everything has a cause’.

But Hume’s fork can be used to question this claim that ‘everything has a cause’:

• Relation of ideas: ‘Everything has a cause’ is not a relation of ideas because we can conceive of something without a cause. For example, we can imagine a chair that just springs into existence for no reason – it’s a weird idea, but it’s not a logical contradiction like a 4-sided triangle or a married bachelor.
• Matter of fact: ‘Everything has a cause’ cannot be known as a matter of fact either, says Hume. We never actually experience causation – we just see event A happen and then event B happen after. Even if we see B follow A a million times, we never experience A causing B, just the ‘constant conjunction’ of A and B.

Further, in the specific case of the creation of the universe, we only ever experience event B (i.e. the continued existence of the universe) and never what came before (i.e. the thing that caused the universe to exist).

This all casts doubt on the premise of cosmological arguments that ‘everything has a cause’.

Russell: Fallacy of composition

Bertrand Russell argues that cosmological arguments fall foul of the fallacy of composition . The fallacy of composition is an invalid inference that because parts of something have a certain property, the entire thing must also have this property. Examples:

• Just because all the players on a football team are good, this doesn’t guarantee the team is good. For example, the players might not work well together.
• Just because a sheet of paper is thin, it doesn’t mean things made from sheets of paper are thin. For example, a book with enough sheets of paper can be thick.

Applying this to the cosmological argument, we can raise a similar objection to Hume’s above : just because everything within the universe has a cause, doesn’t guarantee that the universe itself has a cause.

Or, to apply it to Leibniz’s cosmological argument : just because everything within the universe requires sufficient reason to explain its existence, doesn’t mean the universe itself requires sufficient reason to explain its existence. Russell says: “the universe is just there, and that’s all.”

• Ok, but everything within the universe exists contingently
• And if everything within the universe didn’t exist, then the universe itself wouldn’t exist either (because that’s all the universe is: the collection of things that make it up)
• So the universe itself exists contingently, not just the stuff within it
• And so the universe itself requires sufficient reason to explain its existence

Is the first cause God?

Aquinas’ first and second ways and the Kalam argument only show that there is a first cause . But they don’t show that this first cause is God .

So, even if we accept that there was a first cause, it doesn’t necessarily follow that God exists – much less the specific being described in the concept of God .

So, even if the cosmological argument is sound, it doesn’t necessarily follow that God exists.

This objection doesn’t work so well against Descartes’ version because he specifically reasons that there is a first cause and that this first cause is an omnipotent and omniscient God .

Similarly, you could argue that any being that exists necessarily (such as follows from Aquinas’ third way and Leibniz’s cosmological argument ) would be God.

The problem of evil uses the existence of evil in the world to argue that God (as defined in the concept of God ) does not exist.

These arguments can be divided into two forms:

• The logical problem of evil is a deductive argument that says the existence of God is logically impossible given the existence of evil in the world
• The evidential problem of evil is an inductive argument which says that, while it is logically possible that God exists, the amount of evil and unfair ways it is distributed in our world is pretty strong evidence that God doesn’t exist

And evil can be divided into two types of evil:

One final definition: a theodicy is an explanation of why an omnipotent and omniscient God would permit evil.

The logical problem of evil

“Epicurus’s old questions have still not been answered. Is he willing to prevent evil, but not able? Then he is impotent. Is he able, but not willing? Then he is malevolent. Is he both able and willing? Then where does evil come from?” – Hume, Dialogues Concerning Natural Religion, Part 10

J.L. Mackie: Evil and Omnipotence

Inconsistent triad.

The simple version of Mackie’s argument is that the following statements are logically inconsistent – i.e. one or more of them contradict each other:

• God is omnipotent
• God is omnibenevolent
• Evil exists

Mackie’s argument is that, logically, a maximum of 2 of these 3 statements can be true but not all 3. This is sometimes referred to as the inconsistent triad .

He argues that if God is omnibenevolent then he wants to stop evil. And if God is omnipotent, then he’s powerful enough to prevent evil.

But evil does exist in the world. People steal, get murdered, and so on. So either God isn’t powerful enough to stop evil, doesn’t want to stop evil, or both.

In the concept of God , God is defined as an omnipotent and omnibenevolent being. If such a being existed, argues Mackie, then evil would not exist. But evil does exist. Therefore, there is no omnipotent and omnibenevolent being. Therefore, God does not exist.

Reply 1: good couldn’t exist without evil

People often make claims like “you can’t appreciate the good times without experiencing some bad times”.

This is basically what this reply says: without evil, good couldn’t exist.

Mackie’s response

Mackie questions whether this statement is true at all. Why can’t we have good without evil?

Imagine if we lived in a world where everything was red. Presumably, we wouldn’t have created a word for ‘red’, nor would we know what it meant if someone tried to explain it to us. But it would still be the case that everything is red, we just wouldn’t know.

It’s a similar story with good and evil.

God could have created a world in which there was no evil. Like the red example, we wouldn’t have the concept of evil. But it would still be the case that everything is good – we just wouldn’t be aware of it.

Reply 2: the world is better with some evil than none at all

You could develop reply 1 above to argue that some evil is necessary for certain types of good. For example, you couldn’t be courageous (good) without having to overcome fear of pain, death, etc. (evil).

We can define first and second order goods:

• First order good: e.g. pleasure
• Second order good: e.g. courage

The argument is that second order goods seek to maximise first order goods. And second order goods are more valuable than first order goods. But without first order evils, second order goods couldn’t exist.

Let’s say we accept that first order evil is necessary for second order good to exist. How do you explain second order evil ?

Second order evils seek to maximise first order evils such as pain. So, for example, malevolence or cruelty are examples of second order evils.

But we could still have a world in which people were courageous (second order good) in overcoming pain (first order evil) without these second order evils. So why would an omnipotent and omnibenevolent God allow the existence of second order evils if there is no greater good in doing so?

Reply 3: we need evil for free will

We can develop the second order evil argument above further and argue that second order evil is necessary for free will. And free will is inherently such a good and valuable thing that it outweighs the bad that results from people abusing free will to do evil things.

So, while allowing free will brings some suffering, the net good of having free will is greater than if we didn’t. Therefore, it’s logically possible that an omnipotent and omnibenevolent God would allow evil (both first order and second order) for the greater good of free will.

• An omnipotent God can create any logically possible world
• If it’s logically possible to freely choose to act in a way that’s good on one occasion, then it’s logically possible to freely choose to act in a way that’s good on every occasion
• So, an omnipotent God could create a world in which everyone freely chooses to act in a way that’s good

In other words, there is a logically possible world with both free will and without second order evils.

This, surely, would be the best of both worlds and maximise good most effectively: you would have second order goods, plus the good of free will, but without second order evils. This is a logically possible world – the logically possible world with the most good.

So, why wouldn’t an omnipotent and omniscient God create this specific world? Second order evils do not seem logically necessary, and yet they exist.

Alvin Plantinga: God, Freedom and Evil

Plantinga argues that we don’t necessarily need a plausible theodicy to defeat the logical problem of evil. All we need to show is that the existence of evil is not logically inconsistent with an omnipotent and omnibelevolent God.

So, even if the explanation of why God would allow evil doesn’t seem particularly plausible, as long as it’s a logical possibility then we have defeated the logical problem of evil .

Free will defence

(The free will theodicy is also known as the Augustinian theodicy after St. Augustine).

Even Mackie himself admits that God’s existence is not logically incompatible with some evil (first order evil). But his argument is that second order evil isn’t necessary .

Plantinga argues, however, that it’s logically possible (which is all we need to show to defeat the logical problem of evil) that God would allow second order evil for the greater good of free will . His argument is as follows:

• A morally significant action is one that is either morally good or morally bad
• A being that is significantly free is one that is able to do or not do morally significant actions
• A being created by God to only do morally good actions would not be significantly free
• So, the only way God could eliminate evil (including second order evil) would be to eliminate significantly free beings
• But a world that contains significantly free beings is more good than a world that does not contain significantly free beings

In short, this argument shows that it’s at least logically possible that God would allow second order evil for the greater good of significant freedom.

Perhaps God could have created the world where everyone chose to only do morally good actions ( as Mackie describes above ) – but such a world wouldn’t be significantly free. Free will is inherently good and so significant free will could outweigh the negative of people using that significant free will to commit second order evils.

Natural evil as a form of moral evil

The free will defence above explains why an omnipotent and omnibenevolent God would allow moral evil. But it doesn’t explain natural evil.

When innocent people are killed in natural disasters, it doesn’t seem this is the result of free will. So, even if an omnipotent and omnibenevolent God would allow moral evil, why does this kind of evil exist as well?

Plantinga argues that it’s possible natural evil is the result of non-human actors such as Satan, fallen angels, demons, etc. This would make natural evil another form of moral evil, the existence of which would be explained by free will.

Even if this doesn’t sound very plausible , it’s at least possible . And remember, Plantinga’s argument is that we only need to show evil is not logically inconsistent with God’s existence to defeat the logical problem of evil.

Soul-making

The Irenaean theodicy below (what Hick calls soul-making) can also serve as a possible explanation of why God allows evil: We need evils in order to overcome them and freely develop spiritual virtues.

The evidential problem of evil

Unlike the logical problem of evil , the evidential problem of evil can allow that God’s existence is possible .

However, it argues the amount and distribution of evil in the world provides good evidence that God probably doesn’t exist.

• Innocent babies born with painful congenital diseases
• The sheer number of people currently living in slavery, extreme poverty or fear
• The millions of innocent and anonymous people throughout history killed for no good reason

We can reject the logical problem of evil and accept that God would allow some evil. But would an omnipotent and omnibenevolent God allow so much evil? And to people so undeserving of it?

The evidential problem of evil argues that if God did exist, there would be less evil and it would be less concentrated among those undeserving of it.

Free will (again)

Sure, God could have made a world with less evil. But this would mean less free will. And on balance, having free will creates more good than the evil it also creates.

OK, maybe God would allow some evil for the greater good of free will. But it seems possible – simple, even – that God could have created a world with less evil than our world without sacrificing the greater good of free will.

For example, our world exactly as it is, with the same amount of free will, but with 1% less cancer. God could have created this world, so why didn’t He?

The evidential problem of evil could insist that the amount of evil – or unfair ways it is distributed – could easily be reduced without sacrificing some greater good, and so it seems unlikely that God exists, in this world, given this particular distribution of evil.  

John Hick: Evil and the God of Love

Soul making.

(The soul making theodicy is also known as the Irenaean theodicy after St. Irenaeus).

Hick argues that humans are unfinished beings. Part of our purpose in life is to develop personally, ethically and spiritually – he calls this ‘soul making’.

As discussed above , it would be impossible for people to display (second order) virtues such as courage without fear of (first order) evils such as pain or death. Similarly, we couldn’t learn virtues such as forgiveness if people never treated us wrongly.

Of course, God could just have given us these virtues right off the bat. But, Hick says, virtues acquired through hard work and discipline are “good in a richer and more valuable sense”. Plus, there are some virtues, such as a genuine and authentic love of God, that cannot simply be given (otherwise they wouldn’t be genuine).

Soul making explains why God might allow some evil – i.e. it deals with the logical problem of evil. But there are some evils that don’t seem necessary for soul-making, such as pointless evils or animal suffering , and so the evidential problem remains. Hick’s responses are as follows:

Why God allows animals to suffer

The evidential problem of evil can ask Hick why God would allow animals to suffer when there is no benefit. After all, animals can’t develop spiritually like we can, so what greater good does their suffering serve?

Hick’s response is that God wanted to create epistemic distance between himself and humanity – i.e. a world in which his existence could be doubted . If God just proved he existed, we wouldn’t be free to develop a relationship with him. Also, we wouldn’t choose to do good for its own sake – we might just do good in expectation of being rewarded by God.

If animals didn’t exist or humans were clearly differentiated from animals, then it would be obvious that humans existed as part of a divine plan. However, humanity’s similarity with animals provides an alternative account of our existence that doesn’t require God (e.g. via evolution ) and thus creates epistemic distance where God’s existence can be doubted.

Why God allows such terrible evils

We might still ask why would God allow such terrible evils – e.g. torturing a baby or mass murder – when we could still achieve spiritual development with lesser evils?

Hick argues that it’s not possible for God to just get rid of terrible evil – e.g. baby torture – and leave only ordinary evil. The reason for this is that terrible evils are only terrible in contrast to ordinary evils. So, if God did get rid of terrible evils, then the worst ordinary evils would become the new terrible evils. If God kept getting rid of terrible evils then he would have to keep reducing free will and thus the development of personal and spiritual virtues ( soul making ).

Why God allows such pointless evils

Finally, we might ask why would God allow such pointless evils – e.g. an innocent child struck down with cancer at a young age.

Hick argues that such pointless evils must remain something of a mystery. But, paradoxically, this mystery actually helps the case for soul making: If every time we saw someone suffering we knew it was for some higher purpose (i.e. it wasn’t pointless), then we would never be able to develop virtues such as deep sympathy.

“It seems, then, that in a world that is to be the scene of compassionate love and self-giving for others, suffering must fall upon mankind with something of the haphazardness and inequity that we now experience. It must be apparently unmerited, pointless, and incapable of being morally rationalized. For it is precisely this feature… that creates sympathy between man and man and evokes the unselfish kindness and goodwill which are among the highest values of personal life.” – John Hick, Evil and the God of Love, Chapter 16 Part 6

Further, without seemingly unfair and pointless evil, we would never be able to develop virtues such as hope and faith – both of which require a degree of uncertainty. This again comes back to God maintaining epistemic distance and creating a world where his existence can be doubted.

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Ontological Example Essay

• Created by: Maddy
• Created on: 30-12-12 19:16

i)                     Examine the key concepts of the ontological argument for the existence of God. (18 marks)

The ontological argument is an a priori argument which means it does not rely on our senses and experiences but on reason. The argument is also a deductive and analytic argument. The ontological argument was first devised in 1078 by St Anselm, then the Archbishop of Canterbury in part two and three of his book The Proslogian.  Philosophers Decartes, Malcolm and Platinga have also have offered different forms of the argument.

Possibly the most important concept of Anselm’s version of the ontological argument is the definition of God that he gives, this is also the starting point of the argument. Anselm described God as “That which nothing greater can be conceived”. He then went on to argue that it is better to have something in reality than just in the mind. As God is the greatest thing by definition, God must therefore exist in reality as well as the mind because he wouldn’t be the greatest thing if he only exists in the mind. The second form of the argument; Proslogian 3 focused on God having necessary existence. In other words, ‘he cannot not be’.  Necessary existence means a being whose non-existence would be a self-contradiction and if you can accept Anselm’s definition of God then God must have necessary existence by definition: He has to exist!

French philosopher Rene Decartes developed the ontological argument. Decartes began his argument by doubting his own existence and concluded that because he was ‘doubting’ he must exist. He said ‘ Cognito ergo sum’ meaning ‘I think therefore I am’. According to Decartes, the second most important piece of knowledge following from our own existence is knowledge of God. Decartes, like Anselm, argued that God has necessary existence. He used the classic example of the triangle to help explain. A triangle must have 3 sides to be a triangle, like this God’s existence is as necessary as the triangle having three sides. Decartes defines of God as a ‘supremely perfect being’ and like Anselm then went on to say that God must exist as existence is perfection. He also said: ‘ Existence can no more be separated from the essence of God than the fact that its three angles equal two right angles can be separated from the essence of a triangle’.

Modern philosopher Norman Malcolm offered his version of the ontological argument. He argued that if God does not exist, he never has or never will. However, he argued that God’s existence is either necessary or it is impossible but God as an impossible being is self-contradictory. This is because the most possible perfect being cannot be imaginary because then it wouldn’t be perfect so God has to exist.  

Another modern philosopher Alvin Platinga seeked to modernise Malcolm’s argument with something called ‘possible world semantics’.  He argued that there is a possible world in which there exists a being with maximal greatness and maximal…

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Anselm: Ontological Argument for the God’s Existence Essay

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Since time immemorial, the human race has been on its toes trying to validate the existence of superior beings. Religion exists to teach and house virtues of the beliefs of the existence of a God. In this document, the concept of Anslem will be outlined and discussed in depth. In the end, a conclusion will be drawn regarding the same concept.

Anslem plays a key role in outlining the concept behind the existence of God. He points out that God exists since human understanding acknowledges this. He views the human mind as a place in which things exist. He considers the understanding of God’s existence as some of the things that exist in the stated place. Those that comprehend the claims behind the existence of God but refuse to accept that he exists are fools. “Hence even the fool is convinced that something exists in the understanding, at least, than which nothing greater can be conceived. For when he hears of this, he understands it. And whatever is understood, exists in the understanding” (Mackie 2). His proof is strange in that he argues that the fool has invalid concepts. The claims that it is one thing for something to exist in the human understanding and another for the thing to be understood to exist get a place in this debate. He argues that God exists beyond human understanding. His argument is strange since it focuses on the fool’s perspective and the contradiction of this perspective.

Anselm emphasizes that our love of God involves memory and understanding as well as love. He claims that all existing human souls possess an immortal nature. He views the souls of all those who love God to be destined for eternal blessings. On the other hand, the souls of those who do not love God will experience nothing short of eternal misery. He states that the love for God is the main aspect of the just among the human race (Mackie 47).

Anslem’s work can be explained and evidenced by the use of the object theory. This theory helps to explain the brainchild of the concepts presented by Anslem. The Object theory focuses on validating the existence of objects based on the theories and ideas surrounding the existence of the object.

In conclusion, Anslem in his attempt to explain the existence of God and the related proofs develops a unique strange approach. Anslem just like his fellow human race members is interested in explaining the origin and nature in which God exists. His concept includes perceiving the human mind as a place. The place has things that exist. The human mind has the concept of God’s existence this is considered a thing in the place. The existence of the belief is therefore the cause of the belief of God’s existence. It is, therefore, valid to claim that the existence of God is valid. He looks down upon the people who claim they understand the existence and the ideas behind this belief of God’s existence yet they do not believe that God exists. He calls them fools. He also makes the claims that the love for God will create eternal happiness while the non-believer will experience nothing short of external misery. Anslem also acknowledges that human souls are immortal. The human race should approach the aspects of the Anslem concept to conclude on whether God exists or not.

Works Cited

Mackie, Leslie. The miracle of Theism. Arguments for and against the existence of God. Oxford: Clarendon Press, 1982.

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• “Rational Monotheism” by Edip Yüksel
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Exemplar Essay: 'To what extent is the ontological argument successful in proving God's existence'

Subject: Religious education

Age range: 16+

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Last updated

5 March 2018

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Here is a model essay in answer to the question ‘To what extent is the ontological argument successful in proving God’s existence’.

It is an A* essay and uses Anselm, Descartes, Malcolm with challenges from Gaunilo, Kant and Hume.

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Descartes' Ontological Argument

Descartes' ontological (or a priori ) argument is both one of the most fascinating and poorly understood aspects of his philosophy. Fascination with the argument stems from the effort to prove God's existence from simple but powerful premises. Existence is derived immediately from the clear and distinct idea of a supremely perfect being. Ironically, the simplicity of the argument has also produced several misreadings, exacerbated in part by Descartes' failure to formulate a single version.

The main statement of the argument appears in the Fifth Meditation. This comes on the heels of an earlier causal argument for God's existence in the Third Meditation, raising questions about the order and relation between these two distinct proofs. Descartes repeats the ontological argument in a few other central texts including the Principles of Philosophy . He also defends it in the First, Second, and Fifth Replies against scathing objections by some of the leading intellectuals of his day.

Descartes was not the first philosopher to formulate an ontological argument. An earlier version of the argument had been vigorously defended by St. Anselm in the eleventh century, and then criticized by a monk named Gaunilo (Anselm's contemporary) and later by St. Thomas Aquinas (though his remarks were directed against yet another version of the argument). Aquinas' critique was regarded as so devastating that the ontological argument died out for several centuries. It thus came as a surprise to Descartes' contemporaries that he should attempt to resurrect it. Although he claims not to be familiar with Anselm's version of the proof, Descartes appears to craft his own argument so as to block traditional objections.

Despite similarities, Descartes' version of the argument differs from Anselm's in important ways. The latter's version is thought to proceed from the meaning of the word "God," by definition, God is a being a greater than which cannot be conceived. Descartes' argument, in contrast, is grounded in two central tenets of his philosophy — the theory of innate ideas and the doctrine of clear and distinct perception. He purports not to rely on an arbitrary definition of God but rather on an innate idea whose content is "given." Descartes' version is also extremely simple. God's existence is inferred directly from the fact that necessary existence is contained in the clear and distinct idea of a supremely perfect being. Indeed, on some occasions he suggests that the so-called ontological "argument" is not a formal proof at all but a self-evident axiom grasped intuitively by a mind free of philosophical prejudice.

Descartes often compares the ontological argument to a geometric demonstration, arguing that necessary existence cannot be excluded from idea of God anymore than the fact that its angles equal two right angles, for example, can be excluded from the idea of a triangle. The analogy underscores once again the argument's supreme simplicity. God's existence is purported to be as obvious and self-evident as the most basic mathematical truth. It also attempts to show how the "logic" of the demonstration is rooted in our ordinary reasoning practices.

In the same context, Descartes also characterizes the ontological argument as a proof from the "essence" or "nature" of God, arguing that necessary existence cannot be separated from the essence of a supremely perfect being without contradiction. In casting the argument in these terms, he is implicitly relying on a traditional medieval distinction between a thing's essence and its existence. According to this tradition, one can determine what something is (i.e. its essence), independently of knowing whether it exists. This distinction appears useful to Descartes' aims, some have thought, because it allows him to specify God's essence without begging the question of his existence.

1. The Simplicity of the "Argument"

2. the distinction between essence and existence, 3. objections and replies, bibliography, other internet resources, related entries.

One of the hallmarks of Descartes' version of the ontological argument is its simplicity. Indeed, it reads more like the report of an intuition than a formal proof. Descartes underscores the simplicity of his demonstration by comparing it to the way we ordinarily establish very basic truths in arithmetic and geometry, such as that the number two is even or that the sum of the angles of a triangle is equal to the sum of two right angles. We intuit such truths directly by inspecting our clear and distinct ideas of the number two and of a triangle. So, likewise, we are able to attain knowledge of God's existence simply by apprehending that necessary existence is included in the clear and distinct idea of a supremely perfect being. As Descartes writes in the Fifth Meditation:

[1] But if the mere fact that I can produce from my thought the idea of something entails that everything which I clearly and distinctly perceive to belong to that thing really does belong to it, is not this a possible basis for another argument to prove the existence of God? Certainly, the idea of God, or a supremely perfect being, is one that I find within me just as surely as the idea of any shape or number. And my understanding that it belongs to his nature that he always exists is no less clear and distinct than is the case when I prove of any shape or number that some property belongs to its nature (AT 7:65; CSM 2:45).

One is easily misled by the analogy between the ontological argument and a geometric demonstration, and by the language of "proof" in this passage and others like it. Descartes does not conceive the ontological argument on the model of an Euclidean or axiomatic proof, in which theorems are derived from epistemically prior axioms and definitions. On the contrary, he is drawing our attention to another method of establishing truths that informs our ordinary practices and is non-discursive. This method employs intuition or, what is the same for Descartes, clear and distinct perception. It consists in unveiling the contents of our clear and distinct ideas. The basis for this method is the rule for truth, which was previously established in the Fourth Meditation. According to the version of this rule invoked in the Fifth Meditation, whatever I clearly and distinctly perceive to be contained in the idea of something is true of that thing. So if I clearly and distinctly perceive that necessary existence pertains to the idea of a supremely perfect being, then such a being truly exists.

Although Descartes maintains that God's existence is ultimately known through intuition, he is not averse to presenting formal versions of the ontological argument. He never forgets that he is writing for a seventeenth-century audience, steeped in scholastic logic, that would have expected to be engaged at the level of the Aristotelian syllogism. Descartes satisfies such expectations, presenting not one but at least two separate versions of the ontological argument. These proofs, however, are stunningly brief and betray his true intentions. One version of the argument simply codifies the psychological process by which one intuits God's existence, in the manner described above:

Version A : Whatever I clearly and distinctly perceive to be contained in the idea of something is true of that thing. I clearly and distinctly perceive that necessary existence is contained in the idea of God. Therefore, God exists.

The rule for truth appears here in the guise of the first premise, but it is more naturally read as a statement of Descartes' own alternative method of "demonstration" via clear and distinct perception or intuition. In effect, the first "premise" is designed to instruct the meditator on how to apply this method, the same role that the analogy with a geometric demonstration serves in passage [1].

When presenting this version of the argument in the First Replies, Descartes sets aside this first premise and focuses our attention on the second. In so doing, he is indicating the relative unimportance of the proof itself. Having learned how to apply Descartes' alternative method of reasoning, one need only perceive that necessary existence pertains to the idea of a supremely perfect being. Once one attains this perception, formal arguments are no longer required; God's existence will be self-evident (Second Replies, Fifth Postulate; AT 7:163-4; CSM 2:115).

Descartes sometimes uses traditional arguments as heuristic devices, not merely to appease a scholastically trained audience but to help induce clear and distinct perceptions. This is evident for example in the version of the ontological argument standardly associated with his name:

Version B : I have an idea of supremely perfect being, i.e. a being having all perfections. Necessary existence is a perfection. Therefore, a supremely perfect being exists.

While this set of sentences has the surface structure of a formal argument, its persuasive force lies at a different level. A meditator who is having trouble perceiving that necessary existence is contained in the idea of a supreme perfect being can attain this perception indirectly by first recognizing that this idea includes every perfection. Indeed, the idea of a supremely perfect being just is the idea of a being having all perfections. To attempt to exclude any or all perfections from the idea of a supremely being, Descartes observes, involves one in a contradiction and is akin to conceiving a mountain without a valley (or, better, an up-slope without a down-slope). Having formed this perception, one need only intuit that necessary existence is itself a perfection. It will then be clear that necessary existence is one of the attributes included in the idea of a supremely perfect being.

While such considerations might suffice to induce the requisite clear and distinct perception in the meditator, Descartes is aiming a deeper point, namely that there is a conceptual link between necessary existence and each of the other divine perfections. It is important to recall that in the Third Meditation, in the midst of the causal argument for the existence of God, the meditator already discovered many of these perfections — omnipotence, omniscience, immutability, eternality, simplicity, etc. Because our mind is finite, we normally think of the divine perfections separately and "hence may not immediately notice the necessity of their being joined together" (First Replies, AT 7:119; CSM 2:85). But if we attend carefully to "whether existence belongs to a supremely perfect being, and what sort of existence it is" we shall discover that we cannot conceive any one of the other attributes while excluding necessary existence from it (ibid.).

To illustrate this point Descartes appeals to divine omnipotence. He thinks that we cannot conceive an omnipotent being except as existing. Descartes' illustration presupposes the traditional, medieval understanding of "necessary existence." When speaking of this divine attribute, he sometimes uses the term "existence" simpliciter as shorthand. But in his more careful pronouncements he always insists on the phrase "necessary and eternal existence," which resonates with tradition. Medieval, scholastic philosophers often spoke of God as the sole "necessary being," by which they meant a being who depends only on himself for his existence ( a se esse ). This is the notion of "aseity" or self-existence. Since such a being does not depend on anything else for its existence, he has neither a beginning nor an end, but is eternal. Returning to the discussion in the First Replies, one can see how omnipotence is linked conceptually to necessary existence in this traditional sense. An omnipotent or all-powerful being does not depend ontologically on anything (for if it did then it would not be omnipotent). It exists by its own power:

[2] when we attend to immense power of this being, we shall be unable to think of its existence as possible without also recognizing that it can exist by its own power; and we shall infer from this that this being does really exist and has existed from eternity, since it is quite evident by the natural light that what can exist by its own power always exists. So we shall come to understand that necessary existence is contained in the idea of a supremely perfect being ... . (ibid.)

Some readers have thought that Descartes offers yet a third version of the ontological argument in this passage (Wilson, 1978, 174-76), but whether or not that was his intention is unimportant, since his primary aim, as indicated in the last line, is to enable his meditator to intuit that necessary existence is included in the idea of God. Since there is a conceptual link between the divine attributes, a clear and distinct perception of one provides a cognitive route to any of the others.

Although Descartes sometimes uses formal versions of the ontological argument to achieve his aims, he consistently affirms that God's existence is ultimately known through clear and distinct perception. The formal versions of the argument are merely heuristic devices, to be jettisoned once has attained the requisite intuition of a supremely perfect being. Descartes stresses this point explicitly in the Fifth Meditation, immediately after presenting the two versions of the argument considered above:

[3] whatever method of proof I use, I am always brought back to the fact that it is only what I clearly and distinctly perceive that completely convinces me. Some of the things I clearly and distinctly perceive are obvious to everyone, while others are discovered only by those who look more closely and investigate more carefully; but once they have been discovered, the latter are judged to be just as certain as the former. In the case of a right-angled triangle, for example, the fact that the square on the hypotenuse is equal to the square on the other two sides is not so readily apparent as the fact that the hypotenuse subtends the largest angle; but once one has seen it, one believes it just as strongly. But as regards God, if I were not overwhelmed by philosophical prejudices, and if the images of things perceived by the senses did not besiege my thought on every side, I would certainly acknowledge him sooner and more easily than anything else. For what is more manifest than the fact that the supreme being exists, or that God, to whose essence alone existence belongs, exists? (AT 7:68-69; CSM 2:47)

Here Descartes develops his earlier analogy between the (so-called) ontological argument and a geometric demonstration. He suggests that there are some meditators for whom God's existence is immediately manifest; for them God's existence is akin to an axiom or definition in geometry, such as that the hypotenuse of a right triangle subtends its largest angle. But other meditators, whose minds are confused and mired in sensory images, must work much harder, and might even require a proof to attain the requisite clear and distinct perception. For them, God's existence is akin to the Pythagorean Theorem. The important point is that both kinds of meditators ultimately attain knowledge of God's by clearly and distinctly perceiving that necessary existence is contained in the idea of supremely perfect being. Once one has achieved this perception, God's existence will be manifest or, as Descartes says elsewhere, "self-evident" ( per se notam ) (Second Replies, Fifth Postulate; AT 7: 164; CSM 2:115).

Descartes' contemporaries would have been surprised by this last remark. While reviewing an earlier version of the ontological argument, Aquinas had rejected the claim that God's existence is self-evident, at least with respect to us. He argued that what is self-evident cannot be denied without contradiction, but God's existence can be denied. Indeed, the proverbial fool says in his heart "There is no God" (Psalm 53.1).

When confronted with this criticism by a contemporary objector, Descartes tries to find common ground: "St. Thomas asks whether existence is self-evident as far as we are concerned, that is, whether it is obvious to everyone; and he answers, correctly, that it is not" (First Replies, AT 7:115; CSM 2:82). Descartes interprets Aquinas to be claiming that God's existence is not self-evident to everyone , which is something with which he can agree. Descartes does not hold that God's existence is immediately self-evident, or self-evident to everyone, but that it can become self-evident to some careful and industrious meditators.

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In the Fifth Meditation and elsewhere Descartes says that God's existence follows from the fact that existence is contained in the "true and immutable essence, nature, or form" of a supremely perfect being, just as it follows from the essence of a triangle that its angles equal two right angles. This way of putting the a priori argument has puzzled commentators and has led to a lively debate about the ontological status of Cartesian essences and the objects which are purported to "have" them. Some commentators have thought that Descartes is committed to a species of Platonic realism. According to this view, some objects that fall short of actual existence nevertheless subsist as abstract, logical entities outside the mind and beyond the physical world (Kenny, 1968; Wilson, 1978). Another commentator places Cartesian essences in God (Schmaltz 1991), while two recent revisionist interpretations (Chappell, 1997; Nolan, 1997) read Descartes as a conceptualist who takes essences to be ideas in human minds.

Descartes' reference to "essences" raises another important issue more directly related to the ontological argument. In claiming that necessary existence cannot be excluded from the essence of God, Descartes is drawing on the traditional medieval distinction between essence and existence. According to this distinction, one can say what something is (i.e. its essence), prior to knowing whether it exists. So, for example, one can define what a horse is — enumerating all of its essential properties — before knowing whether there are any horses in the world. The only exception to this distinction was thought to be God himself, whose essence just is to exist. It is easy to see how this traditional distinction could be exploited by a defender of the ontological argument. Existence is included in the essence of a supremely perfect being, but not in the essence of any finite thing. Thus it follows solely from the essence of the former that such a being actually exists. At times, Descartes appears to support this interpretation of the ontological argument. In the Fifth Replies, for example, he writes that "the existence of a triangle should not be compared with the existence of God, since the relation between existence and essence is manifestly quite different in the case of God from what it is in the case of the triangle. God is his own existence, but this is not true of the triangle" (AT 7:383; CSM 2:263). But Descartes' complete view is subtler and more sophisticated than these remarks first suggest. Understanding this view requires a more careful investigation of the distinction between essence and existence as it appears in medieval sources. Although one often speaks of the "traditional" distinction, the exact nature of the relation between essence and existence in finite things was the subject of a fierce debate among medieval philosophers. Seeing where Descartes' position fits within this debate will provide a deeper understanding of his version of the ontological argument.

The distinction between essence and existence can be traced back as far as Boethius in the fifth century. It was later developed by Islamic thinkers such as Avicenna. But the issue did not become a major philosophical problem until it was taken up by Aquinas in the thirteenth century. The issue arose not as part of an effort to establish God's existence on a priori grounds (as mentioned above, Aquinas was one of the staunchest critics of the ontological argument), but out of concern to distinguish God from finite spiritual entities such as angels. Like many scholastic philosophers, Aquinas believed that God is perfectly simple and that created beings, in contrast, have a composite character that accounts for their finitude and imperfection. In the case of purely spiritual or nonmaterial creatures, he attempted to locate this character in the composition of essence and existence.

Some of the details of Aquinas' account will emerge from our discussion below. The primary interest of his theory for our purposes, however, is that it led to a lively debate among his successors both as to how to interpret the master and about the true nature of the relation between essence and existence in created things. This debate produced three main positions:

• The Theory of Real Distinction
• The Intermediate Position
• The Theory of Rational Distinction

Proponents of the first view conceived the distinction between essence and existence as obtaining between two separate things. In the eyes of many Thomists, this view was considered to be quite radical, especially as an interpretation of Aquinas' original position. The latter is sometimes expressed by saying that essence and existence are "principles of being" rather than beings themselves. One problem with the theory of real distinction then was that it reified essence and existence, treating them as real beings in addition to the created entity that they compose.

The theory of real distinction was also considered objectionable for philosophical reasons. Following Aquinas, many participants in the debate urged that essence and existence are related to each other as potency and act, so that existence can be said to "actualize" essence. On the theory of real distinction, this view leads to an infinite regress. If an essence becomes actual only in virtue of something else — viz. existence — being superadded to it, then what gives existence its reality, and so on ad infinitum ? (Wippel, 1982, 393f).

In response to these difficulties some scholastic philosophers developed a position at the polar extreme from the theory of real distinction. This was the view that there is merely a rational distinction or a "distinction of reason" between essence and existence in created beings. As the term suggests, this theory held that essence and existence of a creature are identical in reality and distinguished only within our thought by means of reason. Needless to say, proponents of this theory were forced to distinguish purely spiritual entities from God on grounds other than real composition.

Giving up the doctrine of real composition seemed too much for another group of thinkers who were also critical of the theory of real distinction. This led to the development of a number of intermediate positions. One such position was that essence and existence are modally or formally distinct, such that existence constitutes a mode or property of a thing's essence.

Like Francisco Suárez, his most immediate scholastic predecessor, Descartes sides with the proponents of a rational distinction between essence and existence. His position is unique, however, insofar as it springs from a more general theory of "attributes". Articulating this theory in an important passage in the Principles of Philosophy , Descartes claims that there is merely a distinction of reason between a substance and any one of its attributes or between any two attributes of a single substance (1:62, AT 8A:30; CSM 1:214). For Descartes' purposes, the most significant instance of a rational distinction is that which obtains between a substance and its essence — or what he sometimes refers to as its "principal attribute" (1:53, AT 8A:25; CSM 1:210). Since thought and extension constitute the essence of mind and body, respectively, a mind is merely rationally distinct from its thinking and a body is merely rationally distinct from its extension (1:63, AT 8A:31; CSM 1:215). But Descartes insists that a rational distinction also obtains between any two attributes of a substance. Since existence qualifies as an attribute in this technical sense, the essence and existence of a substance are also distinct merely by reason (1:56, AT 8A:26; CSM 1:211). Descartes reaffirms this conclusion in a letter intended to elucidate his account of the relation between essence and existence:

[4]... existence, duration, size, number and all universals are not, it seems to me, modes in the strict sense ... . They are referred to by a broader term and called attributes ... because we do indeed understand the essence of a thing in one way when we consider it in abstraction from whether it exists or not, and in a different way when we consider it as existing; but the thing itself cannot be outside our thought without its existence ... . Accordingly I say that shape and other similar modes are strictly speaking modally distinct from the substance whose modes they are; but there is a lesser distinction between the other attributes ... . I call it a rational distinction ... . (To an unknown correspondent, AT 4:349; CSMK 3:280)

Indications are given here as to how a rational distinction is produced in our thought. Descartes explains that we regard a single thing in different abstract ways. Case in point, we can regard a thing as existing, or we can abstract from its existence and attend to its other aspects. In so doing, we have distinguished the existence of a substance from its essence within our thought. Like scholastic proponents of the theory of rational distinction, however, Descartes is keen to emphasize that this distinction is purely conceptual. Indeed, he goes on to explain that the essence and existence of a substance are "in no way distinct" outside thought (AT 4:350; CSMK 3:280). In reality they are identical.

While borrowing much from scholasticism, Descartes' account is distinguished by its scope of application. He extends the theory of rational distinction from created substances to God. In general, the essence and the existence of a substance are merely rationally distinct, and hence identical in reality.

This result appears to wreak havoc on Descartes' ontological argument. One of the most important objections to the argument is that if it were valid, one could proliferate such arguments for all sorts of things, including beings whose existence is merely contingent. By supposing that there is merely a rational distinction between essence and existence abroad in all things, Descartes seems to confirm this objection. In general, a substance is to be identified with its existence, whether it is God or a finite created thing.

The problem with this objection, in this instance, is that it assumes that Descartes locates the difference between God and creatures in the relation each of these things bears to its existence. This is not the case. In a few important passages, Descartes affirms that existence is contained in the clear and distinct idea of every single thing, but he also insists that there are different grades of existence:

[5] Existence is contained in the idea or concept of every single thing, since we cannot conceive of anything except as existing. Possible or contingent existence is contained in the concept of a limited thing, whereas necessary and perfect existence is contained in the concept of a supremely perfect being (Axiom 10, Second Replies; AT 7:166; CSM 2:117).

In light of this passage and others like it, we can refine the theory of rational distinction. What one should say, strictly speaking, is that God is merely rationally distinct from his necessary existence, while every finite created thing is merely rationally distinct from its possible or contingent existence. The distinction between possible or contingent existence on the one hand, and necessary existence on the other, allows Descartes to account for the theological difference between God and his creatures.

Now, when Descartes says that a substance (be it finite or infinite) is merely rationally distinct from its existence, he always means an actually existing substance. So how are we to understand the claim that a finite substance is merely rationally distinct from its possible existence? What is meant by "possible (or contingent) existence"? It is tempting to suppose that this term means non-actual existence. But as we saw already with the case of necessary existence, Descartes does not intend these terms in their logical or modal senses. If "necessary existence" means ontologically independent existence, then "possible existence" means something like dependent existence. After all, Descartes contrasts possible existence not with actual existence but with necessary existence in the traditional sense. This account is also suggested by the term "contingent." Created things are contingent in the sense that they depend for their existence on God, the sole independent being.

This result explains why Descartes believes that we cannot proliferate ontological arguments for created substances. It is not that the relation between essence and existence is any different in God than it is in finite things. In both cases there is merely a rational distinction. The difference is in the grade of existence that attaches to each. Whereas the concept of an independent being entails that such a being exists, the concept of a finite thing entails only that it has dependent existence.

Looking back at the problematic passage cited above from the Fifth Replies, it becomes clear that Descartes intended something along these lines even there. He says that "the existence of a triangle should not be compared with the existence of God", reinforcing the point that it is the kind of existence involved that makes God unique. And just before this statement, he writes, "in the case of God necessary existence...applies to him alone and forms a part of his essence as it does of no other thing". Later he adds: "I do not ... deny that possible existence is a perfection in the idea of a triangle, just as necessary existence is perfection in the idea of God" (AT 7:383; CSM 2:263). Descartes' final position then is that essence and existence are identical in all things. What distinguishes God from creatures is his grade of existence. We can produce an ontological argument for God, and not for finite substances, because the idea of a supremely perfect being uniquely contains necessary — or ontologically independent — existence.

Because of its simplicity, Descartes' version of the ontological argument is commonly thought to be cruder and more obviously fallacious than the one put forward by Anselm in the eleventh century. But when the complete apparatus of the Cartesian system is brought forth, the argument proves itself to be quite resilient, at least on its own terms. Indeed, Descartes' version is superior to his predecessor's insofar as it is grounded in a theory of innate ideas and the doctrine of clear and distinct perception. These two doctrines inoculate Descartes from the charge made against Anselm, for example, that the ontological argument attempts to define God into existence by arbitrarily building existence into the concept of a supremely perfect being. In the Third Meditation, the meditator discovers that her idea of God is not a fiction that she has conveniently invented but something native to the mind. As we shall see below, these two doctrines provide the resources for answering other objections as well.

Given our earlier discussion concerning the non-logical status of the ontological argument, it may seem surprising that Descartes would take objections to it seriously. He should be able to dismiss most objections in one neat trick by insisting on the non-logical nature of the demonstration. This is especially true of objection that the ontological argument begs the question. If God's existence is ultimately self-evident and known by a simple intuition of the mind, then there are no questions to be begged. Unfortunately, not all of the objections to the ontological argument can be dismissed so handily, for the simple reason that they do not all depend on the assumption that we are dealing with a formal proof.

Although it is often overlooked, many of the best known criticisms of the ontological argument were put to Descartes by official objectors to the Meditations . He in turn responded to these objections — sometimes in lengthy replies — though many contemporary readers have found his responses opaque and unsatisfying. We can better understand his replies and, in some cases, improve upon them by appealing to discussions from previous sections.

One classical objection to the ontological argument, which was first leveled by Gaunilo against Anselm's version of the proof, is that it makes an illicit logical leap from the mental world of concepts to the real world of things. The claim is that even if we were to concede that necessary existence is inseparable from the idea of God (in Kant's terms, even if necessary existence were analytic of the concept "God"), nothing follows from this about what does or does not exist in the actual world. Johannes Caterus, the author of the First Set of Objections to the Meditations , puts the point as follows:

[6] Even if it is granted that a supremely perfect being carries the implication of existence in virtue of its very title, it still does not follow that the existence in question is anything actual in the real world; all that follows is that the concept of existence is inseparably linked to the concept of a supreme being. So you cannot infer that the existence of God is anything actual unless you suppose that the supreme being actually exists; for then it will actually contain all perfections, including the perfection of real existence (AT 7:99; CSM 2:72).

To meet this challenge, Descartes must explain how he "bridges" the inferential gap between thought and reality. The principle of clear and distinct perception is intended to do just that. According to this principle, for which he argues in the Fourth Meditation, whatever one clearly and distinctly perceives or understands is true — true not just of ideas but of things in the real world represented by those ideas. Thus, Descartes' commitment to the principle of clear and distinct perception allows him to elude another objection that had haunted Anselm's version of the argument.

The previous objection is related to another difficulty raised by Caterus. In order to illustrate that the inference from the mental to the extra-mental commits a logical error, critics have observed that if such inferences were legitimate then we could proliferate ontological arguments for supremely perfect islands, existing lions, and all sorts of things which either do not exist or whose existence is contingent and thus should not follow a priori from their concept. The trick is simply to build existence into the concept. So while existence does not follow from the concept of lion per se , it does follow from the concept of an "existing lion."

Descartes' actual reply to this objection, which he took very seriously, is highly complex and couched in terms of a theory of "true and immutable natures." We can simplify matters by focusing on its key elements. One of his first moves is to introduce a point that we discussed earlier ( see passage [5] in section 2), namely that existence is contained in the idea of every thing that we clearly and distinctly perceive: possible (or dependent) existence is contained in our clear and distinct idea of every finite thing and necessary (or independent) existence is uniquely contained in the idea of God (AT 7:117; CSM 2:83). So for Descartes one does not have to build existence into the idea of something if that idea is clear and distinct; existence is already included in every clear and distinct idea. But it does not follow that the thing represented by such an idea actually exists, except in the case of God. We cannot produce ontological arguments for finite things for the simple reason that the clear and distinct ideas of them contain merely dependent existence. Actual existence is demanded only by the idea of God, which uniquely contains independent existence.

A natural rejoinder to this reply would be to ask about the idea of a lion having not possible but wholly necessary existence. If Descartes' method of reasoning were valid, it would seem to follow from this idea that such a creature exists. This formulation of the objection requires Descartes' second and deeper point, which is only hinted at in his official reply. This is that the idea of a lion — let alone the idea of a lion having necessary existence — is hopelessly obscure and confused. As Descartes says, the nature of a lion is "not transparently clear to us" (Axiom 10, Second Replies; AT 7:117; CSM 2:84). Since this idea is not clear and distinct, the method of demonstration employed in the ontological argument does not apply to it. Recall that the geometrical method of demonstration is grounded in the principle of clear and distinct perception and consists in drawing out the contents of our clear and distinct ideas. If an idea is not clear and distinct then we cannot draw any conclusions from it about things outside thought.

The key difference then between the idea of God on the one hand and the idea of a necessarily existing lion is that the former can be clearly and distinctly perceived. For Descartes, it is just a brute fact that certain ideas can be clearly and distinctly perceived and others cannot. Some critics have charged him with dogmatism in this regard. Why should Descartes be allowed to legislate the scope of our clear and distinct perceptions? Perhaps we can clearly and distinctly perceive something that he could not.

Descartes cannot be saved entirely from this charge, but two important points can be made in his defense. First, he has principled reasons for thinking that everyone has the same set of innate or clear and distinct ideas. When the meditator first proved God's existence in the Third Meditation, she also established that God is supremely good and hence no deceiver. One consequence of God's perfect benevolence is that he implanted the same set of innate ideas in all finite minds. Thus, Descartes feels justified in concluding that the limits of his capacity for clear and distinct perception will be shared by everyone.

Second, when responding to objections to the ontological argument such as the ones considered above, Descartes typically does more than insist dogmatically on a unique set of clear and distinct ideas. He also tries to dispel the confusion which he thinks is at the root of the objection. Since the ontological argument ultimately reduces to an axiom, the source of an objection according to Descartes' diagnosis is the failure of the objector to perceive this axiom clearly and distinctly. Thus, Descartes devotes the bulk of his efforts to trying to remove those philosophical prejudices which are hindering his objector from intuiting the axiom. These efforts are not always obvious, however. Descartes is good at maintaining the pretense of answering criticisms to a formal proof. But his replies to Caterus' objections to the ontological argument are best read as an extended effort to dispel prejudice and confusion, so as to enable his reader to intuit God's existence for himself.

Perhaps the most interesting objection to the ontological argument, and the one that has received the most attention since being formulated by Immanuel Kant, is that existence is not a property or predicate. This objection enjoys the status of a slogan known by every undergraduate philosophy major worth her salt. In claiming that existence is included in the idea of a supremely perfect being, along with all the other divine attributes, Descartes' version of the argument appears to succumb to this objection.

It is not obvious of course that existence is not a predicate. To convince us of this point, Kant observes that there is no intrinsic difference between the concept of a hundred real thalers (coins common in Kant's time) and the concept of a hundred possible thalers. Whenever we think of anything, we regard it as existing, even if the thing in question does not actually exist. Thus, existence does not add anything to the concept of a thing. What then is existence if not a predicate? Kant's answer is that existence is "merely the positing of a thing" or "the copula of a judgment," the point being that when we say "God exists" we are simply affirming that there is an object answering to the concept of God. We are not ascribing any new predicates to God, but merely judging that there is a subject, with all its predicates, in the world (CPR:B626-27).

Kant's formulation of the objection was later refined by Bertrand Russell in his famous theory of descriptions. He argues that existential statements such as "God exists" are misleading as to their logical form. While serving grammatically as a predicate, the term "exists" in this sentence has a much different logical function, which is revealed only by analysis. Properly analyzed, "God exists" means "there is one (and only one) x such that ‘x is omnipotent, omniscient, etc.’ is true." Russell thinks this translation shows that, appearances to the contrary, the statement "God exists" is not ascribing existence to a subject, but asserting that a certain description (in single quotes) applies to something in reality. Russell's view is reflected in the standard modern logical treatment of existence as a quantifier rather than a predicate.

It is widely believed that Descartes did not have a response to this objection, indeed that he blithely assumed that existence is a property without ever considering the matter carefully. But this is not the case. The seventeenth-century empiricist Pierre Gassendi confronted Descartes with this criticism in the Fifth Set of Objections (and probably deserves credit for being the first to enunciate it): "existence is not a perfection either in God or in anything else; it is that without which no perfections can be present" (AT 7:323; CSM 2:224). As with most of his replies to Gassendi (whom he regarded as a loathsome materialist and quibbler), Descartes responded somewhat curtly. But it is clear from the discussion in section 2 that he had the resources for addressing this objection in a systematic manner.

Before examining how Descartes might defend himself, it is important to note that the question at issue is typically framed in non-Cartesian terms and thus often misses its target. Both Kant and Russell for example are interested in the logical issue of whether existence is a predicate . Descartes, in contrast, was not a logician and disparaged the standard subject-predicate logic inherited from Aristotle. Although, as discussed above, he sometimes presents formal versions of the ontological arguments as heuristic devices, Descartes thought that God's existence is ultimately known through intuition. This intuitive process is psychological in character. It is not a matter of assigning predicates to subjects but of determining whether the idea of a supremely perfect being can be clearly and distinctly perceived while excluding necessary existence from it through a purely intellectual operation. To be sure, Descartes was interested in the ontological question of whether existence is a "property" of substances. For him, however, the analogues of properties are clear and distinct ideas and ways of regarding them, not predicates.

Having said that, Descartes' best strategy for answering the ontological version of the objection is to concede it, or at least certain aspects of it. Descartes explicitly affirms Kant's point that existence does not add anything to the idea of something (provided that the terms "idea" and "concept" are regarded as psychological items). Once again we should recall passage [4] from the Second Replies: "Existence is contained in the idea or concept of every single thing, since we cannot conceive of anything except as existing" (Axiom 10, AT 7:166; CSM 2:117). So Descartes agrees with Kant that there is no conceptual difference between conceiving a given substance as actually existing and conceiving it as merely possible. In the first instance one is attending to the existence that is contained on every clear and distinct idea, and in the other instance one is ignoring the thing's existence without actively excluding it. He would, however, stress another conceptual difference that Kant and other critics do not address, namely that between the two grades of existence — contingent and necessary. The clear and distinct ideas of all finite things contain merely contingent or dependent existence, whereas the clear and distinct idea of God uniquely contains necessary or wholly independent existence (ibid.). As discussed previously, the ontological argument hinges on this distinction.

Another intuition underlying the claim that existence is not a property is that there is more intimate connection between an individual and its existence than the traditional one between a substance and a property, especially if the property in question is conceived as something accidental. If existence were accidental, then a thing could be without its existence, which seems absurd. It seems no less absurd to say that existence is a property among other properties (accidental or essential), for how can a thing even have properties if it does not exist? Descartes shares this intuition. He does not think that existence is a property in the traditional sense or is even distinct from the substance that is said to bear it. Recall the view discussed in section 2 that there is merely a rational distinction between a substance and its existence, or between the essence and existence of a substance. This means that the distinction between a substance and its existence is confined to thought or reason. Human beings, in their efforts to understand things using their finite intellects, draw distinctions in thought that do not obtain in reality. In reality, a substance (whether it be created or divine) just is its existence.

The purpose of this defense of Descartes is not to render a verdict as whether he has the correct account of existence, but to show that he had a rather sophisticated and systematic treatment of what has been one of the great bugbears in the history of philosophy. He did not make the ad hoc assumption that existence is an attribute in order to serve the needs of the ontological argument. Indeed, on Descartes' view, existence is not a property in the traditional sense, nor can one conceive something without regarding it as existing. Descartes' critics might not be convinced by his account of existence, but then they have the burden of providing a better account. The focus of the debate will then be shifted to the question of who has the correct ontology, rather than whether the ontological argument per se is sound.

Primary Texts

• Adam, Charles, and Paul Tannery. 1964-1976. Oeuvres de Descartes , vols. I-XII, revised edition. Paris: J. Vrin/C.N.R.S. [references to this work (abbreviated as "AT") are by volume and page, separated by a colon.]
• Cottingham, John, Robert Stoothoff, Dugald Murdoch, and (for vol. 3) Anthony Kenny, eds. and trans. 1984. The Philosophical Writings of Descartes , vols. 1-3. Cambridge: Cambridge University Press. [All quotations are taken from this edition (abbreviated as "CSM"); any deviations from it are the author's own. References to this work are by volume and page, separated by a colon.]
• Kant, Immanuel. 1990. Critique of Pure Reason , trans. Norman Kemp Smith. London: Macmillan Education Ltd. [abbreviated as CPR]

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• Gueroult, Martial. 1984. Descartes's Philosophy Interpreted According to the Order of Reasons , vol. 1 . Trans. Roger Ariew. Minneapolis: University of Minnesota Press.
• Gueroult, Martial. 1955. Nouvelles réflexions sur la preuve ontologique de Descartes . Paris: J. Vrin.
• Hartshorne, Charles. 1965. Anselm's Discovery . LaSalle: Open Court.
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• Nolan, Lawrence. 1998. "Descartes' Theory of Universals," Philosophical Studies , 89/2-3: 161-180.
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Anselm, Saint [Anselm of Bec, Anselm of Canterbury] | Aquinas, Saint Thomas | Descartes, René: epistemology | Descartes, René: life and works | existence | -->Kant, Immanuel --> | ontological arguments | Russell, Bertrand

• Open access
• Published: 12 September 2024

From ontological to relational: A scoping review of conceptions of dignity invoked in deliberations on medically assisted death

• Isabelle Martineau 1 ,
• Naïma Hamrouni 1 &
• Johanne Hébert 2  

BMC Medical Ethics volume  25 , Article number:  96 ( 2024 ) Cite this article

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Dignity is omnipresent in Western ethics, but it also provokes dissension and controversy. One of the most striking examples is the debate on medically assisted death, where dignity is invoked to support antagonistic positions. While some authors conclude that the concept is useless as an ethical reference, many others invite us to deepen our analysis from a multidimensional perspective, to enrich it and make it useful. This scoping study is intended to provide an overview of the different conceptions of dignity used in the assisted dying debate, to better grasp the multiple facets of the concept.

The Joanna Briggs Institute's JBI Manual for Evidence Synthesis guided the scoping review. Key words were based on the researchers' expertise and were used to identify relevant literature in French and English. Eleven databases covering the last six decades were consulted. Initially, 2,071 references were found in the databases. After excluding duplicates, screening titles, abstracts, and full texts, and after a specific literature search on the concept of relational dignity, 156 papers were found to match the identified inclusion criteria.

The literature highlights the stark confrontation between two dominant conceptions of dignity: ontological and autonomist. However, a lesser-known conceptualization of dignity integrates these two perspectives, underlining the relational and social dimensions of dignity. As a result, dignity emerges as a dynamic, experiential, and dialogical concept, that modulates itself according to circumstances. This raises the possibility of breaking through the binary debate and questioning the current frameworks that define dignity.

Conclusions

This multidimensional conceptualization of dignity could lead to a more complete and nuanced understanding of the concept, as well as open richer normative horizons regarding the issue of medically assisted death.

Peer Review reports

There is no question that Western liberal societies place tremendous value on the concept of human dignity. Indeed, it is striking to note just how often dignity is brought up in everyday language, political and legal discourse [ 1 ], normative ethical arguments [ 2 , 3 ] and the principles underlying professional practices such as nursing [ 4 ]. Thus Rigaux [ 5 ] described a “contemporary explosion” or “overheating” of deliberations on dignity, as witnessed by the reams of related literature. This does not mean, however, that there is any consensus on the interpretation or meaning of dignity. In fact, the definition of dignity and its use are the subject of considerable controversy.

Of all the contemporary issues in the Western world involving the concept of dignity, surely, one of the most patent examples is the controversial issue of legalization and decriminalization of medically assisted death. Footnote 1 In the fierce debate on dignity [ 6 , 7 , 8 , 9 , 10 ], many authors point to the paradoxical use of the concept to support contradictory positions on the practices of euthanasia and assisted suicide [ 7 , 9 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 ]. This antilogy is certainly not without bearing on the position of the many authors who bemoan the multivocity, ambiguity, lack of clarity and “plasticity” of dignity and the lack of consensus regarding its content [ 3 , 4 , 7 , 8 , 26 , 27 , 28 , 29 , 30 , 31 , 32 ], or who go so far as to deem it outright meaningless [ 33 ]. Therefore, some even suggest eliminating references to dignity in all ethical and clinical reflections and adhering to concepts such as respect for autonomy or respect for the individual, which they find to be more effective guides [ 34 , 35 , 36 , 37 ], especially in regard to end-of-life issues, including medically assisted death [ 32 ].

However, these exhortations to ignore the concept of dignity have led to several arguments reasserting its relevance. While some authors point out or deplore the polysemy of the term ‘‘dignity’’ [ 5 , 38 ], for others, the many ways in which dignity has been conceptualized can be a source of fecundity, and an incentive to pursue discussion on the topic [ 1 , 39 ]. Although it is wishful thinking and inappropriate to seek an unequivocal definition of dignity [ 40 , 41 , 42 ], due to its complexity and even its ambiguity, we argue it is essential to explore and better understand its multiple facets and interpretations, and to study them more in depth so that dignity may ultimately prove a useful concept in normative ethics and bioethics [ 1 , 3 , 9 , 16 , 43 , 44 ].

This analysis of the term of dignity and its various uses is even more worthwhile in the specific context of euthanasia and medically assisted suicide, since it seems, according to some, to provide a language within which conflicting values and rights appear to cohabitate [ 1 ]. Moreover, since the concern for dying with dignity is unanimously espoused both by proponents and opponents of medically assisted death [ 11 , 13 , 15 , 39 , 42 , 45 ], if it is better conceptualized, dignity could become a “nodal point” [ 39 ], thus furthering ethical reflection on the issue. At least, this is what Muders [ 33 , 42 ] proposed when he urged us to enrich the concept of human dignity so that it could play a useful role in applied ethics, including in the specific case of medically assisted death. He writes:

although assisted death is still a prominent topic in bioethics, the relevance of human dignity for this debate has not yet found the adequate, multifaceted treatment it deserves, namely a treatment that assembles all important perspectives and positions, examines the arguments that may be enhanced by it, and enriches the yet undertheorized role it currently holds in this debate  ([ 42 ], p.3) .

This is the framework for this scoping review, which aims to explore the various conceptions and uses of the term of dignity in the debate surrounding medically assisted death. This method of analysis is particularly helpful in examining the scope of a complex subject based on vast quantities of heterogeneous literature [ 46 , 47 , 48 ]. It will also make it possible to map the key elements related to the concept [ 46 , 48 , 49 ], highlight potential avenues in future research to enrich ethical reflection, and perhaps even contribute to the treatment of the issues of dignity, medically assisted death, euthanasia, and medically assisted suicide.

Primary question

In the debate on medically assisted death in the past sixty years in North America, Europe, and Australia, what are the main conceptions of dignity, and which ones seem to open up new possibilities?

Subquestions

What are the conceptions on which the practice of medically assisted death is based?

What are the conceptions on which criticism of the practice is based?

Should some of these conceptions be revisited in an effort to enrich the debate?

Review method

A scoping review was conducted based on Joanna Briggs Institute’s 2020 version of the JBI Manual for Evidence Synthesis [ 47 ]. The manual is available at https://jbi-global-wiki.refined.site/space/MANUAL/4687342/Chapter+11%3A+Scoping+reviews .

Research strategy

First, one of the members of the research team, who assisted a committee of Quebec experts exploring the eligibility of incompetent patients for medically assisted death, identified the references relevant to the question of dignity. These documents served as a springboard for reflection. Then, keywords adapted to the specific characteristics of each database were identified with the help of a research librarian (see Table  1 ).

The team subsequently conducted systematic research in eleven databases, two specializing in philosophy, four in biomedical science and five in social sciences and the humanities (Philosopher’s Index, Religion & Philosophy Collection [RPC], CINAHL with Full Text [EBSCOhost], MEDLINE, Cochrane, PubMed, Sociological abstract, SocINDEX, Cairn, JSTOR and Érudit); two multidisciplinary databases [Repère and Scopus]; and two others including grey literature [Google Scholar and Santécom]. The literature review took place between September 2021 and April 2022 and was updated in March 2023.

The Boolean operators “OR” and “AND” were used for text searches in Abstract/Title/Keyword, crossing the following two concepts:

Concept 1: (dignit* OR dignified OR dignif* OR “perceived dignit*” OR “dignity loss” OR “loss of dignity” OR indignit*) AND (conception OR perception OR definition

Concept 2: (Euthanas* OR “right to die” OR “assisted suicide” OR “medical* assisted suicide” OR “medically assisted death” OR “hasten death” OR death OR dying OR “droit à la mort” OR “aide médicale à mourir” OR “suicide assisté”)

Research criteria

Since the goal was to determine the scope and construct a map of the conceptions of dignity related to medically assisted death, the inclusion criteria were intentionally broad. The literature had to (1) have been published since 1960, (2) be published in English or French, and (3) take one of the following forms: experimental, quasi-experimental, evaluation, observational or qualitative protocols; joint studies; philosophical analyses and reflections; trials; or grey literature. The target population was (1) adults and (2) those capable of consenting to assisted in dying. The exclusion criteria were as follows: (1) references published before 1960, (2) were published in a language other than English or French, and (3) were social media or mass media publications.

Selection of references

Initially, 2,071 references were in the databases (for an example, see Fig.  1 ). The reference management software EndNote was used and deleted 187 entries. Thus, 1,884 references were imported into Covidence for the purpose of screening the titles and abstracts. The software program deleted an additional 223 duplicate entries. The remaining 1,661 references were subsequently analyzed in parallel by two members of the research team. A third member made the final decision in the case of disagreement. Thus, with an interrater agreement of 81%, 1,327 references were rejected. Another 122 articles were deleted after discussion within the team. Of these, 110 made only marginal reference to assisted death. The other 12 references were either published in a language other than English or French, were unavailable or were proven to be duplicates. In the end, 212 references were exported to NVivo (R 1.6) for full screening (Fig.  2 ). A few book chapters (37) were also extracted and treated individually. Eighteen references (including 13 from a single collection) were imported on the recommendation of two external experts in the field of assisted death: an ethicist and a jurist. In a March 2023 update, 6 references were added. Finally, during the process, the research team noted what appeared to be the emergence of a literature on “relational dignity”. Although writings embracing a relational conception of dignity were still marginal, the team deemed it pertinent to perform a specific search on this concept, using the same databases. This additional search provided 3 more references. After a full analysis of the literature, 119 references were rejected because they did not meet the selection criteria. In the end, 156 references were codified using NVivo (R 1.6), which made it possible to answer the study’s primary question involving the identification of the different conceptions of dignity used in the debate on medically assisted death.

Example of search strategies

Flow diagram

To codify the references, the principal investigator iteratively developed a grid of typologies of dignity based on the initial readings and the selection of references by title/abstract. After approval by the other two members of the research team, the final version of the grid was adopted.

Charting the data

The majority (51%) of the references included (Additional file 1) were from North America: 51/156 from the United States, 26/156 from Canada, including from Quebec, and 2/156 from both countries. Approximately 41% (64/156) of the included documents were written by Europeans. Of these, 16/156 were from France, 13/156 from the United Kingdom, 7/156 from Germany, 6/156 from Belgium, 5/156 from the Netherlands, and 5/156 from Switzerland. In addition to the five references by Australian authors, two literature reviews were included although they were from Iran and Singapore since almost all of the included documents were written in the West. Additionally, although only 25 of the references were published before 2000, more than 60% (95/156) were published after 2010, testifying to the growing interest in the subject.

Apart from a few framework documents, such as reports of commissions or expert committees, almost all the literature analyzed (134/156, or 86%) comprised reflective or analytical works. Many of them were in the field of philosophy, ethics, or bioethics. Only 7/156 of the documents were scientific literature reviews, three of which were systematic reviews. In addition, six studies were identified, of which only two were specifically aimed at exploring conceptions of dignity from the point of view of people at the end of life [ 14 ] or the elderly [ 50 ]. This vast, heterogeneous collection of literature raises a variety of questions about the nature and function of dignity. For example, what is it that justifies the concept of human dignity? Should it be understood in absolute or in relative and subjective terms [ 27 ]? Can it be considered the basis for human rights [ 51 , 52 ]? More generally speaking, as McCrudden suggested [ 1 ], there are basically two levels in the debates surrounding dignity: the foundational level, or the grounding of the concept, and its ability to provide a guide for human action. By circumscribing the literature to what is relevant to assisted death, we can provide a general overview of the conceptions of dignity employed in discussions on the subject, starting with those whose use, whether to oppose or support euthanasia or assisted suicide, is easiest to define.

Conceptions of dignity that argue against assisted death

Dignity from an ontological perspective, different terms.

Without question, according to the terminology used by several authors, ontological dignity [ 25 , 27 , 30 , 38 , 41 , 51 , 53 , 54 , 55 , 56 , 57 ], that is, a dignity inherent to the human being qua human being, is the most common conception of dignity evoked in the literature on medically assisted death, essentially among those who oppose it. Footnote 2 Other terms are used in a similar fashion, including human dignity [ 4 , 11 , 16 , 19 , 22 , 28 , 38 , 44 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 ]; intrinsic dignity (sometimes referred to as “intrinsic human dignity”) [ 12 , 13 , 15 , 22 , 23 , 25 , 28 , 30 , 38 , 39 , 74 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 ]; inherent dignity [ 9 , 27 , 28 , 53 , 64 , 65 , 75 , 76 , 81 , 83 , 87 , 88 ]; basic or fundamental dignity [ 9 , 17 , 25 , 30 , 51 , 52 , 60 , 75 , 78 , 81 ]; absolute dignity [ 13 , 22 , 27 , 28 , 38 , 53 , 68 , 89 , 90 ]; universal dignity [ 13 , 27 , 28 , 52 , 60 ]; and, finally, objective dignity [ 13 , 15 , 22 , 25 , 51 , 89 , 91 ]. Although some of these terms are at times used differently (for example, human dignity, which is not always understood in the ontological sense Footnote 3 ), overall, the different formulations affirm the idea of unique value [ 92 ] and are recognized as applying to every human being, not because of what they “have” but because of what they “are” [ 20 ] “by virtue of their very existence” [ 53 , 54 ], in other words, unconditional human dignity [ 27 ].

This idea of the inherent dignity of every human being, “indissolubly attached” to the “human family” [ 27 ], has a long tradition [ 66 ]. It can be found as far back as in the writings of Cicero [ 80 , 93 , 94 , 95 ], who alluded to dignity in relation to human beings’ unique ability to learn and contemplate [ 3 ] as well as reason [ 94 ]. Seneca and, more broadly, the Stoic philosophers of ancient Greece, often associated human dignity with the possession of reason [ 74 , 80 ]. However, other groundings for ontological dignity have also been postulated. Specifically, from a religious, and especially Judeo-Christian viewpoint, the unique value of humans is predicated on the fact that they were created in God’s image ( Imago Dei ) [ 3 , 5 , 9 , 12 , 17 , 25 , 28 , 32 , 39 , 56 , 63 , 69 , 73 , 74 , 95 , 96 ]. Although dignity is not an exclusively religious concept [ 65 , 85 , 88 , 95 ], Christian thought, by combining the Stoic notion of rationality and the idea that human beings were created in God’s image, has made ontological dignity a key element of its theology and ethics [ 80 , 85 ] and led to its wide dissemination. It is therefore unsurprising to hear that critics say that dignity has too much of a religious connotation to guide ethical reflection [ 3 , 5 ]. Nevertheless, some authors point out that there are also secular foundations for intrinsic dignity in legal, political, and human rights related arguments [ 85 ]. Many authors mention the determining role of the Universal Declaration of Human Rights published in 1948, which contributed to the rather recent promotion of the concept of dignity, particularly in ethics, bioethics, and law [ 3 , 5 , 12 , 18 , 22 , 25 , 27 , 28 , 34 , 38 , 51 , 53 , 54 , 63 , 65 , 80 , 83 , 97 , 98 ]. At any rate, regardless of its foundation or justification, in ontological terms, dignity admits of neither degree nor relativity; for it is given at the same time as humanity, and refers to the latter's absolute value, its intangibility [ 97 ]. As it does not depend on the gaze of others, (ontological) dignity cannot be conferred or taken away by human decision because it is inalienable and unavailable [ 23 , 25 , 52 , 64 , 69 , 85 , 97 ]. No one can waive their dignity since no one has the power to exile themselves from humanity [ 97 ]. Similarly, no condition or situation can alter it or cause a person to lose it, whether through illness, old age, suffering or even imminent death [ 23 , 39 , 53 , 54 , 62 , 78 , 85 , 99 , 100 ]. Therein lies its connection to respect for human life.

Dignity and sanctity of human life

Ontological dignity applies not only to certain human attributes, such as reason but also, to the entire being, including the physical body. As such, human life has value, independent of any judgment [ 9 , 77 , 78 , 91 , 101 , 102 ], and that justifies its inviolability and respect [ 28 ]. This explains the often-postulated connection between dignity and the sanctity of human life [ 23 , 39 , 69 , 71 , 74 , 101 ]. Obviously, the sanctity of human life can be understood from a religious perspective, where life is considered a gift from God [ 35 , 63 , 99 ], which humans cannot simply manipulate as they please without it being an insult to the sanctity of life or a usurpation of divine authority [ 8 , 99 , 103 ]. This approach clearly leads to an argument against medically assisted death. However, like the concept of ontological dignity, to which it is related, the sanctity of human life is not strictly a religious or Christian idea [ 61 , 89 ]. Some interpretations go so far as to suggest that respect for it may include putting an end to life when it loses its meaning [ 89 ], but these are few and far between.

Conceptions of dignity that argue in favor of assisted death

Dignity from an autonomous perspective.

The second perspective on dignity, copiously used in the debate on medically assisted death, could be referred to as “dignity/autonomy,” as described by Landheer-Cieslak [ 79 ]. In our view, this term can be used as an umbrella notion covering several concepts, such as relative dignity [ 12 , 25 , 39 , 63 , 68 ], contingent dignity [ 39 , 63 , 74 ], subjective dignity [ 3 , 11 , 12 , 15 , 22 , 39 , 60 , 75 , 79 , 80 , 82 , 89 , 91 , 104 ], experienced dignity [ 25 , 80 ], phenomenological dignity  [ 25 ], personal dignity [ 4 , 9 , 11 , 17 , 20 , 22 , 52 , 57 , 58 , 60 , 68 , 73 , 76 , 88 , 105 , 106 , 107 , 108 , 109 ], individual dignity [ 76 , 87 , 110 ] and dignity as freedom [ 38 , 53 , 87 , 97 ] . Despite the nuances in the definitions of these various terms and in the way they are used, they share the same general meaning. More specifically, in arguments in favor of assisted death, these variants support the idea that it is exclusively up to the person concerned to define the conditions under which they can live and die with dignity [ 15 , 89 , 105 , 111 ]. Footnote 4 These are subjective forms of dignity based on an assessment by the person, who feels that they have dignity or that they are losing it [ 27 , 80 ]. In concrete terms, from this perspective, in the case of physical or mental deterioration as a result of a severe illness, for example, a person who deems that they are no longer living with dignity should be able to choose to die [ 24 , 67 , 89 , 93 , 112 , 113 , 114 , 115 , 116 ]. This choice is seen as ensuring dignity, both because it allows the person to escape from a life they deem void of dignity [ 117 ] and that impedes “authentic human freedom” [ 112 ], and because it embodies the exercise of free existential choice [ 115 , 117 , 118 ]. Here, dignity is clearly associated with freedom [ 89 , 117 ] in the sense of self-determination [ 119 ].

While it is possible to trace the concept of dignity as freedom all the way back to Pico della Mirandola (1463‒1494) [ 3 , 80 ], the concept of subjective dignity or dignity as autonomy is more modern [ 9 , 53 , 70 ]. Some authors associate it with Descartes [ 27 , 39 ], who advocated for autonomy and mastery [ 12 ] and who is thought to have inspired the postmodern idea of moral and political emancipation [ 27 ]. Others refer to Kant [ 3 , 70 , 101 , 116 ], although as we shall see below, the reading of Kant is open to disagreement. In any case, several authors embrace this perspective, according to which individual autonomy is the foundation of dignity or, at the very least, is closely related to it [ 90 , 104 , 111 , 112 , 120 , 121 , 122 , 123 , 124 ]. In fact, in Western society and from a more global perspective, the terms “autonomy” and “dignity” are so often used together [ 20 , 29 , 35 , 57 , 67 ], or even combined, that they are sometimes considered synonyms [ 11 , 34 ]. According to some authors, the Anglo-Saxon philosophical, political, legal, and bioethical traditions are undoubtedly responsible for the importance of individual autonomy in this conceptualization of dignity [ 10 , 57 , 119 , 125 ].

Dignity, integrity, and identity

From the perspective of dignity as autonomy, a particularly influential conception is that grounded in respecting a person’s integrity and identity. This vision is part of a narrative or biographical approach to dignity [ 65 , 116 , 126 ], and its most well-known version was described by the American liberal philosopher and jurist Ronald Dworkin in the early 1990s [ 96 ]. According to this approach, human life, from beginning to end, revolves around critical interests. These interests give life coherence and shape, and ensure the person’s integrity, thereby preserving their identity [ 127 ]. Respect for human dignity is based on respect for these critical interests. From the narrative perspective, death is seen as the final chapter in a person’s life [ 128 ] or as the final act of existence, and, since everything is intensified at that point in time, the manner of death can affect the overall character of the person’s life [ 116 , 126 , 127 ]. In other words, when the circumstances of a person’s death go against their convictions regarding their critical interests, it is like a story, says Dworkin, “whose bad ending mars what went before” ([ 127 ], p. 27). As a result, to maintain the integrity and coherence of their life, to show consideration of the values that provide coherence and are at the very core of their self-identity, a person may choose to die and avoid ending their life in a manner that, in their opinion, would betray or be inconsistent with the pursuit of their critical interests [ 127 ]. This person is making sure they die with dignity, since their death will be in line [ 70 ] with the values they have always lived by [ 128 ] and will preserve the integrity of their life until the day they die [ 96 ].

The abovementioned approach contributes to the argument in favor of legalizing medically assisted death for those who ask for it [ 109 , 116 , 128 ] and, as such, it supports the argument made by certain advocacy organizations [ 11 , 45 , 129 ]. Moreover, various official documents granting access to medically assisted death in Quebec, Canada and elsewhere, including reports from advisory boards and other experts, judgments, and legal analyses, are directly or indirectly partly based on Dworkinian theory. In brief, they take up the idea that, to preserve dignity, it is up to the person approaching death to determine what aligns with the aspirations and values (religious or secular, philosophical, etc.) that have guided them up to now and to be able to make their choices accordingly. Footnote 5 Some of the documents go so far as to talk about the right to die [ 12 , 13 , 20 , 32 , 35 , 51 , 67 , 76 , 107 , 130 , 131 , 132 , 133 , 134 ].

The Kantian conception of dignity: Conflicting interpretations and impasse

The Kantian conception is another conception of dignity that cannot be overlooked in the debate on medically assisted death, although it is not without its detractors. It is most often invoked by those who oppose medically assisted death and who ground their opposition in a ontological conception of dignity. For these authors, the fact that Kant’s view is that human beings have absolute value, above all price [ 12 , 18 , 88 , 97 ], which requires that they be treated as an “end in themself,” conforms to this vision of dignity [ 5 , 12 , 22 , 27 , 39 , 54 , 66 , 72 , 74 , 78 , 80 , 84 , 96 , 100 ]. Moreover, although the Kantian view of dignity was not initially religious, theologians, especially Catholics, but also other Christians, integrated it into their doctrine [ 85 ] and into their argument against euthanasia and assisted suicide. Several authors cite Kant’s categorical opposition to suicide [ 5 , 12 , 31 , 41 , 66 , 78 , 95 , 96 , 135 , 136 , 137 ]. By extension, several of them conclude that the Kantian perspective opposes assisted death [ 32 , 41 , 78 ].

However, this widespread interpretation is on the other hand criticized by others [ 70 , 121 , 135 , 136 , 137 , 138 , 139 , 140 ], especially by those who emphasize the importance, in the Kantian view, of rationality, moral autonomy or agency, and personal autonomy Footnote 6 ), as the foundations of dignity [ 3 , 70 , 101 , 116 , 119 , 121 , 125 , 135 , 141 ]. Some of these authors point out that the opportunity to autonomously choose to hasten one’s death to “die in dignity” is consistent with respecting a person’s moral agency and status as a rational being [ 116 , 121 , 140 ]. According to these authors, this is especially true since the end-of-life process, prior to natural death, can alter the rationality (practice) and moral agency upon which, in this view, dignity is based [ 58 , 116 , 119 ]. Some authors go even further, postulating that prohibiting medically assisted death could even run counter to Kantian thought. Footnote 7 For example, according to Lossignol and Dumitrescu [ 68 ], refusing someone the right to die as they wish under the pretext of respecting their dignity (in the ontological sense) is manipulative. In their view, this amounts to using the person as a means to an end decided by others who oppose assisted death (e.g. caregivers), which also conflicts with the Kantian principle of non-instrumentalization.

Given these divergent and deeply conflicting interpretations of the Kantian perspective, when it comes to debating the issue of medically assisted death and the role dignity plays in it, some analysts conclude that the concept is ambiguous [ 74 ] and of no use in furthering reflection. In its report End-of-Life Decision Making , the Royal Society of Canada Expert Panel states that “the influential Kantian approach to ethics does not provide an unequivocal ethical guidance and justification on the issue of assisted dying” [ 32 ], suggesting that the divide between the different Kantian interpretations can only lead to an impasse on the subject.

Minority views on dignity and their ambiguous role in medically assisted death

In addition to the conceptions previously discussed, the literature addresses a few other, lesser-known views of dignity. One of them can be termed dignity as a virtue or flourishing dignity , based on the Aristotelian tradition, and essentially refers to dignified conduct or a dignified nature, admirable for its virtue [ 20 , 38 , 52 , 70 , 74 , 77 , 78 , 84 , 85 , 86 , 88 , 96 , 126 , 136 ]. There is also dignity as status or attributed dignity , which is based on the value conferred on a person by others according to a certain scale [ 52 , 78 , 85 , 86 , 99 , 135 ]. Many authors also cite the etymological meaning of the Latin word dignus and the Roman concept of dignitas , which essentially refers to a recognized value, deserving of honor, respect, or esteem [ 3 , 5 , 10 , 12 , 51 , 58 , 70 , 72 , 86 , 101 , 113 , 135 ].

These conceptions, like some of those found sparingly in the literature (e.g., dignity as decency [ 38 , 53 , 54 , 97 ] and esthetic decency [ 9 ], etc.), do not play a clearly defined role in the debate on medically assisted death. In a way similar to Kantian’s interpretations of dignity, because of divergent readings of his philosophy, these conceptions (of dignity as virtue, as status or decency) can be used to argue against or in favor of the practice. In addition, many of these definitions of dignity overlap, which makes it difficult, if not impossible, to provide a clear and exhaustive overview of the different terms. For example, Van Brussel [ 74 ] used external dignity to cover everything to do with a person’s conduct (dignity as a virtue ), social status ( attributed dignity ) and self-identify ( narrative dignity ), although the latter appears to be somehow better described as internal than external. Given all of this, it is easy to understand why some authors believe that the concept of dignity is too “vague” [ 16 ] and not of much use in regard to ethical reflection.

Relational dignity: a relatively unexplored conception

Although it remains relatively marginal, another conception of dignity articulated in discussions on medically assisted death is that of “relational dignity”. In fact, many authors, including those who endorse the dominant conceptions of dignity, already mention the influence of relational or social elements in the experience of dignity, even if they do not make these elements central to their definition of the concept [ 3 , 19 , 24 , 25 , 39 , 53 , 54 , 57 , 61 , 65 , 77 , 78 , 90 , 92 , 93 , 104 , 109 , 114 , 121 , 122 , 124 , 126 , 128 , 142 , 143 , 144 , 145 ]. For example, some address the impact of other people's perceptions (particularly those of family and friends) on a person’s sense of dignity, especially when the person is ill and dependent [ 10 , 19 , 21 , 25 , 73 , 82 , 83 , 95 ]. Others evoke the inexorable interdependence of human beings, sometimes criticizing the contemporary social tendency to value personal autonomy (in the sense of independence) and individualism [ 20 , 44 , 57 , 62 , 75 , 88 , 92 , 108 , 146 , 147 ] or self-sufficiency [ 71 , 73 ]. Regarding this social or collective point of view, several authors mention how the prevailing culture, societal values or the state and its laws tend (or have the power) to shape the way dignity is conceived in the context of end-of-life choices, and medically assisted death [ 8 , 9 , 10 , 13 , 16 , 25 , 26 , 28 , 50 , 69 , 71 , 73 , 76 , 82 , 92 , 95 , 106 , 124 , 125 , 126 , 141 , 148 , 149 , 150 , 151 , 152 , 153 , 154 ]. Authors of religious persuasion, such as Daly [ 16 ], Schirrmacher [ 71 ] and Engelhardt [ 106 ], are particularly critical in this respect. Others note the influence of messages conveyed by the media about end-of-life choices [ 74 , 142 ].

In terms of research on the desire to hasten death, a few studies have been conducted among sick patients and seniors [ 14 , 50 , 75 , 155 ], as well as some conceptual and discursive analyses [ 4 , 10 ] and various literature reviews [ 30 , 57 , 108 , 156 ]. They empirically confirm the importance of the relational dimension in the way people come to experience a sense of dignity or, conversely, the loss of a sense of their own dignity. For example, the fear of dependence and having to be reliant on others [ 155 ] or of being seen as a burden, both by loved ones and by society at large, tends to undermine the sense of dignity of sick patients, the elderly and people approaching the end of life, and to affect their perception of their identity [ 50 , 57 , 75 ]. Apprehension of losing one’s dignity could be experienced through encounters with others and, therefore, the experience of dignity is no longer merely a personal issue, but an intersubjective issue [ 83 ] as well as a social and structural one. However, few authors explicitly discuss the conception of relational dignity [ 3 , 10 , 28 , 50 , 56 , 80 , 110 ]. Moreover, among those who do, there seems a lack of conceptual and theoretical normative underpinnings. Care ethicist Carlo Leget [ 80 ] appears to be an exception to the rule, advancing a relational conception of dignity (he uses the term “social/relational dignity"), his perspective being based on the research of psychiatrist and expert in palliative care Harvey Chochinov [ 14 ], philosopher Paul Ricoeur’s “little ethics,” and the ethics of care . This conception of dignity is notable in that it places the relational dimension at its heart, while at the same time connecting it to the conceptions of dignity usually encountered in the debate on assisted dying.

Groundings and possible connections with subjective and ontological dignity

Like some care ethicists, including Berenice Fisher and Joan Tronto, Leget [ 80 ] emphasizes how a person’s moral conceptions are defined based on the social practices in their surroundings. Thus, the understanding of dignity a person acquires and, by extension, the view they have of their own dignity will be vastly different if they are raised in a culture that values intrinsic dignity or in one that considers it a metaphysical aberration [ 80 ]. Based on Ricoeur’s work, Leget argues that self-respect and one’s perception of one’s own dignity, which go hand in hand with a “good life,” depend heavily on the recognition of others. They are therefore closely linked to attitudes of respect and care, which ensure the cohesion of communities and make personal fulfillment possible. Thus, for Leget [ 80 ], social/relational dignity “genealogically” and “systematically” generates subjective dignity , since the former, through manifestations of recognition, is the basis for the latter. This dynamic can be seen not only in communities but also at the heart of interpersonal relationships. This was clearly demonstrated by the research that led to Chochinov’s dignity therapy , a palliative intervention that helps heighten the sense of dignity of patients near the end of life. According to Leget [ 80 ], ontological or intrinsic dignity serves as a “counterfactual” moral landmark in the cultural landscape, thereby helping create or consolidate institutions that ensure a certain amount of stability and continuity in communities. Leget’s perspective [ 80 ], in which relational dignity is part of a tripartite model along with the subjective and intrinsic conceptions of dignity, does not appear, however, to have made its way into the literature on medically assisted death. In contrast, as this review has shown so far, the literature reveals a persistent gap between the two main conceptions of dignity involved in the discussion.

Dignity and assisted death: a persistent debate between two conceptions

Counterarguments.

Different conceptions of dignity have evolved outside the two main perspectives (ontological dignity and dignity as autonomy) solicited in the dialog on medically assisted death. However, the literature review shows not only how dominant these two perspectives are, but also how much they tend to be used on opposite sides of the debate. In this sense, the concept of dignity appears to stall more than advance the dialog between proponents and opponents of medically assisted death. Burnier [ 157 ] laments the “duologue,” the dichotomous thinking that dismisses the other party’s perspective, tending to evacuate the polysemy of the concept. It is true that the counterarguments on both sides of the debate are often rather mordant.

On the one hand, opponents and critics of euthanasia and assisted suicide condemn several aspects of the conception of dignity as autonomy. In general, they criticize the promotion of individualism [ 145 , 146 ], akin to subjectivism [ 27 , 77 , 102 ], which rejects the interdependence inherent to the human condition [ 6 , 28 , 39 , 62 , 65 , 92 , 136 , 147 , 158 ]; undermines the general sense of the social and community life [ 19 , 38 , 97 , 143 ]; and, in the case of people in a position of dependence, can contribute to intensifying the feeling of being a burden [ 11 , 13 , 19 , 50 , 71 , 73 , 105 , 124 , 148 , 158 , 159 ]. More specifically, and perhaps as a criticism of the narrative conception of dignity, they condemn the idea of a dualistic anthropology that seems to give priority to the life of the mind, notably by prioritizing self-determination, the exercise of personal autonomy and freedom, and by depreciating mere biological human life, limited to an instrumental role [ 53 , 54 , 77 , 78 , 88 ] . In their view, the Dworkinian notions of identity and integrity are based on an illusion, that of human independence and absolute, limitless control over one’s own life [ 44 , 65 , 69 , 73 , 92 , 158 ]. They find it even more incongruous in the socioeconomic context in which, for years, the range of options has constantly been reduced due to resources scarcity and utilitarian-guided governmental cuts in health care [ 57 , 160 ], which have a more significant impact on those on the margins of society, whose needs are the greatest [ 11 , 149 , 150 ].

Additionally, many critics point to what they consider to be a fundamental contradiction. While respect for autonomy and dignity is the main argument used to support the right to medically assisted death in the case of a person who is suffering, these critics believe that some of the mechanisms for regulating the practice not only contradict this principle, but also promote discrimination. For example, in countries that sanction medically assisted death, access to the practice requires that a third person (often a physician) certifies that the person meets the MAID eligibility criteria. As a result, the evaluation of the life and dignity of the person who is requesting to die becomes a shared responsibility. Some authors interpret this as a sort of “heteroevaluation” or “heterodetermination” that goes against respect for a person’s autonomy and calls into question the purported neutrality of the third-party evaluator. In their view, the latter's involvement contributes to categorizing, or at least confirming, certain lives as unworthy [ 6 , 28 , 38 , 77 , 78 , 82 , 91 , 92 , 124 , 151 ]. Moreover, in the case of adults capable of exercising autonomy, these authors question the implementation of criteria (e.g., suffering or terminal illness) restricting access to assisted death [ 39 ] because, in addition to seeming discriminatory [ 78 ], these criteria appear to encourage a substantial evaluation (by a third party) of the person’s reasons for wanting to die [ 134 ]. Some critics also point out that, ironically, the procedures for obtaining approval for medically assisted death and the intervention itself (especially in the case of euthanasia) give physicians undue power and contribute to the medicalization of death [ 57 , 131 ]. Whereas the initial objective, as many proponents of medically assisted death point out, was to support the autonomy (or the dignity as autonomy) of persons approaching the end of life by promoting freedom from medical power and futile medical care [ 13 , 39 , 69 , 77 , 112 , 122 , 132 , 133 , 150 ].

On the other hand, many supporters of medically assisted death strongly criticize the conception of ontological dignity and the role it plays in the debate. To them, the idea of “everlasting” dignity appears to contradict, or reject, the experience of people nearing the end of life, while the sense or fear of losing their dignity is one of the main reasons why people request medically assisted death [ 4 , 14 , 24 , 59 , 94 , 136 , 144 , 155 , 161 , 162 , 163 , 164 ]. The seriously ill, for whom dignity is an invaluable possession, experience that sense or fear very keenly [ 10 , 11 , 14 , 24 , 27 , 83 ]. The conditions frequently identified by authors as potential threats to a sense of dignity include physical and mental decline and, more broadly, suffering [ 13 , 20 , 39 , 94 , 112 , 115 , 117 , 132 , 136 , 164 ]. In particular, situations in which a human being is so dependent that they are incapable of expressing and carrying out their wishes or making key choices, according to their conceptions and personal values, and are therefore subject to heteronomy [ 79 ], are often described as unbearable, undignified, subhuman and “worse than death” [ 13 , 21 , 67 , 111 , 112 , 116 , 118 , 122 , 123 , 132 , 147 , 159 , 161 , 164 ]. On the other hand, elements such as decision-making ability, self-determination [ 12 , 30 , 113 ] and physical control [ 30 , 35 ], especially when it comes to basic human needs (e.g., elimination), are crucial for materially preserving a person’s view of themself and their sense of dignity [ 10 , 30 , 73 ]. Considering these concrete and physical realities, which demand compassion, ontological dignity may be too abstract a concept, real only in an intellectual sense, and somewhat disconnected from these experiences [ 11 , 27 , 80 , 94 ].

Another criticism of ontological dignity is that it is too strongly affiliated with religious metaphysics [ 3 , 20 , 32 , 35 ], especially because of its relationship with the principle of the sanctity of human life [ 90 ]. Consequently, some authors associate it with perfectionist and paternalistic aims [ 39 , 51 , 103 , 104 , 112 , 120 ], or with the imposition of moral norms removed from what they see as actual human experience [ 68 ]. For the critics of ontological dignity, this perspective is irreconcilable with the political liberalism of pluralistic and democratic occidental societies [ 35 , 76 , 82 ] where the emphasis is placed on personal autonomy and morality [ 19 , 112 , 119 , 120 , 134 ]. It is up to the individual alone, not society or the state Footnote 8 to determine their own vision of a good life [ 132 ]. From this perspective, the ontological conception of dignity should give way to a subjective conception of dignity, a conception based on what patients themselves have to say about the matter [ 68 , 104 ].

The gap between the main conceptions of dignity

In recent years, in more and more places, the century-old ban on assisted death based on the sanctity of human life and intrinsic dignity has been giving way to a more liberal approach to medically assisted death Under this view, as we saw previously, where dignity is reconceptualised in such a way as to support freedom of choice and respect for moral and personal autonomy [ 13 , 27 , 74 , 87 , 119 , 120 , 130 , 132 ]. This trend is apparent in Anglo-Saxon countries, including the United States, England, Australia, and Canada [ 32 , 76 , 87 , 123 , 165 ], as well as in countries such as Germany [ 134 ], France [ 38 ], Spain [ 120 ] and Belgium [ 112 ]. This evolving situation brings the public debate on euthanasia and assisted suicide back to the fore. In this context, some authors note that proponents and opponents are still confronting each other, as the “combat” or “controversy” continues [ 12 , 21 , 38 , 157 , 166 ], and each side is trying to delegitimize the other’s arguments, including its different interpretation of the concept of dignity. These seemingly irreconcilable views prompt some authors to conclude that the concept has been instrumentalized to support the ideological goals of both sides [ 18 , 80 , 137 ]. Some authors bemoan the impasse in a debate where both sides are rigid and immovable [ 17 ], and some believe that dignity is being employed like an empty slogan [ 12 , 21 , 25 , 28 , 34 , 39 , 84 , 91 , 143 , 146 ] or a rhetorical element used as a conversation stopper [ 55 , 65 , 95 , 138 , 140 ].

In this context, following his analysis of the Consultative Commission discussions that preceded the legalization of medical aid in dying in Quebec, Burnier [ 12 ] urges us to move beyond such binary and polarized discourse. Many others agree [ 17 , 33 ]. This is even more important since the two main perspectives in the debate could each have moral legitimacy [ 109 ] and be incorporated into a single theory of dignity [ 33 ].

Dominant views on dignity and the desire to overcome the impasse

This scoping review is limited to the literature on dignity in the context of medically assisted death. Most of the texts reviewed are philosophical, reflective and argumentative. Many of them refer to the underlying conceptions of dignity that support the two principal stances on medically assisted death (for and against), and often provide justification for one or the other. As previously discussed, the two predominant conceptions of dignity (dignity as autonomy and ontological dignity) are different but important angles from which to shed light on the issue of medically assisted death [ 108 ]. But, as we have just seen, they tend to be placed in opposition to each other, which ultimately leads the debate into an impasse. The question is: what strategies can be employed to move beyond this binary discourse?

Claiming the relational dimension of dignity

To begin with, in order to distance ourselves from the fragmented perspectives on dignity, as some authors suggest, it might be useful to identify the elements that unify the various approaches to the concept of dignity [ 80 ]. On closer examination, our review of the different conceptions of dignity almost systematically highlights the principle of respect as a fundamental element. In the literature reviewed, this principle takes two forms: self-respect and respect from others [ 73 , 93 , 95 ]. Self-respect refers to the positive perception we have of ourselves, which also sustains self-esteem or even fuels pride [ 14 , 101 , 113 ]. It is therefore associated with subjective dignity or dignity as autonomy [ 39 , 75 , 80 , 93 , 113 ]. Respect from others concerns the way in which others, society as a whole or institutions perceive and treat people [ 93 ].

Respect from others is all the more important because, according to some, it is an essential condition for maintaining self-respect [ 116 ]. To illustrate, in the early stages of human development, self-respect or a sense of subjective dignity is initially reflected by the image mirrored by one’s parents. Subsequently this self-respect must be continually nurtured through interpersonal relationships throughout one’s life [ 10 ]. In fact, reciprocal recognition (i.e., seeing oneself in others) is fundamental to establishing any relationship, and underpins personal and social self-determination [ 61 , 95 ]. Indeed, some argue that this mutual recognition is essential not only for defining oneself, but also for shaping one's social world [ 61 ]. In ethical terms, this mutual recognition can contribute to self-respect by opening up an intersubjective space of shared validation, where individuals can assess their conduct and perceive themselves in an honorable light through the eyes of others [ 95 ]. We believe that this process, where self-respect is developed and the individual defined through a dialogical dynamic between “self and other,” holds very great promise for understanding and appreciating the inherently relational dimension of dignity.

Respect (both self-respect and respect from others), and its relationality, plays a fundamental role in various conceptions of dignity. Recognizing this commonality can serve as an initial step for building bridges between approaches to dignity seen as fundamentally opposed. Nevertheless, the relational conception of dignity is still insufficiently explored and would warrant greater attention in future discussions.

A multidimensional view of dignity worth exploring

The multidimensional perspective on dignity articulated by Leget stands out in our review as particularly interesting. This approach aims to integrate the concerns of both traditional conceptions of dignity (both subjective/autonomist and ontological) and, drawing on Ricoeur’s work [ 167 ], emphasizes the “social and relational” dimension of dignity, a focus recently highlighted by care ethicists and feminist philosophers. In fact, Leget, building on Ricoeurian and relational care ethics, proposes a multidimensional conception of dignity not to challenge traditional views or resolve debates but rather aims to provide a possible way out of the ongoing conflict between them and to circumvent the impasse. While this scoping review does not claim that this approach is the key to the debate (which would require further philosophical and argumentative study to verify), it appears worthy of further exploration for three reasons.

The first idea worth considering about this multidimensional conception of dignity is its overlap with the concerns of ethical and feminist philosophers. Indeed, since the late 1990s, ethical and feminist philosophers have highlighted the deeply relational dimension of human life. And they have emphasized the (potentially oppressive) socio-cultural contexts within which individual preferences and choices are formed, shaped, directed, exercised, or constrained. In recent decades, several feminist philosophers have also emphasized the central role that “others” play in identity formation and self-perception. Namely, we can think of philosopher Margaret Urban Walker [ 168 ], who is rethinking the notion of dignity by advocating for a conception she describes as “humanized,” which is to be understood in a “fully relational” sense. She argues that an adequate understanding of dignity should not be limited to recognizing attributes of agency and rationality in human subjects (i.e., confined to seeing human dignity solely as the full and free exercise of rational attributes). In fact, for her, dignity should also consider “The relations and responses […] that join us in what human beings recognize as particularly modes of connection […] in and through which we learn responses, responsibilities, and feelings that embody appropriate acknowledgments” ([ 168 ], p. 177). That is why she suggests that dignity is an “interpersonally effective standing” ([ 168 ], p. 179). Just as Leget talks about dignity as an “intersubjective category,” it seems inconceivable to Walker to conceptualize it independently of its deeply relational dimension.

The second idea worth considering concerning Leget’s multidimensional conception of dignity is its “synergistic” quality. Indeed, for Leget, dignity should be conceived as the product of a synergy between three fundamental dimensions: (1) the subjective dimension, (2) the intrinsic dimension, and (3) the social/relational dimension of dignity. Although each of these dimensions has its own gaps and limitations when considered in isolation, conceiving them as interconnected and synergistic would, in his view, mitigate their specific weaknesses and provide a more precise and complete understanding of dignity.

The third significant aspect of Leget’s multidimensional conception of dignity is its recognition of the dynamic and fluid nature of dignity. This intuition, often overlooked by traditional conceptions of dignity, is supported by empirical studies. Indeed, some authors working on medically assisted death show that the sense of one’s own dignity is dynamic, unstable, and vulnerable. It evolves over time and varies according to individual and collective contexts. For example, in their analysis of qualitative studies, Rodríguez-Prat and Leeuwen [ 57 ] observed that the feeling of dignity among people who wish to hasten their death is influenced by several factors, including social (or relational), as well as physical, psychological, and spiritual factors, which in turn are further shaped by the experience of severe illness. At the societal level, the ontological or intrinsic notion of dignity, typically regarded as stable and a moral benchmark [ 9 ], is also described by Leget [ 80 ] as dynamic and unstable. He argues that dignity is vulnerable, and subject to being undermined or contested (he precises that conceptions of intrinsic dignity "are as vulnerable as their authority or plausibility is" ([ 80 ], p. 949).

Arguing that “[c]oncepts like dignity are powerful tools to organize the world we live in” ([ 80 ], p. 950), Leget analyzes what he calls “dying with dignity” through the lens of care ethics, applying his multidimensional conception of dignity in practice. He concludes that “dying with dignity should refer to a situation in which both the dying person is supported in his or her self-esteem and those surrounding the dying person act out of solicitude upholding an attitude of respect ” ([ 80 ], p. 952), our emphasis). Dignity, which is not conceived outside the intersubjective space, is “constituted and upheld by people who are interrelated in caring relationships” ([ 80 ], p. 952). Again, Leget aligns with Walker [ 168 ], for whom dignity, as an ideal of human interaction, recognition, and concern, has “a normative power.” We find these ideas particularly compelling when considering medically assisted death, as they suggest that the phenomenon extends well beyond individual choices [ 149 ] and also engages ethical considerations that clearly impact society as a whole.

Social issues to be clarified in relation to the ordinary concept of dignity

From a societal perspective, enhancing our comprehension of dignity in the context of medically assisted death is crucial, given its omnipresence in the public space and discussions, debates, and media coverage [ 74 , 142 ]. Among other things, the ordinary concept of dignity and common discourses on dignity—specifically the ones surrounding dying with dignity —makes dignity a tool for constructing ways of thinking and acting [ 10 ]. However, similar to other practical language tools, the term "dignity" can be misleading, or even be harmful if it is used in a way that has a negative effect on specific categories of already oppressed or marginalized people [ 80 ].

In this context, some studies highlight several issues affecting severely ill or elderly people: the stigma and exclusion they experience their apprehension of becoming a burden or losing control over their lives, the belief that such a life is not worth living, and the link between these factors and the desire to hasten death [ 30 , 57 , 75 , 155 ]. Such studies point to unresolved questions and underscore the need for further research at the theoretical, argumentative, and empirical level. How significantly do prevailing views on the nature of dignity at the end of life shape the self-perceptions of gravely ill individuals and influence their consideration of assisted dying? Is it possible that these people have internalized negative stereotypes that portray dependency, vulnerability, and old age as undignified states of being [ 75 ]? Does the prevalent conception of dignity, when closely associated with control, inevitably result in choosing to hasten death [ 10 , 169 ]? Does this preclude the possibility of considering other perspectives and making different choices? Could it be that the high value Western societies place on autonomy, independence and self-sufficiency actually undermines those who are no longer autonomous, stripping them of their identity [ 14 ] and, consequently, of their dignity? Such questions deserve further research and debate.

Recommendations

Like some authors, we postulate the importance of identifying and examining the ideas, frameworks and influences that, in our societies, define the contours of dignity and associated concepts such as dependence and vulnerability [ 75 , 92 , 170 ]. We could achieve this by exploring the understanding of dignity held by those who are considering medically assisted death, while also highlighting the prevalent ideas and discourses in the collective space. In this respect, Leget’s [ 80 ] multifaceted conception seems to us an interesting tool to explore. Especially since this approach doesn't seem to have been really taken up yet. First and foremost, this exercise would help us better understand the subtleties of the construction, experience and understanding of dignity, allowing us to break away from what some authors condemn as the dominance of narrow and uniform discourse on what constitutes a “good death” [ 169 ]. Second, the analysis would fuel and elevate the discussion on medically assisted death above the current binary discourse and disembodied theoretical debate. This approach is even more relevant since medically assisted death is still one of the most socially and politically controversial issues in North America and Europe [ 39 ]. Additionally, considering the small number of empirical studies identified in this Scoping Review, there seems to be a need for more empirical data about conceptions of dignity as embraced by individuals themselves, irrespective of the different theoretical approaches review here. For example, in Quah et al.’s [ 156 ] systematic review of “Stakeholder Perspectives of Dignity and Assisted Dying” between 2001 and 2021 of the 663 references initially reviewed, 88 were selected, and only 13 specifically addressed the patients’ point of view on medically assisted death. Of these, only 4 were studies conducted among patients.

Limitations

This review was limited to references in English and French, which inevitably limit its scope. In addition, our focus was put on a Western perspective of dignity and was therefore necessarily colored by dominant Western values. This choice, since the debate surrounding medically assisted death is most prevalent in North America, Europe or Australia, have necessarily resulted in the neglect of other perspectives nourished in other cultures. For example, discussions based on Confucian [ 171 , 172 ] or Buddhist [ 173 ] ethics were not considered, although they would probably have provided complementary points of view. Future comparative analyses by culture could be beneficial.

Although, as Muders [ 42 ] asserts, dignity has not yet found its rightful place, and the multifaceted analysis it deserves in the debate on medically assisted death, the avenues for reflection proposed by Leget [ 80 ] could help remedy these shortcomings. By taking a more in-depth look at the relational aspect of dignity without ignoring its other, more “traditional” dimensions, we could come to a more comprehensive and nuanced conception of the concept that might, as Dige [ 17 ] hopes, make room for normatively richer positions on an issue as sensitive for our societies as medically assisted death.

Availability of data and materials

No datasets were generated or analysed during the current study.

In this paper, the term «medically assisted death» refers both to euthanasia, known in Quebec and Canada as ‘‘Medical Aid in Dying’’ (MAID), and to assisted suicide, which is legalized in some American states and in Switzerland, for example, and which in Canada is also covered by the term ‘‘Medical Aid in Dying’’. All terms will be used interchangeably in this article.

However, a minority of authors differ. For instance, authors such as Kuře [ 20 ] or Ferry [ 61 ] consider that human or ontological dignity does not necessarily imply an absolute ban on all forms of assisted death. In this vein, Reichstein [ 110 ] goes so far as to assert that intrinsic dignity can justify medically assisted death.

The expression "human dignity" carries a broad range of meanings, and apart from more religious perspectives, it is not necessarily synonymous with "ontological and inalienable dignity". For example, many authors simply use it as a generic term to evoke the value inherent to human beings. It can then refer not only to ontological, intrinsic or inalienable dignity but also, to other conceptions (such as subjective and relative dignity), be linked to certain human attributes (e.g. reason), or, in the legal field, be claimed as the foundation of human rights [ 3 , 7 , 9 , 12 , 13 , 17 , 24 , 25 , 31 , 39 , 41 , 42 , 51 , 53 , 54 , 76 , 77 , 78 , 85 , 87 , 88 , 90 , 94 , 95 , 96 , 101 , 109 , 110 , 116 , 124 , 125 , 126 , 132 , 134 , 140 ].

Although this generalization is indeed possible, variations are nonetheless noted in the literature using these expressions. For some authors, contingent dignity is more of a "socially attributed" dignity, which can be attached to action, position or social rank, or be conferred y virtue of a dignified character [ 124 , 138 , 140 ]. Moreover, according to Landheer-Cieslak [ 79 ], dignity/autonomy is constitutive of dignity/subjective, which also includes dignity/safety. For her, the first two expressions must therefore be understood as synonymous. Personal dignity can also take on different meanings. Gormally [ 77 ] and Lee and George [ 81 ], for example, refer to it in the sense of what Kass [ 52 ] calls "full human dignity", i.e., human dignity that unfolds through choices that enable fulfillment in objective common goods. Others conceive of it, or use it in a way that evokes human or intrinsic dignity [ 78 , 154 ]. Still, others see it as the foundation of a "right to respect" [ 65 ], or associate it with a sense of worth [ 73 , 88 ], without supporting the choice of medically assisted death. Conversely, for some, personal dignity is a subjective term that should support (according to legal developments) the choice to decide when to die [ 76 ].

Obviously, the choice of an assisted death remains within the limits of the eligibility criteria established by the law of the state concerned. These may, however, gradually evolve, as is the case in Canada and Quebec.

Moral autonomy or agency can be understood as the capacity to give oneself the moral law, rather than conforming blindly to the injunctions of others. Personal autonomy, on the other hand, refers to the capacity to form, revise and pursue one's own conception of the good life (regardless of the moral content of this life plan).

Among others, Dige [ 17 ] reports the following quotation which, in his view, justifies an (exceptional) openness to suicide and, therefore, in our context, to medical aid in dying: "If a man can preserve his life in no other way than by dishonouring his humanity, he ought rather to sacrifice it. (…) what matters is that, so long as he lives, he should live honourably, and not dishonour the dignity of humanity" (Kant, 1997), In Lectures on Ethics. New York: Cambridge University Press. Kerstein [ 139 ], for his part, suggests an "unorthodox" reading of Kant in which, morally, the prohibition on treating the rational being as a means permits assisted death, while admitting that this nevertheless entails the disappearance of the person, who remains ultimately the source of absolute dignity.

From a political liberalism perspective, the religious ban on assisted dying can be embraced as a principle guiding personal life and choices but cannot serve as a foundation for common law in a secular state.

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Acknowledgements

The authors would like to thank Didier Dupont for his invaluable support in using N-Vivo, and Marie-Josée Lauzière for her help with the literature search.

The first author (IM) received funding for this work from: the Social Sciences and Humanities Research Council of Canada (Joseph-Armand Bombardier Canada Graduate Scholarships) and from the MES-Universities program’s doctoral scholarship for emerging nursing professors, with RRSIQ university counterpart allocation. The second author (NM) holds a Canada Research Chair.

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Martineau, I., Hamrouni, N. & Hébert, J. From ontological to relational: A scoping review of conceptions of dignity invoked in deliberations on medically assisted death. BMC Med Ethics 25 , 96 (2024). https://doi.org/10.1186/s12910-024-01095-z

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DOI : https://doi.org/10.1186/s12910-024-01095-z

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