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Abstract

Integrity can be deﬁned in the following sense: Integrity accounts for the inviolability of the human being. Although originally a virtue of uncorrupted character, expressing uprightness, honesty, and good intentions, it has, like dignity, been universalized as a quality of the person as such. Thus, it refers to the coherence of life that should not be touched and destroyed. It is coherence of life being remembered from experiences and therefore can be told in a narrative. Therefore respect for integrity is respect for privacy and in particular for the patient’s understanding of his or her own life and illness. Integrity is the most important principle for the creation of trust between physician and patient, because it demands that the physician listens to the patient telling the story about his or her life and illness.

Introduction

The principle of integrity receives special actuality in medical ethics and in bioethics in general, where it is essential not to intrude into the integrity of the living. For instance, the second medical Helsinki Declaration claims that the “right of the research subject to safeguard his or her integrity must always be respected.” Like dignity, integrity can both be a virtue and an aspect of every human being. The Latin term integrare has its origin in tangere (to touch) and the “privative in.” Integrity means, literally, that which must not be hurt, damaged, or altered but should be respected and protected (Kemp 1998). In order to really understand the signiﬁcance of dignity, we have to refer to integrity. Integrity should not only be understood as the ﬂip side of dignity, as the “untouchable,” but also refers to the wholeness, totality, and unity of the human person.

In this context, integrity is not only understood as a virtue, deﬁned as the honesty and reliability of a person’s character. Rather, dignity and integrity are conceived as fundamental aspects of human life which should not be manipulated or destroyed. And this aspect is the coherence, die Lebenszusammenhang, of not only the sick living body but ﬁrst of all of the narrative coherence of the patients’ life, created by the memory of important events in life and by his or her interpretation of a lifespan. Integrity expresses the irreplaceable character of human beings as bodily existing beings incarnated in living being (Rendtorff and Kemp 2000). This narrative coherence of a life story forms the ground of the patient’s convictions about what is most valuable in life, and of his or her expectations and hopes. As the unity of a life context, integrity can also be applied to the human species and to the cultural unity of society. Integrity refers to the integral unity of human society and civilization (Brown 2005).

History And Development: Background Of The Issue

Against the background of this narrative understanding, integrity can be deﬁned with the following dimensions: (1) Integrity can be considered as a condition of totality, as wholeness and completeness. In this context, integrity signiﬁes something undivided in its entirety as a whole. Further, integrity implies a condition of not being marred or violated. It is the soundness of an original perfect state. (2) Integrity is a personal sphere. This meaning has its origins in international law where integrity refers to the territorial integrity of the state. The borders of a state should be left untouched, and the state has self-determination in relation to its own borders. (3) Integrity is a virtue (Halfdon 1989). As a virtue, integrity refers to the soundness of moral principles, the character of uncorrupted virtue, e.g., in relation to truth and fair dealing, uprightness, honesty, and sincerity. It also reﬂects other virtues such as sincerity, honesty, and candor and avoidance of deception. (4) The legal and judicial notion of integrity, moving from ethics to law, concerns the ethical coherence of the legal system and the speciﬁc values proper to a legal system (Rendtorff and Kemp 2000).

The sphere of integrity of the human person includes a spiritual and a corporeal dimension: psychical and physical integrity. The spiritual dimension can be expressed by the concept of the zone of the “untouchable” or “intangible.” This means that external intervention in the sphere of integrity is prohibited. In relation to psychiatry one can argue that a permanent focus on motives for actions, rather than reasons, constitutes an intervention in the integral zone of the individual. The intervention in this zone of the untouchable demonstrates an ignorance of the importance of the integrity of the person, and therefore psychiatry should rather be very careful when it deals with the personal untouchable aspects of the human person. This concept of the untouchable sphere of the human person and body can be generalized as a deﬁnition of integrity. Integrity concerns the untouchable core of the personality that must not be subject to unwarranted external intervention. Integrity morally prevents manipulations of the bodily incarnated human being. In a wider context it involves protection of the personal integrity of the individual, e.g., protecting the individual in relation to the public gathering and storing of personal data. This follows from the rights to protection of the untouchable sphere of integrity of the human person (Rendtorff and Kemp 2000).

The notion of integrity also implies certain physical characteristics. The bodily incarnated human subject can be said to constitute a zone of integrity. The personal body can in a phenomenological perspective be said to constitute a zone of what is personal and proper to the singular individual. This zone of the bodily incarnated personality is proper to the singular human person and is therefore untouchable. The human body and its parts form a sphere of integrity that should be treated with special care and comprehension. Within this conception integrity includes the right to life and the right to decide about your own death. Integrity can also be extended to the frontiers of human life (i.e., birth, death) where it is the task to protect the human identity and personality in the touchable incarnated human body.

The notion of integrity has many historical roots that are all present in contemporary culture. The Greek and Roman understanding of integrity emphasized the self-mastery of the body. This includes the idea of self-mastery in the context of a body ethics in which the ideas of wholeness and completeness are integrated parts of this self-mastery of the body. The Renaissance conception of Leonardo da Vinci and others focused on the unity of the body as a symmetrical whole. In a Christian concept, one has to manage one’s body carefully and according to some pregiven norms. The liberal concept of integrity states that no one is entitled to use another’s body against that person’s will, meaning that human beings are owners of their bodies (Rendtorff and Kemp 2000).

The notion of bodily integrity has changed during the historical development of the interpretation of the concept. The whole adventure of the study of anatomy was different in antiquity when people simply saw different things in the human body, e.g., discovering circles of wholeness and perfection. The dead body in its entirety was supposed to resurrect in the middle ages and therefore it should not be mutilated. The circle of the wholeness and completeness of the human body was used to indicate its perfection. Today, however, the body is no longer conceived as a beautiful whole but as a number of organs, and therefore our concept of integrity is changing. However, a broader concept than autonomy is needed to protect the individual’s body in the midst of biomedical progress. Although modernity is often thought of as neglecting embodiment, human beings still experience bodily symbols in contemporary society, indicating that the embodiment of the human person remains central to human self-understanding. Even though it might not be possible to ﬁnd a substantial content of the notion of integrity, it seems obvious that every culture needs a speciﬁc understanding of their ideas of bodily integrity (Rendtorff and Kemp 2000).

Conceptual Clarification/Definition

Intactness concerns the bodily integrity of the individual. Completeness refers to the psychological completeness of the individual. It includes respect for the personal sphere of importance of the patient. It is especially important to avoid turning a human being into an object. In this context, integrity varies from person to person because the concept refers to the foundations for the values of the individual. It deals with the respect for the individual’s right to self-determination over his or her private sphere. Respect for the wholeness of the individual sphere includes respect and concern for the individual as a person. In the context of self-determination, integrity is linked to the legal concept of privacy (Arnoux 1994). One can also talk about “untouchable” and “intangible” aspects of persons who cannot express themselves: the dead or the potential person, etc., who should all be treated with honor and respect (Rendtorff and Kemp 2000).

It is however a paradox of the zone of the untouchable that there can be some touching that heals. A gentle intervention in the physical and psychological zone of integrity can help to restore the unity of the living person. It is in this context that the miracles of medical art have their deepest significance. Medical art means a healing intervention in the zone of the untouchable. The medical art is as such an intervention in the area of self-determination of the human subject (Rendtorff and Kemp 2000).

Integrity concerns the rights of the individual to a personal zone of decision-making. A person decides over his or her body in the same way as the state decides over its land. In this way the concept of integrity refers to the personal negative liberty rights of the individual with respect to his or her own body. However, these negative rights might also lead to the recognition of the right to “equal respect and concern,” that is, to be subject to the positive actions of other people. The reason for this is that respect for personal integrity emerges in an intersubjective relation of mutual recognition (Rendtorff and Kemp 2000).

Further, the concept of integrity could be extended to be applied to animal integrity, to the vulnerable life of nature and the whole living world. In relation to nature and animals, it is required to avoid it that human beings violate their own dignity by an extended instrumentalization of animals. Rather human beings should recognize the need to protect the integrity of animals.

Ethical Dimension

One can argue for a common understanding, based on seeking and needing, as fundamental to patient-physician encounters. The dialogue must be based on respect for patient integrity. The loss of integrity and vulnerability in the patient physician relation needs an appeal-response relation, an asymmetrical relation where the physician is available to help the patient. The healing relationship is a “trust relation” built on the experience of vulnerability and common humanity. This refers to the Hippocratic Oath of not doing any harm, where there instead should be a response invitation relation between physician and patient (Rendtorff and Kemp 2000).

As such, the aim of medical practice can be said to restore the totality of the unity of the patient. The concept of health can be conceived as a unitary concept implying balance and harmony between various dimensions of human existence. Health expresses a balance between the bodily, intellectual, and psychosocial dimensions of the life of the individual. Health is directed toward restoring the good life of the individual where integrity is synonymous with the concept of health. The idea of restoration of health means the right ordering of the parts to a whole, the balance and harmony between the various dimensions of human existence necessary for the functioning of the whole organism. The integrity of a person is expressed in a balanced relationship between bodily, psychosocial, and intellectual elements of his or her life. No one element is out of position in comparison with the others. Each takes the lead when the good of the whole requires it. Each yields to the other in the interests of the whole. Integrity in this sense is synonymous with health (Rendtorff and Kemp 2000).

In the integrity view of a human being, a person is conceived as a uniﬁed whole that possesses his or her own integrity and manifests characteristics that are more than equal to the sum of its parts. It is the task of professional medical practice to promote a unitary view of the physician-patient relationship. It is their task to strengthen the coherence and corporeal integrity of each human being and place the patient in the right balance in relation to context and environment. The idea of restoring integrity is built on the fact that the organism retains its integrity in relation to the environment and the nature of the individual.

Further, the goal of the medical act should be to promote the wholeness of the individual. The idea of wholeness is closely related to the unity of the personal identity of the individual. The idea of wholeness extends to imply the social, physical, and psychological integrity in a unity. The human being must be considered as a unity, and the danger to the unity of the person of all disease should not be forgotten. Suffering is a destruction of the integrity of the person and destroys the intactness of the person. Therefore the intervention in the personality and identity of the person is an intervention in personal intactness. To restore a balance in human identity and integrity leads to the restoration of the person in a corporeal context of the ecosystem and the biosphere (Rendtorff and Kemp 2000).

In this context, integrity is closely related to the conscience and personal self-understanding of the individual. It expresses the personal life context. In this way, integrity is closely related to the unity of the personal identity of the individual. It characterizes the totality of the personal identity. As implied in the personal identity of the other, integrity refers to respect for the personal life context of the other. Integrity is understood as respect for the unity of the life story of the other. It implies respect for the values that the individual considers as fundamental for personal development. Integrity could be understood as a life context and life totality. The narrative dimensions of personal identity are important in order to respect the patient’s integrity as personal identity. Respect for the patient’s integrity, as a condition of unity, must imply respect for the experiences of disease and its consequences in the patient’s life situation (Rendtorff and Kemp 2000).

The different perspectives on integrity manifest the close connection between integrity, personal identity, and character. As early as in Plato’s ethical theory integrity had this meaning of basic moral virtue and human character. The psychic and physical aspects of integrity conﬁrm this comprehensive deﬁnition and relate the right to privacy that is revealed by integrity to the concepts of autonomy and dignity. Since moral character and uncompromising adherence to a moral code, as well as sincerity and honesty, can be said to be components of integrity, integrity characterizes the wholeness of an individual life as a whole and integrated self that has moral independence and consistency in his or her actions (Rendtorff and Kemp 2000).

In medical ethics the concept of integrity has another signiﬁcance than the personal sphere of the patient, namely, in relation to the physician (Pellegrino 1990). As a virtue, however, integrity also concerns the actions of the physician. It is a question of the moral habitus of the physician in relation to other human beings. This is a question of how the physician treats the patient. One can say that integrity belongs to every person as being human but not all human beings are persons of integrity. As a virtue belonging to the physician, integrity can be said to refer back to the ideals of Hippocrates of the physician who considers the patient as a whole person. As a virtue in itself the concept of integrity refers to the moral integrity and moral character of the human person. As a virtue, integrity refers to the moral capacities of the individual. It also includes the respect for the values of the individual. Being a patient, the individual is dependent on the moral self-understanding of the health personnel (Rendtorff and Kemp 2000).

The concept of integrity can also be used to describe the political morality of a just legal order. In this understanding of integrity judges and agents of the legal order are said to have integrity, as they build their decisions on impartiality and fairness. They can be said to give each person “equal concern and respect.” This is the objective correspondent to the subjective deﬁnition of the integrity of the human person. The idea of integrity as a central concept of law can be developed in an analysis of the different particular aspects of the applications of integrity (Rendtorff and Kemp 2000).

In a legal perspective, integrity is an old legal principle that has had new life breathed into it in the present legal situation (Dworkin 1986). In the legal sense the principle originates in Roman law where it comes from the Latin “integritas” (wholeness) and the other notion of Latin origin “intact” as well as “noli me tangere,” which signiﬁes that which is intangible, untouchable, undisturbed, and not to be altered. In the French legal tradition this is emphasized by the notion of “L’intangibilité de la personne.” The principle of integrity also plays an important role in declarations of human rights and in various European constitutions and can therefore be said to constitute a necessary presupposition for the development of a biolaw. The legal reference to the integrity of the human person sets limits to biomedical interventions in the human body. In a modern context integrity refers to the protection of patients’ rights. It can be seen as a part of informed consent in the decision-making process (Rendtorff and Kemp 2000).

Reference to the protection the psychophysical integrity of the human person is becoming more and more central in the formulation of legal norms concerning genetic manipulation and the protection of the human genetic structure. The right to inherit a genetic substance that has not been artiﬁcially changed is an important aspect of integrity. This should not be understood as an interdiction of all genetic interventions, only of manipulations that cannot ﬁt with the personal life story and the narrative unity of the individual’s life. In this way integrity is used to protect the personal identity of the human person in connection with manipulation. This does not only concern actual people, it also applies to what is typical for the human species. Respect for integrity protects the genetic pool of future generations and opposes the manipulation of their genetic inheritance and identity. Manipulation of the human body that substantially changes personal identity can be stopped by reference to the integrity of the human person and the protection of privacy. Here there is a close connection between integrity and the private sphere of the human person as subject to individual autonomy (Rendtorff and Kemp 2000).

Furthermore, integrity does not only apply to the human body, it also concerns a wider sphere of protection of the social and economic integrity of the person. Especially the right to the protection of the privacy of personal information can be mentioned but also the right for vulnerable and weak social groups to be provided with a minimum of economic and social protection. Economic and social integrity involves the concern for citizens in a welfare state and seeing to it that they have a minimum of welfare (Rendtorff and Kemp 2000).

From Bioethics To Business Ethics

In organization theory and business ethics, it is possible to make the move from individual to organization and deﬁne the concept of organizational integrity (Paine 1997). The starting point is the requirements of a modern business environment in public and private organizations marked by increasing competition, higher demands on employee knowledge and qualiﬁcations, as well as a value-pluralistic society where employees and management not necessarily have common values prior to their participation in the organization. In this context it is possible to deﬁne organizational integrity in a broad sense as “honesty, self-governance, fair dealing, responsibility, moral soundness, adherence to principle and consistency of purpose” (Rendtorff and Kemp 2000).

This concept of “organizational integrity” also comes from the Latin origin of the word, which is “integritas,” wholeness or purity. In this sense integrity implies a sense of responsibility, commitment, and self-governance. Integrity is closely linked to the identity of the organization or political community. Deﬁned in such a way the quality of integrity comes in degree in accordance with the status and stability of the organization (Rendtorff and Kemp 2000).

Accordingly, organizational integrity means that policies and strategies in organizations are based on ethical principles and values that are promoted as the foundation of organizational excellence. In this way the company is considered as an agent, which shows its character and identity in its actions and capacity of self-governance. In such a perspective of organizational integrity it is important to deﬁne ethics as an “invisible infrastructure of norms.” But these norms may also be formulated explicitly in the policies of value driven management of the company. Ethics and values imply the effort to engage in right relationships with the stakeholders and constituencies of the ﬁrm in order to create an environment of trust and responsibility. Indeed, in the modern knowledge-based economy, these requirements for organizational integrity are becoming increasingly important in order to ensure cooperation for good performance in the organization (Rendtorff and Kemp 2000).

It can be emphasized that organizational integrity is the result of a long process of developing values in organizations (Rendtorff 2009). Moreover, organizational integrity has an independent status, when it is compared to individual integrity (Dworkin 1986). It may be possible to have an organization where all individuals consider themselves as individuals of high integrity while the organization as a whole is acting unethical. But the contrary can also be possible. Due to organizational policies and strategy a high-integrity organization may consist of a number of low-integrity individuals who due to these structures act with integrity in the organization. With a somewhat free citation of Immanuel Kant we might say even a “population of devils can live in a community based on the rule of law.” But this is only the case in very rare circumstances (Rendtorff 2009).

However, organizational integrity is also aiming at the ideals of openness, honesty, wholeness, and thoughtfulness of individuals. As the basis for judgment integrity expresses the virtues of self-control and self-respect of persons in organizations. Integrity is the foundation of the unity of the personality, but individual integrity is a part of the relation between individual and organization. In this way a room for personal responsibility and judgment of employees is promoted (Rendtorff 2009).

It is possible to take the point of departure from such a concept of corporate integrity and situate it within a large framework of integrity as wholeness and coherence of society. Here, it is possible to deﬁne integrity as linked to civic ethics and to social responsibility and situate organizational integrity within the larger framework of cultural, social, and environmental integrity conceived as consistency, relational awareness, inclusion, and worthwhile purpose. In this sense it is important to see an extension of corporate integrity to include the cultural, interpersonal, organizational, social, and natural dimensions of the world. In this sense it can be conceptualized how a philosophy of integrity aims at social and cultural integration.

Conclusion

In conclusion, this presentation of integrity took the starting point with the deﬁnition of integrity as an individual sphere of privacy. The concept of integrity has been deﬁned as a virtue concerning the wholeness of the human person and personality. The sphere of integrity is both physical and moral. Integrity has mostly been understood as coherence or completeness indicating the purity of a totality that has not been destroyed. Very soon, the presentation also accounted for integrity as a political virtue for republican democracy, and it was possible to extend integrity to be applicable in the domains of organizational ethics and politics. Finally, it was realized that there is no real theory of integrity without a concept of moral thinking and reﬂective judgment.

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