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Abstract

This paper provides an overview of the main ways that the category of meaning in life, as a value distinct from well-being and morality, has been prominent in recent bioethical literature on topics of interest to a global audience.

Introduction

This entry begins by indicating respects in which the concept of life’s meaning has only recently become salient in English-speaking bioethical discussions and by clarifying what talk of “life’s meaning” and cognate phrases mean, at least to most of the philosophers and bioethicists who have used them. This essay then addresses six major respects in which thought about what makes a life meaningful has inﬂuenced bioethics. The ﬁrst four issues concern life and death matters for human beings and speciﬁcally involve euthanasia and physician-assisted suicide, reproductive ethics, life extension, and transhumanism. The other two topics are about respects in which meaningfulness ﬁgures into somewhat “less vital” medical contexts, concerning ways in which promoting health is conceived either as a way to advance meaning or as in competition with this value. This essay concludes by offering a brief bird’s-eye reﬂection on the state of the ﬁeld.

History And Development

It is striking how rare it is to ﬁnd explicit discussion of the category of meaningfulness when it comes to healthcare, at least in comparison to the categories of happiness (welfare) and rightness (morality). The reason that nearly all the literature cited in this entry is from the past 10 or 15 years is not merely that its main aim is to enable readers to become aware of cutting-edge debates; it is also that little other literature is readily available.

For about 200 years in English-speaking normative philosophy, the ﬁeld was dominated by egoism, utilitarianism, contractualism, and Kantianism. Adherents to those perspectives tended to divide normative categories into only two: self-interest construed in terms of a person’s welfare on the one hand, and morality, a function of combining people’s self-interest in certain ways on the other.

Twentieth-century bioethical discussion by and large followed suit. Most of the discussion appealed either to notions of what would be good or bad for a patient in terms of her well-being or to right and wrong ways to treat her. The categories of virtue and vice also ﬁgured prominently, but those are of course moral distinctions in the ﬁrst instance.

Meaning in a person’s life, however, appears reducible to neither self-regarding welfare nor other-regarding morality. On the one hand, meaning appears to be something that characteristically makes a person’s life more desirable. On the other hand, quintessentially for a person to acquire meaning in her life, she must focus not on herself, or at least not her happiness, but instead “outwardly” in some way, perhaps by rearing children with love, or being in a romantic relationship, or making sacriﬁces for a charity, or exhibiting a reﬁned skill to others, or advancing knowledge of (human) nature, or creating works of art. Often enough, by positively directing one’s life toward something beyond oneself, one thereby confers meaning on one’s life.

Recently, the ﬁeld of bioethics has begun to invoke this third evaluative category of meaningfulness to describe dilemmas and to prescribe how to deal with them. Instead of asking merely what would promote a patient’s welfare and what one morally owes others, bioethicists have begun also enquiring into which course of action would be meaningful or, conversely, would reduce meaning in life.

Conceptual Clarification

What is it, though, to ask whether a course of action would confer meaning on a person’s life?

The previous section suggested that it is not one and the same thing as to enquire into happiness or rightness. Let us consider that claim more thoroughly.

First off, it appears coherent to think of certain activities or periods that are happy but not meaningful, when “happiness” is construed in a characteristically modern way as something subjective. Where happiness is a matter of feeling pleasure, liking one’s condition, or getting what one wants, then it appears to be something that can be quite separate from meaning. Consider a doctor getting high on laughing gas, or eating ice cream and watching sitcoms, while his patients suffer.

And then note that it is not contradictory to suppose that aspects of a life could be meaningful but unhappy, again construed subjectively. A nurse who works to relieve patients of suffering, stench, and discharge of various kinds can be supposed to acquire meaning thereby but might well neither enjoy it nor like it nor want it to continue.

Similar thought experiments apply to the relationship between morality and meaning. Just because an action or inaction is morally right does not make it meaningful, or at least the degree of the latter does not seem to track the degree of the former. For example, it would constitute a serious wrongdoing to kidnap innocent people, forcibly remove their organs, and then sell them on the black market so that one can vacation in the south of France. However, not much meaning would accrue to one’s life for not engaging in such wrongdoing.

In addition to cases of moral behavior without (much) meaning, there appear to be ones of immorality with meaning. Suppose, say, the only way to save the life of one’s spouse were to steal a scarce medicine from a public hospital. Such behavior arguably would be wrong but would make one’s life more meaningful.

If talk of “meaningfulness” and cognate terms such as “signiﬁcance,” “importance,” and the like is not identical to “happiness” and “rightness,” then what is it about? In the ﬁeld there are a number of ideas that have been suggested (see Metz 2016). According to some, to ask about the meaningfulness of a person’s life is to ask whether it serves some purpose beyond obtaining pleasure for herself. For others, talk of “meaning” by definition connotes ideas of a positive relationship between the individual and something else that is good for its own sake such as another person, an artwork, or a theory. For still others, when thinking about meaning in a life, one is considering what about it might warrant certain emotional reactions such as great esteem or admiration. And ﬁnally there is the idea that meaningfulness is a function of narrative, say, a matter of composing one’s life story.

Professional philosophers spend time trying to determine whether just one of these ideas, or some other one, best captures meaning talk. However, for the sake of this entry it will sufﬁce simply to keep this cluster of them in mind.

Ethical Dimensions

The heading of this section mentions “ethical” considerations, and that should be taken in a broad sense as transcending narrowly moral concerns. Instead, think of it as referring to evaluative or normative matters that include those of meaningfulness as they are potentially distinct from right action and virtuous character.

This section begins by addressing four matters of human survival, where invocation of the category of life’s meaning has been most prominent. It ends by taking up two additional respects in which meaning has ﬁgured into the evaluation of health related activities, namely, where health promotion appears to be a way to produce meaning and where it, conversely, seems to be a way to reduce it.

Ending Life

One of the most common areas of bioethics in which to ﬁnd discussion of meaning in life concerns voluntary euthanasia, physician-assisted suicide, and other forms of killing such as terminating pregnancy and withdrawing life support from severely disabled neonates. Frequent is discussion of the ideas that meaning in one’s life depends on one’s being the author of it, including its end (Richards 1981), and that having no prospect of meaningful engagement can make suicide and related actions apt (Little 1999).

Here, a moral conclusion is drawn from prior considerations of meaning, but the inference sometimes goes in the other direction; that is, sometimes thinkers conclude that an action would be meaningful or lack meaning based on independent premises about morality. For example, if there were some prior judgment that killing an innocent person is invariably immoral, would such killing then reduce meaning, or would not killing enhance it (Varelius 2013)?

Intending Life

One also ﬁnds the category of meaning invoked when considering whether to create new lives, as opposed to end ones already in existence. Some of this discussion is in the context of reproductive technologies, with debate about whether “artiﬁcial” or “unnatural” techniques such as in vitro fertilization, surrogacy, and cloning would reduce meaning in people’s lives. Some ﬁnd meaning to depend crucially on characteristically human behaviors, including heterosexual adults bonding with each other and creating a family through sexual intercourse (Kass 2002), while others do not (David and Kirkhope 2005).

These debates are about whether certain ways of making babies might reduce meaning in their lives or in the lives of the broader society. There are also debates about whether we need babies as such in order to have a meaningful life. That is, there is reﬂection on the respects in which, and extent to which, meaning in our lives depends on the presence of future generations. Some contend that what is particularly admirable about a life are the respects in which it makes sacriﬁces for, or at least contributes to, the good of others who are younger or will come into existence (Schefﬂer 2013). Others maintain that substantial meaning in life could be available even in the absence of the continuation of the human race (Trisel 2004).

Extending Life

A third life-and-death matter that is often addressed through the lens of meaning is life extension. One debate is about what is sometimes called “considerable” life extension, which involves something more than just a handful of extra years beyond what humans have recently achieved but also much less than immortality. Consider the possibility of living 1000 years, say; would meaning in our lives be enhanced or reduced? One ﬁnds arguments on both sides in the literature (canvassed in H€ayry 2011). For some, with more time would come more opportunities to be and to do (Gems 2003), while, for others, opting for considerable life extension would bring a narrow, ego-centric focus on self-preservation in its wake (Pijnenburg and Leget 2007).

Another aspect of the debate about life extension concerns immortality. Traditionally philosophers have considered whether having a soul, an immortal spiritual essence, would be necessary for meaning or, conversely, would be sufﬁcient for a meaningless one. However, those debates are beginning to be recast in terms of the (“singular”) technological possibility of sustaining a person’s identity indeﬁnitely in a physical world, perhaps by successive uploads of one’s consciousness into a string of computerized bodies.

Despite the shift to a focus on immortality in our subatomic, spatiotemporal universe, as opposed to in a supernatural realm, most of the arguments for and against an inﬁnite life span are similar (canvassed in Metz 2016). On the one hand, some have the sense that nothing is really worth doing unless it will make some kind of permanent difference to the world and that, so long as one had one’s wits and powers, more life would be better in terms of degree of meaning available. On the other hand, some believe that an immortal life would be boring, or would become repetitive, or would lose its “shape,” meaning roughly that we would not be motivated in the intense kinds of ways essential for meaning. Being immortal might result in a lack of a sense of preciousness and urgency, and perhaps the absence of will to undertake creative, beneﬁcent, or intellectual projects altogether.

Upending Life

Finally with regard to meaning and our survival, there are the “transhumanism” or “enhancement” debates about how meaning in life might or might not be a function of our human nature. There are those who recommend altering our genetic makeup so that we are no longer strictly speaking a member of the species Homo sapiens. They suggest that radically enhancing our physical and mental abilities by manipulating our DNA would promise to give us a greater capacity for meaningful projects. We could, say, rescue more people or learn more about the natural world than we can as human beings (Danaher 2014; Sandberg 2014). Or we could make our nature more perfect, something closer to angels and further away from animals (Sandberg 2014).

On the other hand, there are those who maintain that our most important values, including that of meaning in life, are grounded on the fact that we are human beings. Sometimes the suggestion is that human nature has a dignity and is something to be honored. Becoming nonhuman would undercut meaning by degrading our humanity (President’s Council on Bioethics 2003). Other times the suggestion is that just as our notions of health and virtue are tied to human limits, so are our notions of meaning in life (Nussbaum 1989).

Meaning As Health Promotion

The rest of this section addresses relationships between bioethics and the value of meaning in life that do not focus squarely on human death, procreation, survival, and the like. Here, it points out that sometimes promoting health is understood in terms of meaning, while below it notes that there are times when meaning is viewed in competition with health.

Promoting health can plausibly be viewed as meaning-conferring in two ways (discussed in Diehl 2009). First off, relieving another’s suffering can be viewed as meaningful for the one doing the relieving. Perhaps most people become healthcare professionals not primarily because they think that it will make them happy or that they have a moral obligation to do so but rather because they sense that their lives would be more important for helping others.

Secondly, promoting health might also be a way of enhancing the meaning of a patient’s life. This is quite reasonably so where physical injuries prevent patients from being artistic, participating in relationships, or learning about themselves or the world. More robust, and controversial, is the claim that certain mental illnesses just are reductions of meaning in themselves, beyond merely preventing additions of meaning in the long run. Perhaps one’s life is less meaningful the more one is depressed, isolated, addicted, or self-blind.

Meaning Versus Health Promotion

Although, as above, the point of medical treatment is sometimes conceived in terms of fostering meaning in patient’s lives, at other times the two seem to be antipodal. That is, on the face of it, there are occcasions when producing health is at odds with enhancing meaning. For instance, consider organ donors. Often people report a great sense of meaning in their lives as a result of having given a kidney away (Quintin 2013), but making such a sacriﬁce is hardly to the good of their body. Even if the risks of harm are low, they are greater from altruistically donating an internal organ than from not donating one.

In this case, one might point out that the overall aim of the physician is still health, even if not the health of the organ donor. In other cases, though, it is not obvious that physicians ought to aim at health, at least not in the most efﬁcient (and even ethically permissible) manner. Consider the claim, for instance, that people’s religious beliefs ought to be given some weight when deciding how to respond to their illnesses and injuries (Orr and Genesen 1997). Such beliefs are at least “meaningful to” those who hold them, and it might be that ignoring them would reduce actual, and not merely perceived, meaning in their lives. That might provide reason for medical professionals not to provide the kind of treatment that would be expected to maximally foster health (while avoiding coercion, deception, and other morally suspect forms of manipulation).

The cases discussed so far are those in which the meaningfulness of patients’ lives appears to conﬂict with an interest in their health. However, there might also be situations in which doing the most for the health of patients would reduce meaning in healthcare workers’ lives.

For example, suppose that two infants are joined as “Siamese twins” and that both will die unless one is killed. In that case, a concern to promote health, at least conceived in one straightforward way, would recommend killing one to save the life of the other. However, if a doctor believes she is morally forbidden from killing in this case, then her doing so could reduce the meaning in her life. Note that this could be true even if her views about morality were incorrect; for many, some meaning is lost when one gives up integrity or cannot act in accord with one’s deepest values.

Conclusion

The aim of this entry has been to point out several respects in which the literature has appealed to the category of meaning in life in order to understand practical dilemmas in bioethical contexts across the world. It ﬁrst indicated that it is only fairly recently that bioethicists have noticeably appealed to the value of meaningfulness, and it then sketched why it is reasonable to think of it as a value distinct from happiness and rightness. Then, the entry considered six major areas where meaning in life has entered into bioethical debate. Most of them have had to do with life and death matters, including killing, procreating, extending life, and altering human nature. The other two topics concerned ways in which promoting health is conceived either as a way to advance meaning or as in competition with the latter value.

The entry has focused principally on work published by bioethicists or appearing in bioethical forums. It has not thoroughly taken up the large amount of research that has been undertaken by philosophers who seek to answer the question of what, if anything, would make a life meaningful. It would be ideal if future research in a given ﬁeld were undertaken in light of a greater awareness of the other one. Bioethicists could beneﬁt from more abstract, theoretical reﬂection about meaning in general, and theorists about meaning in life could usefully consider some of the concrete implications of their views for bioethical matters.

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