The concept of “dignity” is invoked frequently in biomedical ethics. However, the term is not adequately explained. Kant believed that all people have absolute value, or dignity, because they can be autonomous and rational. As such they ought to be treated never as a means but as ends in themselves. But how then are we to account for the moral status of human beings who are not autonomous and do not enjoy a high level of rationality? Does not this version attribute dignity to others because they are like ourselves and therefore possibly justify treating those who are not sufficiently like ourselves as means to our ends? The argument that is proposed here is that we begin not with a consideration of an abstract autonomy and rationality, but with the practice of receiving and giving without which human society and indeed human life would be impossible. (MacIntyre’s dependent rational animals.) What I offer here is an adaptation and development of the philosophies of gift. (Levinas, Derrida, Marion). We could begin with that practice of receiving and giving that is needed to reach agreement to form a peaceful community that is itself necessary for dealing with differences about biomedical ethical issues without resort to force. (Engelhardt) I can receive the agreement of another because I want to get something from that other, for example, an agreement without which we cannot solve a problem and agree on the policies we need to decide. Or I can accept that agreement as a gratuitous gift that I freely accept as freely given. Similarly, I can give my own assent to the establishment of a peaceful community either for an instrumental purpose or gratuitously. An assent given for a merely instrumental purpose is not a fully autonomous assent. It is not an expression of the self. It is only in free giving and receiving that genuine autonomy is expressed. The notion of the self appropriate to a free receiver and giver is not the dominating, autonomous individual of modernity, but a self whose self is received as donation from an other and affirmed in free giving. Only on such a basis can a genuinely peaceful community, free of domination, be based. (Habermas) To acknowledge the dignity of the other as a human person means to accept the other as a giver and receiver, while engaging my self as a free giver and receiver, thus affirming my own dignity. One who can be adopted into a relationship of giving and receiving has dignity, which is to say, ought to be adopted into such a relationship.