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Undignified Arguments

A Critique

Published online by Cambridge University Press:  09 March 2016

Abstract:

Something strange has happened to the concept of dignity in bioethics. After a long period in which U.S. pragmatist and U.K. consequentialist philosophers have argued that the concept is useless and vacuous, and in which they have been reasonably successful in expunging it from mainstream English-language academic bioethics, dignity has suddenly become popular again in debates about the legalization of physician-assisted dying (PAD). And, even stranger, it is deployed not by conservatives but by liberals. In the debates about PAD, liberal proponents of legalization seem to accept without question that there is such a state or process as “death with dignity,” which is juxtaposed to “undignified dying.” It also seems to be accepted that both of these states can be fairly easily identified and that they carry great moral weight. This article provides an analysis of the current resurgence of “undignified” arguments and argues on the basis of that analysis (1) that a proper understanding of the concept of dignity shows that the previous reductive arguments against dignity are partially incomplete and therefore partially misguided and (2) that, despite dignity having meaning, the idea of an undignified death cannot carry the moral weight it is given by proponents of the legalization of PAD.

Type
Special Section: Responsibility, Vulnerability, Dignity, and Humanity
Copyright
Copyright © Cambridge University Press 2016 

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References

Notes

1. Häyry, M. Another look at dignity. Cambridge Quarterly of Healthcare Ethics 2004;13:714.CrossRefGoogle Scholar

2. UN. Universal Declaration of Human Rights; 1948.

3. Council of Europe. Convention for the Protection of Human Rights and Dignity of the Human Being with Regard to the Application of Biology and Medicine: Convention on Human Rights and Biomedicine; ETS 164, 1997.

4. UNESCO. Universal Declaration on the Human Genome and Human Rights; 1997.

5. Obergefell v. Hodge, 576 U.S. [2015], emphasis added.

6. Macklin, R. Dignity is a useless concept—it means no more than respect for persons or their autonomy. BMJ 2003;327:1419–20.CrossRefGoogle Scholar

7. President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research. Deciding to Forgo Life-Sustaining Treatment. Washington, DC: U.S. Government Printing Office; 1983, at 24.Google ScholarPubMed

8. Caulfield, T. Human cloning laws, human dignity and the poverty of the policy making dialogue. BMC Medical Ethics 2003;4(1):3CrossRefGoogle ScholarPubMed. Palk, AC. The implausibility of appeals to human dignity: An investigation into the efficacy of notions of human dignity in the transhumanism debate. South African Journal of Philosophy [Suid-Afrikaanse Tydskrif vir Wysbegeerte] 2015;34(1):3954.CrossRefGoogle Scholar

9. Harris, J. Cloning and human dignity. Cambridge Quarterly of Healthcare Ethics 1998;7(2):163–7, at 163.CrossRefGoogle ScholarPubMed

10. Brownsword, R. Bioethics today, bioethics tomorrow: Stem cell research and the dignitarian alliance. Notre Dame Journal of Law, Ethics and Public Policy 2003;17:1551.Google Scholar

11. See note 1, Häyry 2004. The first two of these categories align with the Catholic and Kantian/Enlightenment conceptions mentioned previously.

12. Jacobson, N. Dignity and health: A review. Social Science and Medicine 2007;64:292302, at 294, references removed.CrossRefGoogle ScholarPubMed

13. http://www.dignityindying.org.uk/ (last accessed 10 Jul 2015).

14. http://www.dignitas.ch/ (last accessed 10 Jul 2015).

15. Carter v. Canada (Attorney General), 2015 SCC 5.

16. The Brittany Maynard Fund. About Brittany Maynard; available at http://www.thebrittanyfund.org/about/ (last accessed 10 Jul 2015).

17. This analysis may potentially include a proviso for suffering that the person suffering accepts or embraces, for instance, because he or she can give it a meaningful interpretation within his or her own worldview.

18. Johnstone, MJ. Metaphors, stigma and the “Alzheimerization” of the euthanasia debate. Dementia 2013;12(4):377–93.CrossRefGoogle ScholarPubMed

19. Fogelstrom L. Allowing Dementia Patients Death with Dignity; 2014; available at http://speak.catlin.edu/?p=2737 (last accessed 10 Jul 2015), emphasis added.

20. The Caregiver’s Voice. Death with Dignity for Dementia; 2013 Nov 5; available at http://thecaregiversvoice.com/tips-caregivers/death-with-dignity-for-dementia/ (last accessed 10 Jul 2015).

21. Cantor N. My plan to avoid the ravages of extreme dementia. Bill of Health [blog]; 2015; available at http://blogs.law.harvard.edu/billofhealth/2015/04/16/my-plan-to-avoid-the-ravages-of-extreme-dementia/ (last accessed 10 Jul 2015). This blog post is not strictly about PAD, because the author does not plan to involve a physician in his suicide, as PAD is not currently legal in his jurisdiction.

22. Vitez M. For former hospice nurse, dementia is worse than death. Philly.com; 2015 Feb 20; available at http://articles.philly.com/2015-02-20/news/59309405_1_end-of-life-care-dementia-alzheimer (last accessed 10 Jul 2015).

23. The situation when personhood is lost is discussed subsequently.

24. Bayley, J. Iris: A Memoir of Iris Murdoch. London: Abacus; 1998.Google Scholar

25. Agamben, G. Homo Sacer: Sovereign Power and Bare Life. Stanford, CA: Stanford University Press; 1998.Google Scholar

26. For an interesting debate about whether degradation caused by disease leads to an undignified life within a strictly Kantian conception of dignity, see Velleman, JD. A right of self-termination. Ethics 1999;109:606–28CrossRefGoogle Scholar, for the view that degradation by disease can lead to an undignified life, and Hershenov, DB. Death, dignity, and degradation. Public Affairs Quarterly 2007;21(1):2136Google Scholar, for the counterargument.

27. Harris, J. The concept of the person and the value of life. Kennedy Institute of Ethics Journal 1999;9(4):293308CrossRefGoogle ScholarPubMed, at 307, original emphasis removed.

28. Fletcher, J. Indicators of humanhood: A tentative profile of man. Hastings Center Report 1972;2(5):14.CrossRefGoogle Scholar

29. I don’t want to be too specific here about the kind of animal to think about, because where we draw the line between persons and nonpersons in the animal kingdom is currently a matter of deep controversy.

30. Gertie, who has developed dementia, is the blog author’s friend.

31. See note 21, Cantor 2015, emphasis and numbering added.

32. The recent case of the civil rights activist and Africana studies instructor Rachel Dolezal tragicomically illustrates this point. After having fashioned a life narrative as a black woman, she was found to have white parents, and to have made official complaints about racial discrimination directed against her when she was a white student at a predominantly black university. Whatever she decides to do with her life, she will never be able to regain control of her own life narrative.

33. Underestimating this ability may be “natural” for academics, because much of the literature displays a distinct lack of charity in interpretation.

34. That is, the claim that for person P, with a life narrative N, there is a set of dying processes D that are objectively undignified in the sense of being strongly incompatible with the core of P’s life narrative.

35. Dworkin R. Life’s Dominion: An Argument about Abortion, Euthanasia, and Individual Freedom. New York: Alfred A. Knopf; 1993. Dresser, R. Dworkin on dementia: Elegant theory, questionable policy. Hastings Center Report 1995;25(6):32–8CrossRefGoogle Scholar. Holm, S. Autonomy, authenticity, or best interest: Everyday decision-making and persons with dementia. Medicine, Health Care and Philosophy 2001;4:153–9.CrossRefGoogle ScholarPubMed