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DISPUTES OVER DIGNITY:
THE ROLE OF DIGNITY IN THE EUTHANASIA DEBATE
AM, FRSC, A.u.A (pharm.), LL.B. (hons), D.C.L.,
LL.D. (hons. caus.), D.Sc.(hons. caus.), D.Hum.L (hons. caus.)
The Canadian Association for Spiritual Care (CASC) National Conference
DIGNITY AT THE CENTRE
Delta Hotel, Winnipeg
April 11th, 2014
Copyright 2014 Margaret A. Somerville
Not to be copied or cited without permission of the author
DISPUTES OVER DIGNITY: THE ROLE OF DIGNITY IN THE EUTHANASIA DEBATE
Both the pro-euthanasia and anti-euthanasia sides in the debate over legalizing euthanasia rely on upholding respect for human dignity as supporting their position. This seeming paradox can be explained by the different definitions of dignity each side adopts.
Is human dignity intrinsic to all human beings, an innate characteristic that comes simply with being human, the primary purpose of which is to protect all human beings lives, as the anti-euthanasia side believes? This definition means that euthanasia intentional killing - is a contravention of human dignity.
Or, as the pro-euthanasia side argues, is human dignity an extrinsic feature the presence of which depends on a persons being autonomous and independent and on others seeing us as having dignity and, thereby, conferring it? This means that dignity and the protections it carries can be lost when a person lacks capacities for autonomy and independence or others refuse to confer it, and euthanasia can be characterized as upholding dignity by putting suffering people out of their undignified state.
What are the consequences which flow from each definition, especially with regard to the protection of the lives of vulnerable people, who include people with disabilities? How should we respond to the argument that legalizing euthanasia and physician-assisted suicide is required to uphold dignity? What arguments and strategies are those advocating euthanasia using to promote its legalization and what are the counter-arguments?
EXPLORING THE CONCEPT OF DIGNITY
IS THE CONCEPT OF HUMAN DIGNITY USEFUL, USELESS OR DANGEROUS?
The lawyers answer: That depends!
It depends on
What we mean by human dignity there is no consensus.
How we use the concept again, there is no consensus.
What we see as its basis in particular, secular or religious or both, and yet again there is no consensus.
As to dangers of the concept of dignity, there is a saying in human rights:
Nowhere are human rights more threatened than when we act purporting to do only good.
Reason is that we dont see the harms unavoidably involved.
Respect for human dignity is overwhelmingly perceived as doing only good.
Are we overlooking some accompanying harms?
If so, what are they?
2. USE OF THE CONCEPT OF HUMAN DIGNITY
Three international instruments that rely heavily on the concept of human dignity are the Universal Declaration of Human Rights (UDHR), the UNESCO Declaration on Bioethics (UDB), and the Universal Declaration on the Human Genome and Human Rights (UDHGHR).
Messages about dignity that these documents deliver, expressly, include that recognition of dignity means recognition of equal rights; respect for dignity affirms the worth of the person, means all people are equal, requires respect for cultural rights, and requires access to paid work.
Scientific advances can threaten dignity, therefore, in light of these advances, we need to promote respect for dignity. We must improve health, but only within the confines of respecting human dignity.
The human genome shows our unity and, as the common heritage of humankind, our common inherent dignity.
We all have dignity no matter what our genetic differences or disabilities.
That dignity means, for example, that we are more than our genetic characteristics - that is, genetic reductionism (Genes R Us, Gene machines theories) is inconsistent with respect for human dignity and genetic discrimination offends human dignity.
Consider that 80 to 90 percent of Downs syndrome children are aborted.
The human dignity of genetic research subjects must be respected;
respect for dignity prohibits practices such as reproductive cloning;
and research on the human genome must respect dignity.
States must defend human dignity; and breaches of human dignity need to be identified.
Human dignity is nowhere defined in these instruments.
Human dignity is distinguished from both human rights and fundamental freedoms.
The rule against redundancy indicates that it must mean something not encompassed by these terms, but what is that something?
Some interventions are expressly labeled as contrary to human dignity, for example, germ-line interventions and reproductive cloning of human beings. What is the basis for that labeling and could knowing that help us to decide whether other interventions, actions or omissions, for example, euthanasia, are contrary to human dignity?
In other words, what human dignity consists of or what respect for it, in general, requires we do or not do, is not spelt out in these documents.
One explanation focuses on the relation of dignity and human rights:
In effect, human dignity serves here as a placeholder for whatever it is about human beings that entitles them to basic human rights and freedoms.
Adam Schulman, Senior Research Consultant at the United States Presidents Council on Bioethics
We can agree that dignity needs to be respected, while we dont necessarily agree what that requires or what it is.
The late Sergio Vieira de Mello, a prominent human rights advocate, described the relation of dignity and human rights this way:
We recognised, through the Universal Declaration of Human Rights, that "the inherent dignity and the equal and inalienable rights of all members of the human family is the foundation of freedom, justice and peace in the world".
De Mello proposes that [w]e should nurture our sense of self as part of a common humanity and that our common humanity is an inclusive one, built on values such as tolerance and dignity.
In a similar vein, physician-ethicist, Daniel Sulmasy describes the relation of dignity and human rights this way:
Intrinsic dignity... can be understood as the foundation of all human rights. We respect the rights of an individual because we first recognize his or her intrinsic dignity. We do not bestow dignity because we first bestow rights. Human beings have rights that must be respected because of the value they have by virtue of being the kinds of things that they are. (p.485)
In short, human rights are secondary to human dignity. Stated another way, human rights establish the conditions that are required if inherent human dignity is to be respected.
Most importantly these descriptions of the relation of dignity and human rights show that if everyones human rights are to be respected, then an inclusive definition of dignity is necessary, that is one that recognizes that all human beings have dignity that must be respected.
Lets look now at how some commentators have defined dignity.
3. DEFINING DIGNITY
So how has dignity been defined?
Philosopher Daniel Brudney says dignity has a complex history in multiple religious and philosophical traditions, but that makes for conceptual richness, which has both advantages and disadvantages, as we will see.
Political scientist Diana Schaub says we no longer agree about the content of dignity, because we no longer share what Meilaender calls a vision of what it means to be human.
Shes correct that the various interpretations of what it means to be human are at the core of our disagreements about the nature of dignity and what respect for it requires, and those disagreements are what I would like to explore with you today in this address.
Then, if we have time, Ill look more explicitly at some of the disagreements between pro- and anti-euthanasia advocates in the context of that debate.
Dignity is a ubiquitous concept in bioethics, and in 2008 the United States Presidents Council on Bioethics issued a report, Human Dignity and Bioethics.
Many of the eminent authors who contributed chapters and comments to that report were responding to American bioethicist Ruth Macklins proposal that dignity is a useless concept that should be abandoned, and that instead we should just use concepts of respect for persons and respect for autonomy.
So, lets look at what some of the essayists who contributed to the Presidents Council report had to say about human dignity. What are some of the questions we can ask our responses to which might help to give us insights into the nature, meaning and purpose of the concept of dignity?
i) Is dignity connected with morality?
American philosopher Holmes Rolston III sees dignity as the marker of the ethical and moral sense humans have, which he sees as distinguishing humans from animals, which also have consciousness.
He sees as a major value question how to recognize and to respect human dignity and says much in our future depends on the answer.
In the latter regard, lawyer and author, Wesley J. Smith, would concur.
The morality of the 21st century will depend on how we respond to this simple but profound question: Does every human life have equal moral value simply and merely because it is human? Answer yes, and we have a chance of achieving universal