Dignity is a useless concept
BMJ 2003; 327 doi: https://doi.org/10.1136/bmj.327.7429.1419 (Published 18 December 2003) Cite this as: BMJ 2003;327:1419
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I find it curious and more that slightly offensive that the author of
this article wishes to further reduce our vocabulary for describing
important facets of the doctor patient relationship. Dignity, "The quality
or state of being worthy of esteem or respect", is not only a synonym for
these words. It is, as the definition shows, a state of being inherent in
the person referred to. One may treat a patient with respect in the ways
the author refers to, like honoring their autonomy, and still not treat
them with the dignity they deserve. I have seen many an informed consent
filled out by patients treated with little dignity. The way the author
refers to respect and autonomy makes them sound like rigidly formed little
boxes filled with just so much meaning and no more. I see dignity as a
broader term, and one that requires of the medical provider a greater
reach and sensitivity to the full embodiment of being human.
Competing interests:
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Competing interests: No competing interests
I think Ruth Macklin has only identified dignity as a ethical aporia.
Instead of responding to policy documents and a desire for operational
terminology, she could inquire what other people, especially patients and
carers, understand by "dignity".
Regarding medical students practising
procedures on newly dead bodies, Macklin states: "Some medical ethicists
charge that these educational efforts violate the dignity of the dead
person. But this situation clearly has nothing to do with respect for
autonomy since the object is no longer a person but a cadaver." Life and
death are not so clearly separated from one another. It is a naive
attitude to language that slots people into categories so neatly and
objectively. Some linguists would reply that the definition of a living
person is only meaningful in the fuller context of its negative term,
cadaver, and vice versa. Hence, I think the terms of Macklin's critique
simplistic, her expert view narrow and dogmatic, and dignity, whatever its
potentiually rich and complex meaning, quite undented by her analysis.
Competing interests:
None declared
Competing interests: No competing interests
I have just read Professor Macklin's article and must say I found it
refreshing and hard hitting. As an academic working in medical ethics I,
like Professor Macklin find the notion of dignity vague and ambiguous
although unlike her I am not convinced for example that if dignity has
meaning then its meaning can be exhausted by substituting autonomy - I
don't believe the two are synonymous. One conclusion might simply be that
dignity is therefore meaningless and I am not quite convinced of this
either. I was interested in what Professor Macklin had to say about
cadavers.
As a former cancer nurse I have been in the position, many
times, of performing what we call 'last offices' preparing a body for
viewing by relatives or removal to the mortuary. If I was teaching a
junior colleague how to perform this procedure then a feature of the
'right and proper' way to treat the corpse would be that the body should
be treated with respect (dignity?) - for example it would be considered
wrong to needlessly expose the genitals or to make lewd jokes about the
deceased etc. - now I am not convinced that the only reason it would be
wrong to do these things would be out of consideration for the living
relatives - it would be easy to construct a situation in which no one else
could know or indeed where there were no relatives or loved ones to be
offended by us treating the corpse in this way - therefore the sanctions I
have just outlined would have no force. I find this conclusion problematic
and one way in which I would construct the counter argument is to talk
about the deceased person's 'abiding interests' - now this may be a weak
argument but I do believe there is a lot more that can be said about
interests that might give some substance to the notion of dignity. Here I
am presuming that it is possible to identify a person's interests
indpendently of their autonomous wishes, if so there is no reason to
suppose that a person's interests end on their death. I would suggest
therefore that rather than conclude that dignity is a useless concept it
should be subjected to a thorough conceptual analysis. Such an analysis
may simply lend support to Professor Macklin's claim - then again it may
not.
Competing interests:
None declared
Competing interests: No competing interests
To read a suggestion that protecting the right to dignity is nothing
but a slogan, and flying that argument under the slogan "dignity is a
useless concept" made me indignant. I've been the "layperson" suffering
through more ethics experts' gobbledygook than I care to remember, so I
could be a bit prejudiced I suppose. But...the word dignity has no real
meaning of its own and therefore no place in medical ethics? Oh, please.
Maybe when there's no indignity possible in illness or medical procedures,
when all caregivers, policymakers and members of ethics committees are
superhumans incapable of having lapses in empathy, then retiring this
notion from active duty could be considered. (A world where no one ever
needs an enema, for example.)
Dignity in a medical experience, or while dying, apparently has
little unique meaning to the author of this piece. But it would be
instantly meaningful to more people who have been patients than some of
the other words the author uses - and distinct from privacy and
"autonomy". A lot of us recognise what people mean when they speak of
dignity. Most of us have a good idea of what we mean by being treated with
dignity (valuing it highly, too). And by crikey, do we know its opposite!
As patients, we inevitably encounter behaviour and experiences that
are humiliating, demeaning and frankly - well, undignified. Do we then
say, "Oh, I just feel that my autonomy was not respected"? How many of us
though, know what this means: "They just left her with no dignity - none
at all."
How could there be no place for eloquent, recognisable, plain
language in discussion of human rights, and no room for a concept that
embraces protection from humiliation and shame in medical situations?
Competing interests:
None declared
Competing interests: No competing interests
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Dignity-US Style
"Dignity is a useless concept in medical ethics and can be eliminated
without any loss of content"--I think the author is likely to receive
President Bush's wholehearted approval for elimination of 'human dignity'
altogether,rather than restricting it to medical ethics.
From the author's own backyard Guantanamo Bay, to Afghanistan via
Iraq, illustrate glaring examples of murdering human dignity by the US
authorities.Most recently we saw Saddam Hussain being examined physically
on our TV screen--another US bullet at killing the concept of dignity.
Given the USA's track record,the author won't have to work too hard
to eliminate a concept,which has already perished in front of the so
called United Nations.Standing shoulder-to-shoulder, I fear that UK might
catch this dignity-busting bug fairly soon, with resulting infestation of
the European Convention.
Competing interests:
None declared
Competing interests: No competing interests