Dignity is a useless concept

Concepts can be slippery things. We believe we understand what
‘happiness’ means, but ask people to clearly define ‘happiness’ and you
might get as many definitions as the number of people asked. More concrete
concepts are easier to define. The concept ‘chair’ might be less of a
cognitive stretch than more abstract concepts such as ‘morality’. So it
would seem with the concept of ‘dignity’.

In 1936 Allport and Odbert set about creating a list of all the words
in Webster’s Dictionary that described the psychological traits of humans.
Their resulting list included some 4,500 words and the basis of their
research became known as the lexical approach to the study of personality.
Simply, if a word exists then it exists for a reason. It describes
something of note, of states, of tendencies, of differences within (I feel
happier today than I did yesterday) and between (Fred is always happier
than Jan) people.

Dignity is a word representing an abstract state or feeling. If I
fall over in the street, I experience a loss of dignity. Furthermore, this
loss can be felt whether the fall occurs in view of others or not. When a
person visits their doctor, or a hospital, or participates in medical
research, the treatment they receive and the manner in which they are
treated impinges on their sense of dignity. It seems quite possible for a
person’s autonomy to be respected yet their dignity upset. While the
person might voluntarily agree to a medical procedure, be well informed of
the procedure, have their records of the procedure kept in strict
confidence, be unharmed by the procedure and actually benefit from the
procedure, they might still incur and feel a loss of dignity. Even the
humble hospital gown might be seen as a challenge to many a patient’s
dignity.

And this is my point of argument with Professor Macklin’s article. I
disagree with the statement that dignity “is no more than respect for
persons or their autonomy”. You can highly respect a person and their
autonomy by your actions, words and thoughts, and as a doctor you will
also be striving for their well-being, but you cannot guarantee that this
will not ‘mess’ with their sense of dignity. It is quite imaginable that
respected, autonomous patients endure indignities for the sake of a hoped-
for cure.

The concept of dignity seems to stretch beyond a person’s life and
into death. Most, if not all cultures, have rites, ceremonies and rituals
honouring a person who has ceased to live. There are procedures and an
expectation of reverence for the handling of bodies. To give an extreme
example, the WWII scenes captured on film of Jewish bodies being tossed,
shoved or bulldozed into mass graves produces a sense of shock and
repulsion in most people. It seems we humans consider that a dead body
should be treated with dignity: we do not just see a cadaver. The thought
of dying without dignity seems frightening to many people, or at the very
least, a dignified death is seen as highly preferable.

The question raised by Professor Macklin’s article is: does the
concept of dignity add anything to medical ethics? I think it does. Yes,
the concept is not well defined, but it clearly exists and seems very
human. It cannot be fully accounted for by other concepts such as respect
and autonomy (or beneficence, non-maleficence or justice) if a person is
given respect, allowed full autonomy, yet still feels a loss of dignity.
This is not only deeply psychological, but highly relevant to medical
ethics. The onus, it would seem, is to develop a greater understanding and
appreciation of this highly abstract concept we call ‘dignity’. Medical
ethics, and those it serves, might well benefit.

Reference:
Allport, G., W., and Odbert, H., S. (1936). Trait names: A psycho-lexical
study. Psychological monographs, 47, 1-171.

Competing interests:
None declared