The Role of Dignity in the Euthanasia Debate

DISPUTES OVER DIGNITY:

THE ROLE OF DIGNITY IN THE EUTHANASIA DEBATE

MARGARET SOMERVILLE

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

Abstract

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 person’s 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?

PART I

EXPLORING THE CONCEPT OF DIGNITY

1. INTRODUCTION:

IS THE CONCEPT OF HUMAN DIGNITY USEFUL, USELESS OR DANGEROUS?

The lawyer’s 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 don’t 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

INTERNATIONAL INSTRUMENTS

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 Down’s 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.

NOTE:

·  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.

Why?

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 President’s Council on Bioethics

We can agree that dignity needs to be respected, while we don’t 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 everyone’s 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.

Let’s 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’.”

She’s 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, I’ll 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 President’s 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 Macklin’s 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, let’s look at what some of the essayists who contributed to the President’s 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 human rights. Answer no, and it means that we are merely another animal in the forest.”

A powerful warning that deciding about dignity is no insignificant issue or choice on our parts.

And nowhere is deciding about dignity more important than in relation to the question of whether or not we should legalize euthanasia.

Many secular humanists argue that dignity is necessarily connected with religion, which is the reason they label it a useless, at best, dangerous, at worst, concept.

But are they correct that it’s necessarily a religious concept?

ii) Is dignity connected with religion?

Robert Kraynak, a professor of political science, believes “human dignity is based on the mystery of the human soul”.

Most people regard “soul” as a religious concept with a theological base. But I’d like to suggest a broader concept linked to soul that might allow us to find a broader consensus about the values we should adopt if we are to respect human dignity.

I have spoken about what I call the human spirit in my book, The Ethical Imagination and its importance in dealing with ethical issues. Let me explain what I mean by the human spirit.

I adopt a very broad definition of spirituality and regard it as a natural, inherent characteristic common to all humans, which some people express through religious belief and practice, and others express in secular ways.

We can call our capacity to experience that spirituality the “human spirit”.

Our longing for transcendence – the need to feel we belong to something larger than ourselves – I see as an expression of the human spirit.

Our human spirit is that which makes us human and enables us to experience amazement, wonder and awe at the mystery of life, and through it we search for meaning.

This search for meaning is of the essence of being human; we are meaning seeking beings and, as far as we know, uniquely so.

Human spirit is a term I use in a religiously neutral sense, so it's open to people who are not religious and those who are, and, if religious, no matter what their religion. In other words, a belief in the human spirit does not require a belief in the supernatural or any religious belief, but it is not antithetical to religious belief.

In short, we can all agree that we have a human spirit and having that shared starting point is very important in searching for some shared ethics in our contemporary, pluralistic, multicultural multi-religious secular societies.

Here’s how I define the human spirit:

It is the intangible, immeasurable, ineffable, numinous reality that all of us need to have access to find meaning in life and to make life worth living — a deeply intuitive sense of relatedness or connectedness to all life, especially other people, to the world, and to the universe in which we live; the metaphysical -- but not necessarily supernatural -- reality which we need to experience to live fully human lives.

iii) Is dignity connected with sacredness?

I believe that we need to enlist a concept of sacredness to protect and promote our human spirit.

The Oxford English Dictionary defines sacred, inter alia, as “regarded with or entitled to respect or reverence”.

I will speak about what I mean by sacredness shortly.

And if dignity is connected with sacredness that would mean dignity is connected with protecting and promoting our human spirit.

British philosopher Roger Scruton provides an insight that is relevant to understanding the nature of dignity.

He says that what is left out of contemporary standard treatments of ethics is the requirement to “face the surrounding world with due reverence and humility” — a disposition he calls piety. I agree with him — although what he calls piety I’d call respect for the secular sacred.

In my book “The Ethical Canary”, I introduced a concept that I called the “secular sacred” – everyone disliked it.

Secular people thought I was trying to impose religion on them and that religion had no place in the public square or public policy, and religious people objected that I was denigrating the concept of the sacred.

One of my students said to me “ You know, Professor Somerville, when you have everyone mad at you, you are probably on to something important”, so I further explored the concept in my following book “The Ethical Imagination”.

In talking about the secular sacred, I am proposing that the sacred is not only a concept that applies in a religious or ritualized context, but also one that operates at a general societal — or secular — level.

I’m proposing it as a concept that, among other outcomes, might help us to find some shared ethics, including in relation to what respect for human dignity requires, in particular with respect to people who are dying, and that we can endorse this concept whether or not we are religious, and, if we are religious, no matter which religion we follow.

I believe that each of us needs to experience a complex interaction of knowing ourselves, relating to others, appreciating our place in the great web of all life, and seeing ourselves as part of the earth, the stars, the universe, and the cosmos. The acute and continuous awareness of such a mind-blowing web of relationships is what I have already described to you as the “human spirit”.