Euthanasia advocates
argue respect for human dignity requires that euthanasia be legalized
and opponents of euthanasia argue exactly the opposite, that respect
for human dignity requires it remain prohibited. In short, the
concept of human dignity and what is required to respect it is at the
centre of the euthanasia debate, but there is no consensus on what we
mean by human dignity, its proper use, or its basis.

American political
scientist Diana Schaub says “we no longer agree about the
content of dignity, because we no longer share… a ‘vision of what
it means to be human’.” She’s correct. So what are the various
interpretations of dignity and what can they tell us about “what
it means to be human”?

Intrinsic dignity
means one has dignity simply because one is human. This is a status
model — dignity comes simply with being a human being. It’s an
example of “recognition respect” — respect is contingent
on what one is, a human being.

Extrinsic dignity
means that whether one has dignity depends on the circumstances in
which one finds oneself and whether others see one as having dignity.
Dignity is conferred and can be taken away. Dignity depends on what
one can or cannot do. Extrinsic dignity is a functional or
achievement model — dignity comes with being able to perform in a
certain way and not to perform in other ways. It comes with being a
human doing. This is an example of “appraisal respect” —
respect is contingent on what one does.

These two
definitions provide very different answers as to what respect for
human dignity requires in relation to disabled or dying people, and
that matters in relation to euthanasia.

Under an inherent
dignity approach, dying people are still human beings, therefore they
have dignity. Opponents of euthanasia believe respect for human
dignity requires, above all, respect for human life and that while
suffering must be relieved, life must not be intentionally ended.
Taking life, except where that is the only way to save life as in
justified self-defence, offends human dignity. That is why capital
punishment is wrong and why euthanasia is wrong.

In fact, the
original primary purpose of the concept of dignity was to ensure
respect for life. It’s ironic that it has been turned on its head by
pro-euthanasia advocates to promote exactly the opposite outcome.

Under an extrinsic
dignity approach, dying people are no longer human doings — that is,
they are seen as having lost their dignity — and eliminating them
through euthanasia is perceived as remedying their undignified state.

Pro-euthanasia
advocates argue that below a certain quality of life a person loses
all dignity. They believe that respect for dignity requires the
absence of suffering, whether from disability or terminal illness,
and, as well, respect for autonomy and self-determination.
Consequently, they argue that respect for the dignity of suffering
people who request euthanasia requires it to be an option.

Importantly, to
respect human dignity we must have respect for both the human dignity
of each individual and for the worth of humanity as a whole. That
means that even if we accepted that individual consent could justify
taking human life, it is not necessarily sufficient to ensure human
dignity is not being violated. For instance, a French court ruled
that the “sport” of “dwarf throwing” was in
breach of respect for human dignity and banned it, even though the
dwarfs involved consented.

Even those people
who argue for euthanasia should agree that it must be used only as a
last resort. The work of Canadian psychiatrist Harvey Chochinov, who
specializes in psychiatric care for dying people, is relevant in this
regard. He and his co-researchers identified the components of
dignity and defined them. They then designed an approach to enhance
terminally-ill people’s feelings of dignity and being treated with
respect for their dignity, in order to address their psycho-social
and existential distress. They call this approach “dignity
therapy.”

Here are their
results: “Ninety-one per cent of participants reported being
satisfied with dignity therapy; 76 per cent reported a heightened
sense of dignity; 68 per cent reported an increased sense of purpose;
67 per cent reported a heightened sense of meaning; 47 per cent
reported an increased will to live; and 81 per cent reported that it
had been or would be of help to their family. Post-intervention
measures of suffering showed significant improvement and reduced
depressive symptoms.”

These are truly
remarkable results and provide a stark contrast to a quick-fix
solution of a lethal injection as being the best way to enhance a
person’s dignity. But to achieve them takes care, time, commitment,
research and expertise. In thinking about investing health-care and
medical-research dollars to enhance human dignity, we should keep in
mind such studies.

Some commentators
have distinguished different ways in which the concept of dignity can
be used in bioethics. One they term “human dignity as
empowerment.” The central idea here is that one’s dignity is
violated if one’s autonomy is not respected, and this concept leads
quite naturally to an emphasis upon informed consent, as we see in
pro-euthanasia arguments. Another concept is “human dignity as
constraint”– that is, constraint on individual choices to
protect human dignity, in general, as we can see in anti-euthanasia
arguments.

The idea of dignity
as constraint of autonomy and self-determination to preserve human
dignity, in general, could be described as “dignity in fetters.”
In that case, it is similar to “freedom in fetters.”
Sometimes we have to restrict freedom to maintain the conditions that
make freedom possible.

Dignity is like
justice, often it’s easier to identify what constitutes a violation
of it, than to define what it is. That probably explains why it is
not uncommon to speak of something being “beneath human dignity”
without defining what dignity is. That tells us that what is involved
— torture, for example — does not respect human dignity, which
might be a judgment informed in part by moral intuition or examined
emotions, not just logical cognitive mentation or reason, important
as the latter are.

Some philosophers
see dignity as the marker of the ethical and moral sense humans have,
which they see as distinguishing humans from animals, which also have
consciousness. They believe humans are “special” because of
this moral sense and, therefore, deserve special respect. Others
reject any special status for humans and see us as just another
animal in the forest. Arguments that we euthanize our dogs and cats
and so should do the same for humans reflect this latter view.

Secularists argue
that dignity is intimately connected with religion and reject it on
this basis. It’s true that some commentators believe “human
dignity is based on the mystery of the human soul” and most
people regard “soul” as a religious concept with a
theological base. But I’d like to suggest a broader concept that
might allow us to find a wider consensus about the values we should
adopt if we are to respect human dignity, in particular in the
context of death and dying.

In my book The
Ethical Canary
, I introduced a concept 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, and religious people objected that I was
denigrating the concept of the sacred.

What I suggested is
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. Among other outcomes, it might help us to
articulate what respect for human dignity requires.

I proposed that
linking the secular and the sacred, by adopting a concept of the
secular sacred, can help to unite everyone who accepts that some
things are sacred, whether they see the sacred’s source as religious
or purely natural or secular. In short, the “secular sacred”
is a concept we can endorse whether or not we are religious, and, if
we are religious, no matter which religion we follow.

The sacred requires
that we respect the integrity of the elements that allow us to fully
experience being fully human; in doing so, we protect that
experience. It is a concept that we should use to protect that which
is most precious in human life, starting with life itself. I propose,
as has been true for millennia, that that requires us, as a society,
to reject euthanasia.

The concept of
dignity must be used to maintain respect for the life of each person,
and for human life and for the essence of our humanness, in general.
The current danger is that in the euthanasia debate it could be used
to realize precisely the opposite outcomes.


Margaret
Somerville is director of the Centre for Medicine, Ethics and Law at
McGill University.

Margaret Somerville is Professor of Bioethics at the University of Notre Dame Australia School of Medicine (Sydney campus). She is also Samuel Gale Professor of Law Emerita, Professor Emerita in the Faculty...