Dr Paulina Taboada
Profesor Centro de Bioetica
Pontificia Universidad Catolica de Chile
Alameda 340 Correo Central 1
Santiago, Chile
According to the Remmelick Commission’s Report (1991) in Holland 56% of the patients who requested euthanasia did so because of a feeling of ‘loss of dignity’. This datum is remarkable not least because the feeling of ‘loss of dignity’ was not listed among the conditions for ‘justifiable euthanasia’ in Holland. Also data stemming from the State of Oregon suggest that a sense of ‘loss of dignity’ is a frequent cause of requests for physician assisted suicide.
As Engelhardt states (2000, p.311-312): "Why should nature be allowed to despoil the final chance to bequeath an example of a life self-possessed, a death completed with dignity, and a dying that does not burden others? Why should one not be free to die on one’s own terms, rather than at the whim of natural forces? If rationality, freedom, dignity, and self-determination distinguish the good life, should they not characterize the good death?... If a society values individual choice and self-determination regarding ways to life, it should presumptively value individual choices and self-determination regarding ways of death."
We encounter here a peculiar post-Kantian idea of an autonomous self informing contemporary understanding of dignity and our responses to pain and suffering. Pain and suffering are often automatically associated with a loss of dignity. An unspoken link between autonomy and dignity can be found here: those who lack autonomy are thought to lack dignity, and it is argued that a life without dignity is not worth living. Under this perspective, the interest in legalizing voluntary euthanasia and physician-assisted suicide appears to be tied to a conception of autonomy and the quest for meaning through self-determination. Indeed, perhaps the most popular arguments in favor of euthanasia and physician assisted suicide today are those stating that these are acts of humanity and compassion because they liberate a person from intolerable sufferings (principle of beneficence). Moreover, proponents of euthanasia would argue that if one does these acts at the patients’ explicit request, their right to autonomous, informed decision-making is secured (principle of autonomy). In this context, collaborating with an other’s free decisions is automatically considered to be a morally good act, while refusing it would be regarded as maleficent (or even cruel).
These arguments lead us to grasp the current need for a refreshed understanding of the concept of human dignity and its sources. An interesting contribution in this direction has been recently undertaken by Pullman in his article: "Human dignity and the ethics and aesthetics of pain and suffer ing" (Theoretical Medicine and Bioethics, 2002, 23: 75 – 94).
The purpose of the article is to show certain preconceptions of the nature of pain and suffering, and of their relationship to human dignity. After introducing a distinction between what he calls ‘basic’ and ‘personal’ dignity, the author shows that "contemporary notions of dignity and autonomy are tied to contingent features of the phenomenal world" (o.c. p. 80). According to the author, this represents a misunderstanding of the Kantian understanding of human dignity which "is a species referenced notion" (o.c., p. 79). Kant did in fact link dignity with autonomy. Nevertheless, the Kantian notion of autonomy was not a self-interested and individualized notion. "In Kant’s noumenal kingdom-of-ends ... autonomy and dignity are essentially one and the same. In that realm human beings have dignity because they are essentially autonomous. It is a dignity that can never be lost." (o.c. p. 79).
In spite of some critical points in Pullman’s position, I think that the way in which the author re-introduces the classical notion of the ‘ontological dignity’ of the human person (‘basic dignity’) by making a reference to the world of ethic and aesthetic values is extremely interesting. I can also share to some extent Pullman’s conclusion: "if we continue to emphasize personal autonomy and independence as the essence of the good and beautiful life, pain and suffering will be constructed as disruptive primarily of individual lives. The ongoing moral challenge in the face of pain and suffering is to ensure that our various expressions of the beautiful life continue to preserve and enhance the dignity we all share."(o.c. p. 91)
Dr. Paulina Taboada, MD, PhD
Palliative Care and Bioethics
