Harry Critchley considers the meaning and role of dignity within debates on medical assistance in dying.

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Though the Supreme Court of Canada unanimously ruled in Carter v Canada that the prohibition on assisted suicide violates section 7 of the Canadian Charter of Rights and Freedoms, medically assisted death continues to be a divisive issue for many Canadians. One clear indication of this are the serious challenges to the federal government’s proposed legislation on medical assistance in dying (Bill C-14).

In Canada and across the globe, debates on medical assistance in dying are frequently couched in language that refers to “the dignity of the human person.” Strangely enough, however, appeals to dignity are made in support of arguments that are completely at odds with one another. Dignity is invoked in support of the right to exercise control over one’s way of life and death, and so to “die with dignity.” At the same time, dignity is associated with the view that life has a sacred value, and so to attempt to shorten it artificially is an indignity of the highest order.

These competing understandings have led some to dismiss dignity outright. Bioethicist Ruth Macklin, for example, has argued that “appeals to dignity are either vague restatements of other, more precise, notions or mere slogans.” According to Macklin, in each case dignity means nothing more than respect for autonomy (that is, respect for the ability of persons to freely determine themselves). Since respect for autonomy is already an important societal principle, dignity could be eliminated “without any loss of content.”

Others, including the philosopher of law Mary Neal, suggest that Macklin’s reductionist view fails to account for dignity’s nuanced applications. Dignity maps onto autonomy when invoked to oppose restrictions on free speech, but seems to be doing something quite different when appealed to in support of bans on therapeutic cloning. Dismissing dignity as a useless concept overlooks the real and serious work that dignity is made to do in various contexts. For example, dignity is invoked to dictate how doctors should treat patients, how researchers should conduct themselves in the lab, and how judges should interpret the constitution. For better or for worse, Neal concludes, dignity is here to stay. For this reason, there is a pressing need to develop clearer parameters with which to distinguish the different guises in which dignity appears.

In recent years, important work has been done to trace the historical developments of the concept of dignity and to create categorizations of its distinct forms. While such categorizations may be useful for describing how dignity has been used in the past, they are much less so for determining how dignity should best be applied here and now. In taking on this second, more difficult task, the prevailing tendency has been either to argue for the primacy of one understanding of dignity (for example, sanctity of life or autonomy), or to allow for multiple different understandings of dignity, all of which are valid to the extent that they share some “core” value (for example, the intrinsic worth of all humans, or the priority of the individual over the collective).

A common problem with both of these approaches to understanding dignity, however, is the underlying assumption that dignity is best understood from a theoretical perspective. Another, more fruitful approach might be to examine the meaning of dignity with reference to its use in public discourse. On this view, to determine what dignity is requires that we ask what appeals to dignity are intended to do. Dignity is not only, or even primarily, appealed to in the solitude of philosophical contemplation, but rather in the company of others. Regardless of whether we understand dignity as sanctity of life or as autonomy, its emergence and acknowledgement in the political arena is an achievement not wholly dependent on its theoretical grounding.

Recall that dignity is said to attach to “human persons.” Though “human” and “person” may seem like synonyms, they are quite different. Roughly speaking, whereas humanity is something natural and shared (belonging to the species homo sapiens), personhood is what makes us distinct on the basis of certain abilities (being freely determining agents). When I make an appeal to dignity, then, as in the current debates about medical assistance in dying, I foreground one at the expense of the other. If I understand dignity as autonomy, my claim is that I am first and foremost a person, and so free to determine the value (or non-value) of my human life. If I understand dignity as sanctity of life, I claim the opposite – that my being a human places limits on my ability to be freely determining. These configurations and reconfigurations of the relation between the human and the person of dignity are matters of political concern. Though they may refer to lofty philosophical or religious convictions, their validity ultimately depends upon free agreement achieved through public discourse and debate.

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