Dignity and medical procedures.

There is little lack of rhetoric on the subject of dignity. 'The dignity of the individual', 'freedom and dignity', 'the dignity of a natural death' these expressions, and others, are familiar in political and ethical discussions. But what exactly does dignity imply? Surprisingly, it is a term which is rarely defined. Just as with cruelty or evil, we tend to recognise indignity when we are confronted by it, but such intuitive recognition is hardly sufficient for the purposes of the serious ethical debate which now surrounds the topic of the control of medical and scientific progress. Two scholars from different disciplines have recently touched on the notion ofhuman dignity. In an elegant essay, 'On Dignity', Aurel Kolnai has attempted to spotlight those attributes of behaviour which lead it to be described as dignified (i). Central to Kolnai's concept of dignity is the control which a person has over his actions. Undignified behaviour is behaviour in which passion of some sort is a predominant feature. We do not conduct ourselves with dignity if we allow ourselves to be 'overcome' with anger or other emotions, acting, as a result, in a way which is seen as inappropriate. A man hopelessly in love and quite incapable of doing anything but pursuing the object of his passion loses in this sense his dignity. Looking at the problem from a different point of view, Leon Kass stresses that dignity is synonymous to an extent with 'excellence'. 'In all its meanings', suggests Kass, '(dignity) is not something which, like a navel or a nervous system, is to be expected or to be found in every living human being' (2). Indignity, on the other hand, is seen as an 'offence against personal dignity' (according to one dictionary definition of it). It is questionable whether Professor Kass is right to stress the 'excellent' or 'honourable' attributes of the notion of dignity, attributes which would be deemed to be present or absent in any one person according to objective criteria. Dignity can surely also be founded on a subjective notion of worth which is entertained by the person himself. Thus one who is devoid of excellence according to what is objectively seen as excellence, and who may also have little worth as an individual in the sense of being of negative value to a community, may still have a sense of his own worth which constitutes his personal dignity. In this sense, indignity is an affront to an individual dignity which may be born by someone who, according to objective standards, may otherwise be considered to be lacking in dignity. If there is then, at the least, a certain level of personal dignity which we may take to be present in every human being (except, arguably, in the case of one who has absolutely no sense of his own worth), in what way can this dignity be affronted by certain medical procedures ? It is a common argument that we should abstain from subjecting a person suffering from a terminal illness to procedures which compromise dignity and merely prolong an existence that is rapidly becoming increasingly undignified. These procedures are certainly not intended as an affront and therefore cannot be said to infringe dignity deliberately, in the way in which an intentional insult may do. If they do pose a threat to dignity then, this threat must exist in certain ambivalent features of the procedures which, by virtue of the condition of the person upon whom they are visited, constitute an indignity.