Sunday, November 22, 2009

Oh Margaret Somerville, It's Not About Your Dignity, It's About My Suffering!

For three decades women argued that abortion should be legal because a woman should have a choice over her body and reproduction. Because of this stance on abortion, the "pro-life" camp was able to steal the moral thunder of the argument.

Now we've got a culture where women are afraid to admit they've had abortions, where the church is ceded the moral high ground on the issue even through their policies subjugate women, particularly the poor. The framing of abortion has become such that Hillary Clinton has said we should work to decrease the number of abortions, missing the point that there is no moral ground for those who argue for it's illegalization.

When I hear arguments for aid in dying being based on dignity, I get a little nervous, afraid that the same framing we have seen around the abortion issue (and what has perpetually kept us on the brink of losing abortion rights) could be applied - is being applied! - to end of life rights.

In the below excerpt from an article in Canada's The Gazette, hyper-conservative bioethicist Margaret Somerville (no same-sex marriage, no reproductive rights for women, no patients' rights...) takes apart the idea of dignity in her defense of imposing religious ideology on patients.

Despite the oral arguments in the recent Baxter v. Montana case, I would say that framing aid in dying as an issue of dignity is going to get us nowhere in this global discussion. We all define dignity in very subjective ways.

What people are contesting in the fight for aid in dying is: Who Has Jurisdiction Over Suffering? Of course suffering comes in many forms. But no one but the patient can tell you what is suffering and what is not. And no one but the patient can tell you what suffering they can handle and what they can not. The problem with Somerville's argument is that she wants to defend the state's or the church's or the medical professions jurisdiction over suffering. These institutions have a vested interest in telling patients what they will and won't suffer for reasons that include: punishment, religious redemption, and professional pride and profit.

Don't miss me here, I'm talking about institutions, not individuals. If someone tells you they will decide how much you're going to suffer, no number of claims for human dignity are going to stop them. Suffering is sacred and powerful.

Let's make certain that the aid in dying movement doesn't lose site of the role suffering must play in this discussion; not just dignity, personal rights, autonomy, and choice. I would hate for those with other purposes to frame the argument in a way that sets back the movement thirty years.

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.

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