Movement Strategy: Human Dignity, Suffering and Aid in Dying.

The self-proclaimed "politically incorrect" NoApologies latches onto Margaret Somerville's recent piece in the Montreal Gazette (which I wrote about here) and titles his post with a question, "What is 'Human Dignity?' Grandma's Life May Depend on the Answer...." NoApologies writes:

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.

Framing the argument for aid in dying around the concept of human dignity (as was in part done in the Baxter v. Montana case) may work for some state constitutions and for some advocates but it's not a viable long term strategy for the movement. Precisely because, as NoApologies inadvertently points out, it allows aid in dying advocates to be vulnerable on two fronts: the "slippery slope" front, a very old argument that defining one's dignity will lead to an ever-increasing "elasticity" (as Wesley J. Smith says) of the law. This scares people and leads to association with the long-time boogie-bear issue aid in dying advocates have had since WWII, "euthanasia."

The second front is disability. Once a terminal patient talks about living in a wheel chair or a bed or being incontinent, it is seen as an affront to all those who live their lives with extreme disability (see the Not Dead Yet folks).

The objective of the movement is to support and advocate for patients' rights. Only a patient can decide when they have had enough suffering, when they wish to end their life. Not the medical profession, not the state, not the church. Of course, the attacks here are also pat (again, see Wesley J. Smith) but more defensible. Mental health and depression will always be unquantifiable measures regarding aid in dying, but as the laws are currently written in Washington and Oregon, two doctors are left to decide if the patient is mentally competent (so the decision is left with the medical profession, not the patient, which pleases proud organized medicine with the final word and pleases the state because they can claim they've got a "professional" on the case).

The third party to oppose aid in dying, the Church, has cerebral and emotional appeal (or aid in dying would be universally legal by now). Examining why the Church wishes to protect suffering, however, sounds a little bunk to most who fear the pain of death and see their life as their own. Suffering is redemptive and protected by the church as a method of winning souls. Tell a man dying of leukemia, in pain, and uninterested in suffering that it will make him a better person, at least until his body gives out. No fly.

While dignity may be a common argument in the end of life movement, it can't be the only one. Suffering is what opponents of aid in dying wish to protect - or rather their authority over human suffering. Losing sight of this will do the movement no good.