Few concepts are more disputed in bioethics than “human dignity”. Ruth Macklin wrote a very short but very famous demolition of the notion in 2003, asserting that “Dignity is a useless concept”. The broad consensus amongst bioethicists is that she was right.
However, in the Journal of Medical Ethics, Linda Barclay, of Monash University, in Melbourne, takes a second look at her argument and concludes that while “human dignity” may be disputed and unclear, it is not altogether useless. For even though it has become a punching bag for bioethicists, there survives an “enormous practical concern for dignity in healthcare settings”.
She makes sense of this by accepting the traditional distinction between intrinsic dignity and extrinsic dignity. As for the former, she agrees with Macklin that it is a useless concept. But external dignity is far from useless; whether it is articulated or not, it is fundamental to healthcare. She interprets “dignity” as “status”.
On my conception of dignity, dignity is conferred in social relations where we follow social norms for treating people as sharing equal status. When we do so, we communicate to others that we consider them our social equals ... Conversely, people do not enjoy dignity when they are routinely treated in a way that relegates them to a lower social status.
Patients are often treated as social inferiors and their privacy, decorum and respect are disregarded. She cites one researcher who found that “the day-to-day exchanges of the sick, homeless and poor are characterised by rudeness, indifference, condescension, contempt, exclusion and vilification”.
This is not only a violation of their dignity, but poses a danger for their physical well-being. “Specifically, when people are regularly treated as social inferiors, they can be particularly vulnerable to maltreatment and abuse.” This danger is particularly acute for people with cognitive impairment, who become victims of dehumanising stigma.
Barclay concludes: “We are now in a position to see that Macklin is wrong to claim that dignity is a useless concept. Respecting persons and respecting their autonomy are not coextensive with treating them with dignity.”
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