Dignity of the Patient

Abstract

This chapter will explore the concept of “dignity,” with particular reference to its use in the health-care setting. There is a substantial philosophical literature on dignity, both in discussion of its relevance or otherwise to bioethics, and perhaps more fundamentally, as to the precise meaning of the term. The chapter proceeds by introducing the way in which dignity language is used by patients and patient advocates. It is, crucially, a term that non-philosophers find effective in articulating their moral demands and protests. The chapter will then review the use of the term in international and national policy documents, before reviewing a number of core positions in the philosophical debate. Ruth Macklin’s rejection of the concept of “dignity,” as at best reducible to the more fundamental concept of autonomy, provides a stepping-off point. Defenders of dignity may be seen to take a number of different tactics. A “metaphysical” conception, as found most influentially by Kant, argues forcefully that dignity is a mark of the moral status of humans regardless of any empirically perceptible capacities or qualities they may possess. Other philosophers (such as Nussbaum) either seek to link dignity to empirically identifiable capabilities or to differentiate and articulate diverse uses of the term, thereby untangling moral arguments and identifying core or dominant senses. Running through these debates are a series of problems that affect the dignity of the patient. Most importantly, there lies the problem of respecting patients who either are unwilling or unable to assert their own dignity claims. These may be patients whose subjective sense of dignity has been so eroded that they no longer recognize themselves to be worthy of dignified treatment; others may have lost the capacity for autonomous action altogether. The worth of the language of dignity, and of different accounts of dignity, may be seen to be tested by their applicability to such cases.