During a recent (and fortunately failed) campaign to legalize euthanasia in Portugal, I heard an argument which is usually waged on these sorts of debates by those favorable to euthanasia: “We just want people to be able to die with dignity”.
This is an understandable response to watching people (sometimes close family members or acquaintances) undergoing suffering on their last days of life. But as much as I can understand and even empathize with such reaction, I also know it is emotionally-driven and it betrays some confusion regarding end-of-life decisions and practices. Unfortunately, for various reasons, many people don’t get the best end-of-life treatment they can get, because palliative care resources are not widespread in many countries and especially, because a palliative care mindset is not widespread among the general population and, more grievously, among the medical profession. I will address this on a later article.
But, for now, I would like to focus on the “dying with dignity” canard. Usually, this slogan is coupled with lots of repulsive imagery of dying sick people enduring all sorts of physical and psychological pains, with no possible relief, described in the most gruesome way possible in order to elicit a visceral reaction against it, so that people will say: “this person would be better off dead”.
As a doctor who deals with these kinds of experiences every day, I must say this is not close to the reality of facts, at least not on the vast majority of cases. On my end (and mind you, this is an anecdotal experience), most of the patients who were in such dire situations actually were the ones who clung more avidly to life and fought against death the most. And since euthanasia is all about personal autonomy, this means that they would never choose euthanasia… meaning euthanasia would not “solve” the suggestive imagery that pro-euthanasia folks would use to describe such cases.
In fact, all my patients who consistently and consciously asked me for euthanasia were people who weren’t experiencing physical pain from their illness at all… and who died without suffering major pain.
So, I’ve come to the conclusion that the “die with dignity” problem is actually more deep than what a shallow Culture Wars approach might think. Pro-life people, fighting against euthanasia legislation, have focused too much on the “die” part of “die with dignity”, and less on the “dignity” part.
The problem is that our human perceptions have a warped idea of what “dignity” is. Our postmodern worldview (with all its utilitarian and hedonist thinking) exacerbates this problem, no doubt. But this warped perception of “dignity” is actually intrinsically connected to our humanity.
I have reached this conclusion by attending elderly patients who, comparing themselves to their younger selves, would complain: “But why am I still here now, doc? Wouldn’t I be better off dead?” They can’t work anymore, as they used to. They can’t do their pleasurable hobbies and activities, as they used to. They can’t perform, as they used to. They view themselves as burdens on their loved ones. And they think this is grounds for thinking themselves better off dead.
Mind you, these elderly people are usually extremely religious and would never, ever choose euthanasia. But still, they also share from this warped vision of dignity, since they think that old age, frailty, and impairment can somehow diminish their dignity.
However, this thinking is wrong. It means that dignity is based on what you “do”, not on what you “are”. That dignity is somehow contingent on what you can contribute to society or to the family unit. This is utilitarianism pure and simple… and therefore wrong. People aren’t valued more the more useful they are.
The Universal Declaration of Human Rights states, right at its beginning: “recognition of the inherent dignity and of the equal and inalienable rights of all members of the human family is the foundation of freedom, justice, and peace in the world”. In other words, dignity is inherent to all members of the human family, without distinction… and the human rights that come with such dignity are inalienable.
Mind you, this is a secular document. It is, however, not alone. The very well-known United States’ Declaration of Independence (which is also secular, even though clearly more Christian-based) also states: “We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness”.
By saying that rights are endowed by the Creator, the Founding Fathers were postulating that human rights are God-given… and, for that reason, unalienable. No human authority has the right to take them away. This ties very nicely with the Christian doctrine of Imago Dei (i.e. the image of God). For the book of Genesis states that man and woman were created “in the image and likeness of God” (Gn 1:26-28).
This means that whenever someone infringes on the rights of any man or woman, he is actually attacking a vessel containing the image and likeness of God. Religious people will usually shudder at the thought of someone desecrating some kind of sacred ground, building or object. If it is so, just imagine how much more should we tremble whenever the image and likeness of God are trampled on when someone attacks the dignity of the human person. God will never be mocked… and even if He may remain silent for some time, in the end, justice will prevail.
From this we can see that it is easier to defend the inherent concept of human dignity on religious grounds (especially religions with the Imago Dei doctrine): in these instances, human dignity is God-given in an unalienable fashion, and can’t be taken away or diminished.
Nevertheless, even on purely secular grounds, we can see that human rights only make sense if they are viewed as intrinsic to human nature. As something so inherent and inseparable from a person, as the concept of “roundness” is to a ball. If it were not so, we would have to arrive at conclusions that are unacceptable to our modern sensitivities (and rightly so).
If human dignity is not intrinsic to a human being, but contingent on external situations, then this means that every dictator who has incarcerated, tortured and eventually killed a freedom fighter who dissented against his corrupt and bloody regime… as won. This dictator was able to take away their human dignity. This dictator has become the taker of human dignity… and, as a corollary, this means that he is also the giver of human dignity, in the sense that a person can only have human dignity if he does not take it away.
Is this really what we want? Do we want to give the authority to grant and take human dignity to other human beings, as fallible and sinful as we are? And yet, even in western and “civilized” nations, we have fallen for the fallacy that human rights are given by governments and other human institutions. An unborn child only has dignity if he/she is chosen by their mother. An immigrant only has rights if he crosses the border legally. In all this, we see that human dignity seems to be contingent on what these human beings “do”, in their external situation.
This cannot stand. We must know that human dignity and human existence are intertwined. A human being in a dire situation does not lose his/her dignity. And this extends also to external situations which are not human-caused, like natural disasters and illnesses. People who can’t “do” what others can, people who are in situations of vulnerability, have exactly the same dignity as any other person.
However, I would like to venture one step even further. Let us not just claim that vulnerable people have the same dignity as others… let us try to understand that they have, in fact, more dignity.
This is most perfectly highlighted in the Christian religion. Christians worship a God Who died in a Cross. As a doctor, I tremble whenever I think of all the biological ramifications of someone being crucified. The suffering and the pain are excruciatingly atrocious.
And yet, who can say that this Crucified man has less dignity than the passersby of this horrible show? He is the living God incarnate! Who in the whole wide universe can claim a superior dignity than the One God of all things? And still, look at His suffering! Look at the miserable external conditions He was put on! Look at how impotent He is, without being able to do anything anymore, with His hands and feet nailed to a wooden instrument of torture… and yet, here is the source and summit of all human dignity.
This same God tried to teach us this lesson throughout His whole life. When the Magi from the East thought that a new king was born in Judah, they went straight to Herod’s palace. That’s where our human nature tells us human dignity is at its highest… someone of superior dignity should be in a royal palace, no? And yet, how many times those who we deem of superior dignity, kings, and princes, presidents and VIPs, have behaviors below their station as Imago Dei? How many times do their hearts get corrupted so that they act in inhuman fashion like Herod did?
No, God means to tell us that dignity lies elsewhere. The true King of Kings was born on a manger, in a stable, for He was rejected by every inn. Still, is there any more dignified vision than a Nativity Scene?
This Jesus of infinite dignity was, at some point during His life, an unborn child, a refugee fleeing persecution in a foreign land, a humble carpenter, a homeless sojourner dependent on the charity of others, and a convicted criminal. This is the perfect antidote to our natural human tendency to warp the concept of dignity into something it’s not.
That’s why, as Christians, we can understand the meaning of the biblical sentence: “Truly I tell you, whatever you did for one of the least of these brothers and sisters of Mine, you did for Me” (Mt 25:40).
Translating this into the secular realm, I think it’s quite obvious that, only by ascribing a dignity of the highest order to those who are most vulnerable can we evolve into a more solidary and civilized society. Only by seeing those who suffer as more dignified versions of the human ideal, can we start to relocate our resources and efforts into what should be our true priorities.
By doing so, we would not spend so much time quarreling over “dying with dignity” or whether the terminal sick have “lives worth living”. Those questions would not make any sense at all. Of course, those sick people have dignity! They have the utmost dignity! And because of that, we should roll up our sleeves to help them, be either through our voluntary work, our charities, but also with our political activism to change unfair political structures. We should fight for the cause that they will be able to have access to affordable healthcare in general, and palliative care in particular… but also be met with those human needs that institutional structures can’t ever provide in full: companionship and empathy. We should seek, above all political fireworks, to alleviate the suffering of those who are ill and help them cope with their situation.
Only by doing so can we achieve a more dignified society, and a Christian one.
Blogger @ https://wherepeteris.com