Human Dignity and Bioethics

Human Dignity and the Seriously Ill Patient | 509
The concerns I describe are separate from the bioethics concepts
Macklin invokes. As Miles Bore observes, “While [patients] might
voluntarily agree to a medical procedure, be well informed of the
procedure, have their records of the procedure kept in strict confidence,
be unharmed by the procedure and actually benefit from the
procedure, they might still incur and feel a loss of dignity.” 11
Dignity concerns arise in connection with the broader area of
personal privacy, but contrary to Macklin, they go beyond protecting
the confidentiality of medical communications. Patients enter a
world of forced and one-sided intimacy with strangers. Besides the
physical exposure that goes along with clinical care, there can be unwanted
exposure to members of the public.
Patients feel a loss of dignity when care intrudes into areas raising
particular privacy concerns. Having to wear “flimsy and revealing
hospital gowns” and being gossiped about by staff are some of the
violations that can occur. 12 Other examples include being bathed, using
a bedpan, and receiving an enema. 13 Being wheeled through the
halls in a wheelchair or on a gurney feels undignified too, especially
when the halls are public places with visitors and others who cannot
resist staring at the sight. Having medical students and residents
troop into a hospital room to make one an object of study can also
be experienced as an indignity. Having to open one’s bedroom to
home care professionals is yet another example of the forced intimacy
patients endure.
Although some personal invasions are probably unavoidable,
clinical care should minimize them as much as possible. The ordinary
norms governing physical privacy should be observed unless there
are good medical reasons to deviate from them. Clinicians and students
entering the examining room, hospital room, or home should
acknowledge the intrusion and undertake compensatory efforts to
preserve the patient’s dignity. As I discuss below, communication,
respect for personal knowledge, and responses to dependency can
reduce the indignities accompanying the loss of privacy that illness
brings.
Communication can have a lot to do with preserving patients’
dignity. The outward signs of illness create a heightened need to be
treated in a dignified manner. Hair loss, severe weight loss, and other
unwelcome changes make patients sensitive about appearing in