Human Dignity and Bioethics

510 | Rebecca Dresser
public. Small actions, such as making eye contact with a skinny, bald
cancer patient, are ways to confer dignity on such patients. Other
methods of reaching out, in person or in writing, can make a huge
difference in how a patient experiences the burdens of illness.
It is all too tempting to look away from people who are obviously
ill, in part because they are reminders of human frailty and mortality.
But the person inside still needs to be recognized, to be honored
and valued. If dignity is “a psychospiritual connection…that involves
empathy, presence, and compassion,” 14 sincere efforts to communicate
are essential to establishing this connection.
Another dimension of dignity is respect for the patient’s personal
knowledge. Being diagnosed with a life-threatening illness is
life-altering. Priorities, relationships, and social roles undergo drastic
change. Patients face mortality in ways that healthy people cannot
imagine. In this sense, patients know more than the relatives, friends,
and clinicians around them. Many patients suffer through chemotherapy,
radiation, surgery, and other burdensome interventions, and
this demands a kind of strength never before required. Dignity is
promoted when others honor the patient’s ordeal and look up to the
person enduring the assaults of illness and treatment.
Serious illness also brings a new kind of dependence, and being
dependent feels undignified to many people. Sometimes clinicians
respond to a patient’s desire for independence by giving her too
much responsibility for decisions she is unequipped to make. Telling
a patient that it is up to her to decide whether her symptoms merit
hospitalization is inappropriate when the patient lacks the medical
expertise needed to make such a choice. Expecting patients on high
doses of pain medication to exercise full autonomy is inappropriate,
too. On the other hand, pressuring patients to accept beneficial treatments
they are resisting can be appropriate.
Clinicians and informal caregivers respect human dignity when
they attend to patients’ needs for help in navigating the complicated
course of a serious illness. Thoughtless invocations of autonomy can
conflict with patients’ dignity interests. Patients are persons deserving
of high-quality care, and sometimes this requires others to assume
or share with them the authority for making difficult medical
decisions.