Human Dignity and Bioethics

526 | Edmund D. Pellegrino
even when made by the patient himself. Sensitivity to the subtle differences
between inherent and perceived dignity must be developed
in physicians and all who minister to the sick or to persons in distress
for any reason.
Ascertaining the patient’s own quality-of-life choices does not
entail an obligation on the part of physicians to suppress their moral
beliefs in deference to the patient’s wishes. This would violate the
dignity inherent in each physician; how, ethically, to deal with such
conflicts is a question for another occasion.
Chronic Illness
Any serious illness is an assault on the whole person, one that challenges
the image we have fashioned of ourselves over a lifetime. That
image is pieced together carefully to form a synthesis of who we think
we are, who we wish to be, and who we are in fact. Our aspirations
are carefully molded to fit our physical, mental, or social limitations.
Throughout life, we repair or adjust our image as it is challenged by
the events in our lived world. Most of us reach some sort of equilibrium
between our hoped-for worthiness and our worthiness as judged
by others. We settle somewhere between the dignity we would prefer
to have attributed to us and the dignity we possess in the eyes of the
world we live in.
Serious illness shatters that equilibrium. It forces upon us a new
image of ourselves, often drastically altered compared to our old selfimage.
The business mogul who suffers a massive heart attack, the
truck driver who has had his first epileptic episode, the housewife
and mother whose lymphoma is outpacing her chemotherapy—each
suffers an ontological assault. The image they cherish of their own
worth and the worth of their lives to others is forcibly shattered.
Some patients can renovate their self-images. Many cannot, or
do not, do so. Too many lose all sense of personal worth and despair
of regaining identifiable dignity. They often become depressed or suicidal.
Others present heroic examples of recapturing a new sense of
dignity and grow with the experience. Still others fear dying without
dignity. The way each responds becomes a determinant of the dignity,
or indignity, others impute to them.