A note on dying with dignity

DonaldLow[NOTE: I wish I could properly cite the interview on which I am basing this post, but I just can’t find it.  If anyone can provide me with a link to the actual story, please let me know.]

On 25 September, around 7:00 pm, I listened to an interview on CBC Radio 1 (Toronto) of a professor of Disability Studies from Ryerson University.  The interview was essentially a commentary of a powerful video by Dr. Donald Low, the exceptional microbiologist who steered Toronto through the 2003 SARS crisis. In that video, Dr. Low called for new standards to provide dying with dignity to everyone.  The commentary by the Ryerson professor, herself disabled, raised warning flags about Dr. Low’s call.

She talked – very eloquently – about all the different ways that one can define “dignity” as a social norm, and that any such norm would lead to a slippery slope that would end up with the disabled being euthanized without their consent because society had decided they lacked “dignity” in their lives.  Essentially, she argued that every life has some kind of inherent dignity that must be respected – even if that means denying them dignity in death.

Unfortunately, this misses Dr. Low’s point entirely.  (Not to mention the fact that “slippery slopes” are representative of fallacious reasoning.  Rule 38: There are no slippery slopes, only slippery people.)

There are all kinds of people with disabilities out there who are living brilliant, fulfilling, meaningful, and dignified lives out there.  Only a fool would think otherwise, and only a troglodyte would argue that a disability de facto robs a person of dignity.  Dr. Low’s message was not about that at all.

Instead, Dr. Low argued was that one should be able to self-determine one’s own definition of dignity, and to decide on a course of action at the end of one’s life that was consistent with that personal definition and not with any social or legal norm.

The Ryerson professor argued that a prescriptive definition of “dignity” would end up imposing the standards of the state upon individuals who might not agree with those standards.  This would surely be terrible if it led to people being killed without their consent.  Indeed, I think it would be murder to do so.

But in arguing against such a stance, the professor was actually arguing for something just as prescriptive and therefore just as detrimental. In an effort to prevent the admittedly horrendous possibility of disabled people being killed against their wishes, one must assume – as the Ryerson professor did – that there is an inherent dignity in every person that is independent of their abilities or disabilities. This results in two significant and, I believe, harmful effects.

First, all universal definitions of “dignity” as social (and legal) norms are equally prescriptive, whether they define when people can be euthanized against their will, or whether they result in an effective ban on dignified dying because everyone’s life has inherent dignity that is violated by assisted dying, thus condemning many people to unnecessary suffering.  The problem here is the prescriptive nature of the norm.  In this sense, the professor’s stance against all types of assisted suicide, or dignified death, or whatever you want to call it, is just as prescriptive as a stance that requires certain people to be killed against their wishes.  This kind of prescription robs one of both the freedom to choose, and the responsibility to live with the consequences of those choices.  Either way, whether prescribing for or against assisted death, she expects the population to abdicate their personal responsibility of living, and dying, as well as they can.

There may well be times when such abdication is warranted, but this isn’t one of them.  Surely, the right to choose the manner of one’s own death is as personal a decision as one could ever make.  To rob one of this kind of choice is all kinds of wrong.

Second, by establishing that dignity is so characterized as to be present in every person to an equal amount makes it irrelevant – it can in essence be cancelled out of any equation that might be used to guide decision making for terminal patients.  That is, if everyone has dignity in equal measure, then it cannot be used in any sensible way in any decision-making process.

I think Dr. Low knew this.  And this is why he argued for something entirely different.  He was arguing for the distinctiveness of each person’s life, experiences, goals, and dreams, and that choosing the manner of one’s death must be framed with respect to that distinctiveness.  Dr. Low wished he could have avoided those last, few, horrible days as he felt his body deteriorate rapidly, because he wanted to die with dignity – where “dignity” was whatever he defined it to be.  He did not ever suggest that what he thought of as a dignified death would apply to anyone other than himself.  He did not think anyone else should be killed because he wished his own life to end under his own control.

If Dr. Low was arguing for a new social norm, it was for one of acceptance that everyone should be able to define their own personal criteria for a successful life and a dignified death.  It’s a norm of choice, of freedom, and of acceptance of “the other” as equally worthy.

Of course, this kind of freedom requires an educated and a well-informed population.  Good decisions cannot be made without them.  So if there’s another norm being advocated for, implicitly, by Dr. Low, it’s one of higher standards of education of, and high quality information for, the general population.

Those are norms that I think any sensible person could get behind.


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