Three views of dignity
Social Science in the City
19 April 2012
How I got here
• Teaching
• Conference
• Awareness of many and varied occasions of
use
– Obama on Syria and the ‘Arab spring’
– Dignity of the care worker
– Dignity of the bereaved or assaulted
– Dominique Strauss Kahn
– Kim Jong-un
Appeals to dignity
in health and social care
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2006:
2009:
Feb 2010:
Feb 2011:
Dignity in Care Campaign
National Dignity Council
Francis Report: Mid-Staffs Hosp
Health Service Ombudsman:
‘Care and Compassion’ Report
Oct 2011: CQC: Dignity and nutrition for older people
Nov 2011: Francis enquiry re-opened.
Nov 2011: EHRC: Inquiry into Home Care
Feb 2012: Cmn on Dignity in Care: ‘Delivering Dignity’
• Winterbourne View?
Defining dignity
• ‘...dignity itself has proved very difficult to define.
For more than a decade, researchers have
struggled to pin down what is in essence an
ethical concept that varies according to the
cultural, historical and philosophical contexts in
which it is discussed…some …have taken the view
that difficulties of definition made an emphasis
on dignity in care, at best, of limited use in
practice…’
(SCIE 2010)
Aims
• To set out some ideas about how the concept
can be understood - particularly through how
it is used
• To consider its strengths and limitations in
thinking about how failures and abuses in
practice can be addressed
Three views of dignity
• Of all - as something shared equally by human
beings as such
• Of each - as something associated with a
particular status or rank
• Of a community - as something which marks
out how we think of ourselves collectively
The dignity of all
• In the West we are much more likely to
acknowledge concern with the dignity of all, than
the dignity of each
• Written into the Universal Declaration of Human
Rights as the basis for asserting them, but is
unexplored:
‘All human beings are born free, equal in dignity
and human rights. They are endowed with
reason and conscience and should act towards
one another in a spirit of brotherhood’
(UN 1948: Article 1)
The dignity of each
• Dignity of each entails hierarchy and differential
status – the assertion of inequality rather than
equality
• If we are prepared to acknowledge a sense of our
own status, rank and honour we will usually
accept that not everyone will see it in the same
way (Eg position in a professional hierarchy)
• Too public assertions of status and rank provoke
at best mixed reactions (eg academic dress)
The dignity of a community
Examples
• Ranking between professions
• Dress indicative of religious community
• Dignity of an office rather than a person
An account of dignity and its uses
• Whether of all, of each or of a community,
dignity is a quality of the possessor that when
asserted, is asserted as the basis for a claim to
– Recognition
– Respect
– Honour
– Deference
• It is not a quality of the treatment offered to
another (ie it is not respect, it is what is
respected)
An account of dignity and its uses
Pride associated with holding status, or
occupation of a rank. For someone’s sense of
their own dignity not to be recognised is
– a dishonour, and an occasion for anger or
resentment,
– and to the extent that others have an interest in
one’s assertion of dignity, potentially a source of
shame
– which requires apology, restitution or revenge
An account of dignity and its uses
Many and complex symbols of dignity. E.g:
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•
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Title
Forms of address
Insignia
Clothing
An account of dignity and its uses
Concern with rank and social differentiation
seemingly much diminished in West over last
two centuries
– duels are rarely fought
– symbols of rank are less ostentatious
An account of dignity and its uses
• Related to the fact that rank and status are
more open to be acquired and can rarely be
asserted across the range of one’s social
encounters
• So a person’s sense of what their dignity
requires is not likely to be as publicly readable
as it once was
Dignity in health and social care
• Likely to emerge as an issue when someone,
for whatever reason, has reduced capacity to
insist on respect for their dignity, or sense of
personal worth
• Appeals to dignity are appeals to others to
treat that person as they (the person
themselves not the others) might expect to be
treated
Dignity in health and social care
• But since a person’s estimation of what their
dignity requires is no longer so publicly
readable, how are we to know how to act?
• And in any case, how comfortable is it for
someone working in the public service to treat
people differentially?
The dignity of all
• Is there some core of respect which should be
offered to all regardless of social status?
• If so, what is the ground for this?
The problem of human rights
• ‘… natural rights is simple nonsense: natural
and imprescriptible rights, rhetorical nonsense
- nonsense upon stilts…’ (Bentham)
• ‘Belief in the existence of [natural or human
rights] is one with the belief in witches and in
unicorns’(MacIntyre 1982:67)
The dignity of all
Some extreme examples of situations giving
rise to appeals to respect for dignity:
• The body on the mortuary table
• The deportee to an extermination camp
The dignity of each and of all
The first is interesting because it shows that
the person for whose dignity respect can be
demanded is in some degree independent of
there being a living body to link it to. While
the body in question no longer has purposes
of its own, we who remain have purposes for
it either as
– the physical site of the social person that we are
intimately connected with or have feelings for
– or as representative of how any body (living or
otherwise) can be treated
The dignity of each and of all
• Since the person is intimately connected to
the body, if a body is treated as no more than
a collection of biological matter (cf Alder Hey)
then our sense of what makes us persons is
exposed as extraordinarily fragile
• Without confidence in how others will treat us
physically, our faith in how other will treat us
socially – in what value and personhood they
are prepared to accord to us – is reduced
almost to nothing
The dignity of each and of all
• We all then become ashamed in the demonstration
of the worthlessness of our bare physical being,
and need reassurance that the dignity and worth
we assert as living social persons will be respected.
• So while dignity might point to social
differentiation we are all interested in participating
in that system of social differentiation (and so of
connectedness) and in having it sustained
The dignity of each
• Note again how dignity (and indignity) are
powerfully linked to clothing. The naked body
is the human person stripped of all pretention.
• Only in the most intimate relationships can
that lack of pretension become something – a
source of personal affirmation.
The dignity of all
• The deportee in the extermination camp is the
type case of the failure of a claim that there
are such things as human rights (or more
particularly that those rights were inalienable)
The dignity of all
• Humans were herded into cattle trucks,
stripped of all marks of personhood and
physical identity – including hair, teeth and
glasses – treated as absolutely the bare
human, and killed in their millions.
• Reduced to their bare humanity there was
nothing left to protect them.
The dignity of all
• On the other hand the extermination camps have
been pointed to as showing the absolute
necessity of establishing the existence of a dignity
and a claim to respect which depends only on
being human, and is independent of social status.
• The urgency of such a claim is evident, but the
question remains – what grounds are there to
accept it?
Dignity and respect for persons
Bernard Williams discusses Kant’s notion of
respect for persons as owed equally to all as
rational moral agents independently of ‘any
empirical capacities which men [sic] may possess
unequally…[there is nothing] empirical about
men that constitutes the ground of equal
respect…’
and says
This… cannot provide any solid foundation for the
notions of equality among men or of equality of
respect owed to them’
[Williams 1973: 235]
Dignity and respect for persons
But Williams argues that notion of respect for
persons is still important in requiring us to
think about people – independently of their
differing abilities, achievements or social roles
– as people with
• capacity to suffer, feel pain, seek attachments
• desires to be identified with own purposes,
and not just as an instrument of others’
purposes
Dignity and respect for persons
This does not provide strong grounds for treating
people equally but does require that we should
• try to see the world from the other’s point of
view (independently of their particular roles and
abilities)
• give relevant reasons for how we treat them in
regard to these (ie not just arbitrarily) and
• not collude in crushing people’s capacity to
develop needs, wants or purposes of their own
The dignity of all
• I think it is in this last point that the notion of a
dignity possessed by all has most purchase.
• Though a given human being may lack any mark
of specific rank, status or social identity (eg the
abandoned infant, the stateless refugee) they do
still bear the capacity for joy and suffering, love
and happiness, flourishing and the fulfilment of
their own purposes – for being or becoming
persons.
The dignity of all
• And even if they do not (as with the case of the
body on the mortuary table) we still have some
collective interest in behaving as if they do.
• This is not to provide a claim of rights with a solid
foundation, but…
• ‘Either we can work out our anxiety and
vulnerability by seeking to demean and oppress
others, or we can seek to develop arrangements
that assure the security and freedom of all’
(Isaac, G. C. 1996:66)
The dignity of all
• What this account suggests is that if there can
be any agreement on common human worth
it is to be found in the willingness of us all to
offer it to each other.
• But while in an increasingly mobile, socially
fragmented and multi-cultural world, we have
growing incentive to reach one, we are at the
same time brought into confrontation with
the challenges of agreeing what this might
consist in.
Thinking beyond dignity
in health and social care
• My reference to Bernard Williams concluded
by suggesting what respect for persons would
require us not to do (collude in crushing
people’s capacity to develop needs, wants or
purposes of their own)
• But do appeals to dignity tell us anything very
specific about what we should do?
The dignity of all
• Different conceptions (eg Catholic, Kantian,
Social democratic, Islamic, Jewish etc) may
require different responses in the same
situation
• A problem in international law as well as in
health and social care
( McCrudden 2008)
The dignity of all and of each
• It should also be clear that Williams’ account of a
ground for asserting the dignity of all does not entail
equality of treatment, and avoids the problems of
accounts which do:
‘There is a contradiction, at the heart of the welfare
state, between the respect we owe persons as
individuals and as fellow human beings… What respect
means to you may not be what respect means to me.
Besides, all individuals are not due the same kind of
respect as individuals… The most common criticism of
modern welfare is precisely that in treating everyone
the same it ends up treating everyone like a thing’
(Ignatieff, M. 1984:16-17 my italics)
Developing dignity
• In so far as an equality of human dignity is
asserted, and human rights legislation does,
this contradication may not be resolvable.
• If it is, one way to do so may be to place less
emphasis on a dignity which presents the
person as a fixed and immutable object of
respect – and more on dignity as formed in
relationship.
Developing dignity
in health and social care
• In health and social care what this entails is a shift
from references to ‘dignfied care’, to the notion
of dignifying care
• What this requires is not just acts of respect by
individual workers, but the development of an
entire culture in which those cared for are offered
not just care, but the opportunity to participate
in and develop that culture, and to develop as
much of a life of their own as they both can and
want.
Developing dignity
and the limits of respect
Cf Christina Patterson on cruelty and kindness in
nursing care
• Those who were cross about being called to help,
or who treated her roughly, appeared to believe
that acts of kindness were ‘beneath their dignity’.
• She contrasts this with the kindness of the nurse
who spent time with her when she was sobbing
with despair and exhaustion – when her
vulnerability was beyond sheilding.
Dignity, vulnerability and kindness
• These seem to me to be accurate uses of the
term dignity
• When we are unable or can no longer do
things for ourselves, when we are ‘at someone
else’s mercy’, when there is ‘very little of
onself left that one can respect’, when hope is
ebbing away, then what we require is not so
much respect for our dignity (though it were
good to get it back) as kindness and attention.
Developing dignity
in health and social care
• This returns us to the point that dignity is likely to
emerge as an issue when someone, for whatever
reason, has reduced capacity to insist on respect
for their own sense of dignity
• Emphasising kindness and dignifying care draws
attention to the vulnerability of the cared for
• But more than this it calls on professionals to go
beyond a distant and unengaged professionalism
and give of themselves.
Developing dignity
in health and social care
• Without offering the opportunity to be more
than a passive recipient of acts of care, any
care, however well intentioned it is, will never
be dignifying.
Developing dignity
in health and social care
• To achieve this, workers will need not only
respect, kindness and compassion. Interest,
creativity, and liveliness could provide a much
stronger focus on the positive possibilities of a
person’s life. Kindness and compassion alone
may draw attention primarily to deficits.
References and bibliography
•
Ignatieff, M (1984) The Needs of Strangers London, Chatto and Windus
•
Isaac, G. C. (1996) A New Guarantee on Earth: Hannah Arendt on Human Dignity and the Politics of
Human Rights in Am Pol Sci Rev 90: 1 (Mar 1996 pp61-73
•
McCrudden, C (2008) Human Dignity and Judicial Interpretation of Human Rights in Eur J Internat
Law V19 No 4 655-724
•
MacIntyre, A (1982) After Virtue: A Study in Moral Theory London, Duckworth
•
Nordenfelt, L (ed) (2009) Dignity in Care for Older People Chichester, Blackwell
•
Rosen, M (2012) Dignity: Its History and Meaning London, Harvard Universtiy Press
•
SCIE (2010) Dignity in Care: Care that supports and promotes a person’s self-respect London, Social
Care Institutue for Excellence http://www.scie.org.uk/publications/guides/guide15/index.asp
•
Williams, B (1973) The idea of equality in Williams, B (1973) Problems of the Self Cambridge,
Cambridge University Press
•
Yeung A. K-Y, and Cohen, D (2011) Within- and Between-Culture Variation: Individual Differencese
and the Cultural Logics of Honor, Face and Dignity Cultures J Personality and Soicial Psychology Vol
100 (No3) 507-526