Andrew Sayer

 

On his book Why Things Matter to People: Social Science, Values and Ethical Life

Cover Interview of March 21, 2012

A close-up

Why are we so worried about our dignity?

References to human dignity are enshrined in human rights declarations as the ultimate value or criterion for assessing what people are allowed to do.  Apparently, nothing is more important. Oppressed people all over the world say they are struggling not just for survival but for their dignity. Elderly patients in hospital often worry more about their dignity than their illnesses. We hear people say things like “at least I was able to leave the job with my dignity intact.”

But while many appeal to dignity, hardly anyone defines it. Sometimes we talk about it as if it were a fundamental universal essence that is there, come what may. But at other times we see it as fragile and dependent on how others treat us. These seem like almost opposite meanings.

Dignity has traditionally been thought of in terms of capacities for self-command, competent performance, and emotional restraint. But there’s another side to it—vulnerability. Philosophy tends to miss this.

Philosophy values calm contemplation and the power of reason, and traditionally has a masculine aversion to acknowledging vulnerability and the fact that we all start out as tiny, dependent babies. It struggles to realize that not all forms of dependence are bad—and indeed that the acceptance of dependence and vulnerability are essential to relations of care, love and friendship.

Elderly patients are particularly vulnerable and may have lost some of their capacities; they may be incontinent and hard of hearing. What they need for their sense of dignity is a kind of care that does not ignore or take advantage of their vulnerabilities but looks after them, yet without drawing excessive attention to them so that the patient is reduced to their impairment.

It is difficult for a nurse to talk to patients who have lost most of their hearing without infantilizing them. It is difficult for caretakers to maintain their own dignity in carrying out such tasks as wiping bottoms; the patient may also be embarrassed on their behalf for this reason.

The dance of dignity in such relations is complex and subtle, though skilled caretakers may make it look effortless.

Seriousness and attentiveness on the part of the caretaker are likely to be helpful, but if overdone they may make the patient feel worse; a light touch, matter-of-factness, and humor are often helpful in restoring a sense of normality rather than crisis or deficiency.  The patient also needs recognition as a particular person with a biography, attachments to others, and commitments—a need for connection as well as “respect for autonomy.”  In providing these things, good care does more than secure dignity—it improves well-being.

Everyday ethical life depends not so much on following moral norms—at best these merely provide rules of thumb—but on being responsive to people’s needs in all their complexity, to what matters to people.