Editorial: On human dignity

Dear readers,

in the last three years me and my colleagues have had the opportunity of addressing the issue of human dignity under the project KEGA 006UK-4/2014. I have to say, it has been a rewarding experience. Allow me to share some reflections on this topic with you.

Respect for human dignity is a fundamental feature of patient care. This phrase or its various forms, which we can often find in many documents, legal norms, regulations and codes related to the health care, but the explanation of what human dignity means in these documents is very rare. However, how we can implement dignity into practice, when we really do not understand what it is? But, on the other hand, we feel intuitively that the human dignity is a needed term which for example covers the goals of palliative care. So, what does it mean? Honestly, it is really difficult to answer.

Some critics are sceptical of using the term human dignity in the health care. They say it is a cliché – an empty phrase that means nothing or it is internally self-contradictory term (on the one side every human being has dignity without distinction and it is inalienable; on the other side, a person can get into a situation where insidious disease deprives her of it). This criticism must be taken seriously. If we want to rehabilitate human dignity in health care, we have to correctly deal with the ambiguities that the usage of this term brings and try to explain it.

I am of the belief that the dignity is a multilayer phenomenon that cannot be explained as a simple attribute of being human. It is not really a logical category in the traditional sense, but it is existential, rather an existential value. This means that it is intrinsically linked to the essence of the human existence, which cannot be described only by the factual categories because every human being is unique, unrepeatable and temporal. These characteristics connected together can be seen as constitutive elements of the human value (dignity). If there is something unique, despite the factual similarities, it cannot be inherently comparable with another entity. Paradoxically, it points out that in the case of dignity, we are all equal, precisely because we are all different. This uniqueness of human beings highlights their unrepeatability because neither in the past, nor now, nor in the future will any two people be exactly the same. Each person is a unique story.

So, there are two kinds of dignity intrinsic and extrinsic. Intrinsic dignity is inherent and inalienable value that belongs to every human being. This kind of dignity cannot be destroyed or measured; it is not conditional, contextual, and comparable between humans, as was described above. Extrinsic dignity provides universal value into behaviour, perceptions and expectations of human beings. Compared to intrinsic dignity this type is contextual, contingent; it can be compared and measured. This type of dignity is realized in relationship to me (personal dignity). In this case it is based on self-esteem, self-worth, integrity and identity of a particular person. Extrinsic dignity is also realized in relationship to others. In this case it is manifested in esteem, respect and honour.

Extrinsic dignity is heavily dependent on personal experience and interaction with others, especially in health care. This kind of dignity can be maintained or vice versa disturbed, destroyed, but also restored. It gives rise to the care-givers three basic tasks: do not cause indignities to the patient by your own behaviour; minimize situations of indignity (for example due to annoying symptoms of the disease) and help regain the dignity of the patient if they lost their feeling of worth.

In the context of the dignity, the human encounter is a distinctive, authentic event of interaction between two unique existences. Being with another person means to be with a unique, unrepeatable and temporal being – the existence, just as much a different and at the same time similar to ourselves. Esteem and respect for the otherness of existences should grow from this meeting as an expression of human dignity.

Juraj Čáp, PhD.
Comenius University in Bratislava, Jessenius Faculty of Medicine in Martin, Department of Nursing