Calum MacKellar takes a bioethical view of the controversy
With the Assisted Suicide (Scotland) Bill currently being discussed in the Scottish Parliament, it has become necessary to seek to understand, unpack and define one of the most contested themes being used by both sides of the debate; namely the concept of human dignity.
On the one side, advocates of assisted suicide suggest that individuals should be able to determine their own dignity and quality of life, unrestricted by the moral, religious or cultural beliefs of others. For them, dignity reflects the manner in which individuals may consider themselves according to their subjective and personal values, desires and relationships, reflecting what is believed to be certain standards of decency. Because of this, it is a dignity which is non-inherent in that it can be gained or lost and can vary quite considerably between individuals.
From this perspective, the right to die with dignity reflects a perceived right of persons to be able to die when they believe that their lives have become unworthy of life. As such, it is consistent with the claim that individuals should be able to make their own decisions as an expression of personal freedom and autonomy.
Compassion, in this context, would mean acknowledging that someone may be in great distress because they cannot put an end to their lives which, they believe, have become meaningless.
Those supporting assisted suicide, therefore, do so on the very strong themes of non-inherent dignity, compassion and autonomy.
But another definition of dignity exists – one that has far more implications and goes to the very fabric of civilised society. It is the dignity which sustains the permanent, immeasurable, inviolable and equal value and worth of all members of a society. As such, it is an inherent dignity that can never be lost (in contrast to non-inherent dignity) and is found in every person to an equal extent. This is in accordance with the United Nations’ Universal Declaration of Human Rights which affirms in its preamble “the inherent dignity and… the equal and inalienable rights of all members of the human family” as “the foundation of freedom, justice and peace in the world”.
From this perspective, legalising assisted suicide would mean that the whole of society, as well as the Scottish Parliament, would accept that some individuals can have, for the first time in history, lives which no longer have any inherent worth and meaning. It would give the message that the very value and significance of a human life is merely based on subjective choices and decisions and whether a life meets certain quality standards.
This would also mean that the intrinsic and universal equality and value between all human beings would no longer exist – a position which would eventually undermine the very basis of civilised society and the foundation on which the Scottish Parliament exists. As a result, it would affect everyone in society and not just those contemplating assisted suicide. For example, such a society could no longer offer any robust arguments against ending the lives of vulnerable, non-conscious individuals who may be considered as having an inferior or unworthy quality of life.
With assisted suicide, therefore, Scottish society has a choice based on which of the two kinds of dignity should prevail. It can maintain the principle that all individuals have the same inherent worth and value which enables a just and civilised society to exist. As such, it would remain a responsible, civilised, benevolent and compassionate society which continues to equally affirm and defend the value and meaning of the lives of all its members even though they may be aged, weak and dependent on others or may have lost their autonomy.
A society in which better palliative care, better pain control and better support for patients is provided. A society that shows compassion to the sick, vulnerable and even suicidal individuals whose very worth, dignity and meaning would no longer be protected if the basis for their inherent equality of value was undermined by the legalisation of assisted suicide.
Or Scottish society can believe and accept that the value of a human life is purely subjective and relative. That some lives may no longer have any meaning, value and worth and should be ended. In this case, a society based on equal rights and the equal worth of all individuals cannot exist.
•Dr Calum MacKellar is director of research at the Scottish Council on Human Bioethics