Dignifying Decisions: The Role of Dignity in Surrogate Decision-Making

Dignity refers, broadly speaking, to a kind of status that is intrinsically connected to certain norms. Often, we think of dignity as the status of having inherent value, which entails that certain kinds of treatment are morally impermissible. References to dignity are pervasive in clinical ethics, where the concept is called on to do a broad variety of work, including bolstering claims about patient-focused health care, advocating in favor of and against euthanasia, and supporting an infinite number of particular medical decisions. In stark contrast to its pervasiveness, the conceptualization of dignity is still an unsettled issue, in particular in the clinical ethics literature.

In this project, I first discuss the Kantian roots of our contemporaneous universal conception of dignity. I demonstrate the problems that the universal account of dignity has inherited from this view, including the potential exclusion of those with compromised capacities and the ability to substantiate conflicting analysis and recommendations for action. In the context of clinical ethics, it is vital that these moral conflicts are navigated and resolved. This means that we stand in need of a new account of dignity.

It is my objective to argue for a relational conception of dignity that is grounded in a person’s narrative. On this view, dignity is not a static status of inherent worth, but a success condition of interpersonal relationships. Dignity is achieved when people respond appropriately, that is in dignifying ways, to a person’s narrative. Here, narrative is made up of a set of elements that constitute the structure of a person’s life. This includes their testimony, actions, preferences, values, relationships, and institutional ties. The relational understanding of dignity is able to support standards of conduct and guide decision-making in concrete cases of moral conflict. I subsequently demonstrate the virtues of this account by applying it to the challenging issue of surrogate medical decision-making for Alzheimer’s patients. Finally, I argue that one of the implications of the narrative account of dignity is that we must reconsider the traditional ethics case format, since this leaves out many of the narrative elements that are vital in surrogate decision-making.