Dignity and Pride

This morning I watched a programme called Choosing To Die.

It is a documentary fronted by Terry Pratchett, a well-publicised supporter of assisted suicide, detailing the procedures and decisions faced by people who choose to end their own lives. Pratchett, a sufferer of Alzheimer's disease, has also long insisted that when the time comes that he can no longer be an author, and no longer communicate, that he wants to die.

There are a lot of issues that this programme touches upon. It is definitely worth seeing, although I would caution that it is by no means easy to watch. The matter that I find myself thinking about most for the moment, however, is the notion of "dignity".

The arguments for the legalisation of suicide often center upon the right to "die with dignity". When somebody is suffering from an incurable disease, and one that gradually eats away at the ability of the sufferer to live their life and that will ultimately prove fatal, it is argued that it should be a human right to be able to choose when to end that life without fear of prosecution for those who may have been involved in assisting that choice. It is an argument I wholeheartedly endorse; it is insane to believe that a loving wife or husband should face conviction for allowing the person they love most to die in the way that they want.

But something that worried me when watching the documentary is whether the matter at hand was truly one of dignity, or one of pride. And there is a deeply important difference.

Dignity, according to the OED, is "The quality of being worthy or honourable; worthiness, worth, nobleness, excellence." By comparison, pride is perhaps more complex. On the one hand it is defined as "A consciousness of what befits, is due to, or is worthy of oneself or one's position; self-respect; self-esteem, esp. of a legitimate or healthy kind or degree." But on the other hand it can also mean "A high, esp. an excessively high, opinion of one's own worth or importance which gives rise to a feeling or attitude of superiority over others; inordinate self-esteem."

One definition of pride is definitely more overtly positive than the other, but what is perhaps most marked is that both rely heavily on self-perception. It is about what is right for oneself, and one's own self opinion. This stands in contrast to dignity, which is a quality that presumably we can ascribe to others. We might say that someone has dignity, even if they are unaware of it. But to say that someone is proud implies a certain state of mind in those of whom we speak.

Watching the documentary, it seemed that those who had chosen to die had often done so because they could not face losing the life they know. They couldn't face living life as an invalid, with the knowledge that it would only get worse and more painful from thereon in. I don't at all want to undermine this decision. It is not one based purely on "pride" or "vanity". The prospect of losing the ability to live one's life as one chooses, and to a certain extent one's identity in the process, is a genuinely terrifying one, and the decision to die rather than face this prospect will never be one taken lightly, nor one that anyone involved will take lightly.

But it was apparent that the loved ones of the people choosing to die in this film were, understandably, conflicted. They wanted to support the person they loved, but they didn't want to lose them. I'm trying to imagine it from the other direction; how determined does one have to be to die in order to leave behind someone you love, knowing that they will be devastated? Perhaps you think that it is preferable to having those loved ones see you die slowly and painfully? I've always felt that, even at the worst of times, we have a responsibility towards those whom our death would impact upon. It is hard to tell where the responsibility we have to ourselves sits in relation to this when faced with the degenerative disease and the decision to take one's own life.

That seems to be a contributing factor in Pratchett's way of thinking about it; he claimed that his wife wants to be able to nurse him through his disease, but that he understands better than she does what is involved in Alzheimer's disease. But it that your decision to make? Maybe it is, but at the same time there seems to a certain degree to be an element of not wanting to be seen to lose control, to not let the ones you love see you gradually stop being yourself. This was most evident when Pratchett discussed his situation with a doctor.

One has to be in a sound state of mind to be able to consent to assisted suicide. The paradox of this is that one can only choose to kill oneself before before the stage of one's disease at which would rule this out, which is often the very stage that motivates one's decision. Pratchett would prefer to die than to know that he has lost himself to his disease, before he loses his words. But to choose to die he would need to still be in possession of himself, and his ability to communicate. To choose to die, he needs to decide to do so before he is ready to die. It is the fear of what will inevitably be lost that motivates the decision to die by assisted suicide, rather than the loss itself.

It is perhaps in this regard that I feel that pride enters in to it. Palliative care for those suffering from a fatal disease is designed to protect the dignity of the patient as much as is humanly possible. If this doesn't suffice, if the thought of being nursed through to one's end is too much to face, then I suspect that this is a deeply subjective issue far more to do with "consciousness of what befits, is due to, or is worthy of oneself" than it is to do with anything else. Not that this is entirely distinct from dignity. A sense of self-worth is inherent to dignity. But is it more valuable than life itself?

I don't know. I've never been faced with such a decision. Nor have I been the primary carer for anyone who has. Those members of my family that I have seen die a gradual death marked by mental and physical decline have all been loved and cared for deeply throughout this period. Even then, it has been painful to see it happen. So I think I can understand why someone would make that decision. But the line between the self-worth inherent to dignity and pride is at best a fuzzy one. One of the definite dangers associated with assisted suicide is which side of this line any given individual falls on.

According to the programme, 21% of the people who pass through Dignitas, the assisted suicide clinic in Switzerland, choose to do so simply because they have become "weary of life". I find it hard to imagine justifying this statistic, but then I don't know the details behind these cases. I also worry that, despite Dignitas being a non-profit organisation, their services are expensive are their finances reputedly lacking transparency.

Nothing in the programme has changed my mind in principle about assisted suicide. I still think that, faced with a gradual but inevitable and painful death, it should be the right of any individual to decide when and how they die. But it is impossible to deny that as it stands the system doesn't work. People shouldn't have to fly to Switzerland to die on an industrial estate. And I worry that by placing this responsibility solely and uniquely in the hands of one organisation we perhaps make it too easy to die, that it plays in to the grey area that exists between dignity and pride. And I'm not sure this in itself is dignified.