Medical ethicist offering a new understanding of dignity at the end of life

By Ed Langlois

Catholic Sentinel
Diocese of Baker, Oregon

October 22, 2004

Severe illness may erode the sort of dignity we ascribe to people, but essential human dignity abides, says a physician who is also a Franciscan friar.

Dr. Daniel Sulmasy, an ethicist and medical school professor in New York, spoke several days last week in Portland to doctors, nurses, chaplains, hospice staff and other health workers. One workshop was linked by video to 41 healthcare sites from Virginia to Hawaii.

The talk came as Oregon’s assisted-suicide law marks its 10th anniversary.

"The loss of attributed dignity does not rob a person of intrinsic dignity," Dr. Sulmasy said in a session at Providence St. Vincent Medical Center. The talk was sponsored by the Portland Guild of the Catholic Medical Association, Physicians for Compassionate Care and the Providence Center for Health Care Ethics.

The friar-physician admitted that patients feel a loss of worth when they lose control of their bodies and need help for even basic functions. But health workers — and families — can appeal to the deeper human worth, he said.

"Patients say, ‘I’ve lost my dignity,’" Dr. Sulmasy explained after the lecture. "All I can say to them is, ‘Not in my view.’"

He said patients sometimes need to hear the good they can do in the difficult last days of life. For example, they can express love and teach survivors what is really important.

Dr. Sulmasy has worked with patients who asked for assisted suicide, but really had other issues to settle. One man, it turned out, feared moving to an unfamiliar hospice where his brother would have trouble visiting him. The patient felt disconnected and afraid.

"Of course, the treatment for that is not two grams of secobarbital; the treatment for that is love and respect," Dr. Sulmasy said.

What seriously ill people are really experiencing is vulnerability, the friar said.

"The only proper response to vulnerability is this thing we call love," he said. "Love is a dangerous word. But it’s the right word, isn’t it?"

Dr. Sulmasy told the health workers that "mutual vulnerability is the core of love," and that real healers strive to make the patients their equals.

"When one takes off the smelly socks of a homeless person, one is made vulnerable," he told the group. "What it says is that they are worthy of your service."

Dr. Sulmasy maintains that the principle of intrinsic worth applies to healthier patients who have other reasons to feel a lack of social status — homeless people, immigrants, those living with HIV.

Intrinsic dignity is not something some people have and some don’t, said Dr. Sulmasy. And no one has more than anyone else.

"We all have it and we all have it equally," he told the health workers. "You pick up a homeless schizophrenic from the street for the same reason you pick up the Wall Street executive from the bathroom floor — intrinsic dignity."

Dr. Sulmasy, who also holds a doctorate in philosophy, traced the development of the idea of dignity. The concept appears little if at all in Scripture or Greek philosophy. Even St. Thomas Aquinas, who wrote about almost everything, spoke of dignity more in terms of rank than innate worth.

The idea emerged from 18th-century philosophy and was adopted and fine-tuned by the church in the mid-19th century. By the end of the 19th century, Pope Leo XIII would use the idea of dignity repeatedly in his groundbreaking encyclical on capital and labor, Rerum Novarum.

For the Second Vatican Council, dignity was a centerpiece idea. Personalist philosophy emerged and heralded human dignity, with Pope John Paul as one of the movement’s main figures.

In this philosophy, the amount of control or power a person wields has no bearing on dignity, Dr. Sulmasy said. The large things in life — when we are born, who will love us and that we will die — are beyond our power.

Dr. Sulmasy used as an example the image of Martin Luther King behind bars after civil rights actions. Though rendered powerless, he was the very picture of dignity, Dr. Sulmasy said.