• Introduction: Dignity in Literature and Medical Ethics
• Johanna Harris (bio)

Can dignity be defined? What experiences have shaped its meaning across human history? How are these experiences expressed, and interpreted? These questions are at the heart of this theme issue, which argues that literature is a fundamentally important place for discovering and understanding how we have historically conceived of dignity and how current conceptions of dignity are informed by its literary history.

In 2003 the philosopher and bioethicist Ruth Macklin controversially argued that “dignity is a useless concept in medical ethics and can be eliminated without any loss of content.”¹ Macklin was responding to the overwhelming prevalence of dignity language in medical literature, particularly in discussions around human cloning, methods of in-vitro fertilization, and assisted suicide, across which she charged the usage to be “vague restatements” or mere sloganeering. Ultimately dignity, according to the medical contexts which the language saturated, “means no more than respect for persons or their autonomy.”² Macklin’s argument about the ambiguities inherent to the language of dignity remains relevant today, and vague or conveniently imprecise usage extends far beyond medical literature. It is, for example, central to the language of human rights, the UN’s Universal Declaration of Human Rights (1948), the first “international” marker of intrinsic human worth, being the most obvious example. In the Anglophone world today, “dignity” can imply strikingly different things where the end of life is concerned. In Britain, for example, “Dignity in Care,” with its associated Dignity Champions and Dignity Day, and the Dignity in Care Commission (2011–12), focuses on the right to respectful care in old age to ensure the end stage of life is positive, meaningful, comfortable, and even prolonged. “Dignity in Dying” champions similar aims of compassion, care, and the right to decide what constitutes quality of life, but with an overarching view to ending rather than prolonging life (death being [End Page 255] preferred, they say, to a life without dignity). The shared semantics in these contrasting contexts encapsulate the interpretive problem.

However, what in Macklin’s view is the concept’s uselessness might alternatively be described as its paradoxical virtue. The Begriff-sgeschichte [conceptual history] of dignity brings to life the usefulness of literature in identifying, and subsequently articulating, the ongoing rich and capacious potential of dignity language in medical ethics and how the concept can be wielded in careful and meaningful ways to demonstrate it as undeniably more serious and compelling a concept than the allegedly synonymous “respect.”

Addressing the origins, crosscurrents, and disjunctions in medical and literary uses of “dignity,” this theme issue helps to highlight the complexities that face medical practitioners, lawyers, policymakers, and writers as they seek to attend meaningfully to human experience. Rather than discouraging use of the concept, the essays that follow together aim to articulate in equal measure the serious freight of dignity in literary history and in moral philosophy, as well as the care required to deploy it in (all forms of) literature. They also work to realize its presence in acts of reading, and therefore to give it fresh impetus in the important role it must play, as a concept, in the health humanities and, ultimately also, in medical practice.

It is no accident that most of the essays in this theme issue engage with aspects of old age and the end of life. It seems integral to the character of humanity that the question of sustaining dignity through to the end of life is an abiding concern, and this makes its way into the questions pursued by scholars and in the very practical demands of configuring excellent, sustainable, and ethically robust health care systems. Always central to the conceptual analysis, however, must be the lived experience of human dignity—or its absence, as the essay by Philip Davis and Fiona Magee reminds us. Their work introduces the idea of “sudden dignity,” drawn from the wonderful work of reading groups established by the charity The Reader along with research by the Centre for Research into Reading, Literature and Society (CRILS), based at the University of Liverpool, which usually brings together people from “easy-to-neglect communities,” such as people in aged...

• 引言：文学尊严与医学伦理
• 约翰娜·哈里斯（生物）

尊严可以定义吗？哪些经历塑造了它在人类历史上的意义？这些经验是如何表达和解释的？这些问题是本主题问题的核心，它认为文学是发现和理解我们在历史上如何构想尊严以及当前的尊严概念如何受到文学历史影响的重要场所。

2003年，哲学家和生物伦理学家露丝·麦克林（Ruth Macklin）有争议地认为“尊严在医学伦理学中是一个无用的概念，可以在不丢失任何内容的情况下消除。” ¹麦克林回应医学文献中尊严语言的压倒性流行，特别是在围绕人类克隆、体外受精方法和辅助自杀的讨论中，她指责这种用法是“含糊的重述”或仅仅是口号。根据语言饱和的医学背景，最终尊严“只不过是对人或他们的自主权的尊重。” ²麦克林关于尊严语言固有的模糊性的论点今天仍然适用，模糊或方便不精确的用法远远超出了医学文献。例如，它是人权语言的核心，联合国的《世界人权宣言》（1948 年）是人类内在价值的第一个“国际”标志，就是最明显的例子。在今天的英语世界中，“尊严”可能意味着与生命终结有关的截然不同的事物。例如，在英国，“Dignity in Care”及其相关的 Dignity Champions 和 Dignity Day 以及 Dignity in Care 委员会（2011-12 年）侧重于在老年时获得尊重护理的权利，以确保生命的最后阶段是积极的，有意义的，舒适的，甚至是持久的。“死亡中的尊严”倡导同情、关怀、[End Page 255]他们说，宁愿没有尊严的生活）。这些对比鲜明的上下文中的共享语义封装了解释问题。

然而，在麦克林看来，这个概念的无用性也可以被描述为它的悖论美德。尊严的Begriff-sgeschichte [概念史] 使文学在识别并随后阐明医学伦理中尊严语言持续丰富而广阔的潜力以及如何以谨慎和有意义的方式运用该概念以证明的有用性方面不可否认，它比所谓的同义词“尊重”更严肃、更引人注目。

解决“尊严”在医学和文学使用中的起源、交叉流和分离问题，这个主题问题有助于突出医疗从业者、律师、政策制定者和作家在寻求有意义地关注人类经验时所面临的复杂性。接下来的文章并没有阻止使用这个概念，而是旨在同等程度地阐明文学史和道德哲学中尊严的严重负担，以及在（所有形式的）文学中部署它所需的谨慎。他们还致力于在阅读行为中实现它的存在，从而赋予它新的动力，使其作为一个概念，在健康人文科学以及最终在医学实践中必须发挥的重要作用。

本期主题中的大多数文章都涉及老年和生命终结的各个方面，这绝非偶然。维持尊严直至生命尽头的问题似乎是人类性格不可或缺的一部分，这成为学者所追求的问题以及在配置优秀、可持续和符合道德的实际需求中的体现。健全的医疗保健系统。然而，概念分析的核心必须是人类尊严的生活体验——或者它的缺失，正如菲利普·戴维斯和菲奥娜·马吉的文章提醒我们的那样。他们的作品引入了“突然的尊严”的概念，取材于慈善机构The Reader建立的阅读小组的精彩作品 以及位于利物浦大学的阅读、文学和社会研究中心 (CRILS) 的研究，该中心通常将来自“容易被忽视的社区”的人们聚集在一起，例如老年人...