Literature and Medicine

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...