The careless conflation of independence, autonomy and dignity

As Jersey begins to legalise assisted dying, there’s keyword confusion.

Henna Cundill

Henna is a researcher with the Centre for Autism and Theology at the University of Aberdeen.

A elderly women in a care home stands and places her hands on the shoulders of a seated woman.

Eberhard Grossgasteiger on Unsplash.

Reviewing Canada’s legislation on assisted dying, one anonymously authored article raises the concern: “Does it make dying with dignity easier than living with dignity?” This insightful question cuts to the centre of the debate: dignity. Or more particularly, the unwitting conflation of dignity with independence, and of independence with autonomy.

As Jersey becomes the first place in the British Isles to begin the process of legalising assisted dying, I feel that we should listen carefully as to how and where these terms are being used, both in the formal debate, and in the commentary that surrounds it. The States Assembly in Jersey voted to allow the development of assisted dying legislation for those with six months to live (or twelve months if their condition is neurodegenerative). A second vote to make assisted dying available more broadly to those who experience conditions that entail “unbearable suffering” was defeated by a narrower margin. Reading the flurry of press releases that followed the vote, these keywords, autonomy, independence, and dignity, are everywhere. But are we really thinking about what these words communicate?

People in positions of wealth and power have more independence and autonomy, more choices and freedoms, but it is we who ascribe dignity to those in that position.

The word dignity comes from the Latin word dignus, meaning ‘worthy’, and this is still the primary definition given to the English word dignity today. The OED has it as “the quality of being worthy or honourable”, immediately followed by reference to “honourable or high estate”. If this is so, then dignity is not something that can be bought, nor assumed – it is a status conferred upon someone by the esteem in which other people hold them. The haughtiest person in the world can still be esteemed undignified, as can the richest. Moreover, the opposite is also true: we are never prevented from conferring dignity upon, and esteeming the worthiness of, those who live the humblest of lives.

And yet, if we are honest with ourselves – do many of us not quietly associate the idea of becoming rich and powerful with becoming dignified? Do we not tend to assume the worthiness of those in high office – at least until we meet them and realise pretty quickly that they all put their trousers on one leg at a time, the same as the rest of us. This association happens because we have such a tendency to conflate dignity with independence (the ability to live without assistance from others) and autonomy (the ability to make one’s own decisions, and not have those decisions limited or interfered with). People in positions of wealth and power have more independence and autonomy, more choices and freedoms, but it is we who ascribe dignity to those in that position. It is society who sees the autonomy of those in high status, and esteems it as dignified.

Does this not unwittingly suggest that choosing to live in a state of extreme dependence on palliative care is, by implication, undignified?

Repeatedly ancient wisdom, in the bible, warns us not to assume that dignity comes with the freedom of wealth or power. All the great ‘heroes’ of that book suffer their indignities. Fresh from the success of his Ark project, Noah gets drunk and exposes himself. Elated from a victory against an enemy, King David dances half-naked through the streets. These are just two examples of the catalogue of embarrassments and mishaps that beset nearly all the kings and leaders whose stories are told as part of the Christian story. One after another, they stumble and struggle with life and leadership. The apostle Paul explains that this is because God uses the foolish things of this world to shame human pride, “for even the foolishness of God is still wiser than human wisdom.” Therefore, Paul argues, God chooses to speak to us through the weak and the lowly things and people of this world. Never was this demonstrated so clearly as when Jesus was born in a draughty stable, lived a life of poverty, and died a criminal’s death on a cross.

But what has all this to do with the debate over assisted dying? Well, I am struck by how often the idea of losing one’s independence (through disabling or terminal illness) is conflated with losing one’s dignity, and so dying through personal choice (autonomy) is presented as regaining it. One campaign group that speaks to this debate even calls itself ‘Dignity in Dying’ – but does this not unwittingly suggest that choosing to live in a state of extreme dependence on palliative care is, by implication, undignified?

Independence is not possible for everybody, or not possible to the same degree. And dignity? Well, dignity is possible for anyone.

The Dean of Jersey, the Very Reverend Mike Keirle, has spoken of his concern that the change in legislation will make vulnerable people feel pressured to end their lives. Examples from Canada, where physician assisted dying is already available, show that his concern is not unfounded. In 2022, Canadian veteran and Paralympian Christine Gauthier phoned her caseworker to chase up the over-due installation of her new wheelchair ramp. She then describes how she was horrified to find herself being advised to consider assisted dying instead.

"It is remotely just what they're doing,” says Gauthier, “exhausting us to the point of no return. […] I was like, 'Are you serious?' Like that easy, you're going to be helping me to die but you won't help me to live?"

Gauthier is not alone – she spoke out when she learned that four other Canadian veterans had reported similar experiences. In these unhappy moments, one can see how dangerous the assumption can be – the assumption that no one would want to live a life of needing help. Here are disabled people who do want to live, and this assumption, this careless conflation of independence, autonomy, and dignity, leaves them fighting for their right to do so. Why should anyone have to fight or even speak for their right not to commit suicide? It is little wonder that disabled actress, Liz Carr, describes assisted dying legislation as “terrifying” for disabled people.

I respect that there are terminally ill people, and those who love them, who speak from a desire to end their suffering; it is clear that people on all sides of the debate need to have this difficult and emotionally charged conversation. But whatever the eventual outcome in terms of legislation, we must be careful that it is not based on careless assumptions, or on the conflation of one thing with an entirely different other. Independence is not possible for everybody, or not possible to the same degree. And dignity? Well, dignity is possible for anyone – it is a state that can be conferred whenever, and upon whomever society chooses to confer it. Autonomy is the matter in question – we are talking about autonomy in dying. And whatever happens, we should by no means legislate in a way that leaves disabled people esteemed unworthy, left open to the indignity of fighting for their right to live.

Article

Community

Culture

Sport

19 June 2024

4 min read

The decade that defined sport

What the sports stars of today owe to the eighties.

Simon Burton-Jones

Simon is Bishop of Tonbridge in the Diocese of Rochester. He writes regularly round social, cultural and political issues.

Maradona runs in celebration, holding a hand aloft as an England player sits dejected on the ground.

Maradona celebrates, 1986 World Cup.

Dani Yako via Wikimedia Commons

If the 1980s were your formative years as a sports fan, you will carry many images with you even today. Dennis Taylor potting the last black after midnight to beat Steve Davis. Barry McGuigan defeating Eusebio Pedrosa in the ring at Loftus Road. The races between Coe and Ovett at the Moscow Olympics. The tie break between Borg and McEnroe. Botham’s Ashes. Diego Maradona versus England at the Mexico World Cup.

You will undoubtedly have other memories, though these will have been controlled by a limited number of broadcast editors. I clearly recall watching Viv Richards’ astonishing century in one cricket World Cup final against hosts England being regularly interrupted on BBC1’s Grandstand with coverage of a routine horse race meeting. The introduction of the less fusty World of Sport on ITV was a route in for some sports that faced an implicit class bias, but it was all still far removed from the 24/7 reverencing of sport today.

The eighties was an era of transition as sport began to gain a place in our cultural consciousness. It was also a decade in which the relationship between sport and politics became cemented on paths we still walk. In Everybody Wants To Rule The World, academic and journalist Roger Domeneghetti has written an entertaining and informative book subtitled ‘Britain, Sport and the 1980s’.

In our branding of the twenties as the decade of polarisation, we forget how deeply divided Britain was in the eighties. Recent commentary on the fortieth anniversary of the miners’ strike has been a reminder of this and how violent public life proved. Football hooliganism was pervasive and after a riot at a Luton Town – Millwall game in 1985, Margaret Thatcher asked of football officials: ‘what are you going to do about it?’. In a pithy and telling response, the FA secretary Ted Croker said: ‘Not our hooligans, Prime Minister, but yours. The product of your society’. Perhaps more than any other exchange, it symbolised the braiding of sport and politics, threads that endure to this day.

The sports stars of today have become surrogate saints, held up as an inspiration for what can be achieved and frequently employed as motivational speakers.

The argument that sport and politics don’t mix has a familiar ring for people who live with the tired old trope that religion and politics don’t either, as if our experience of culture and values are sealed off from each other. Sporting boycotts in the 1980s - from Olympics to apartheid South Africa – placed athletes in the unavoidable position of having to make decisions about participation that would reflect on their values and could affect their careers; positioning that other people were spared. These were an early taste of the moral standing afforded to sportsmen and women today; a status that somehow asks more of them, perhaps because other professions have become so tarnished and mistrusted.

Domeneghetti’s book is also a sobering reminder of how ugly and careless much of our shared life was in the eighties. The Bradford City fire and Hillsborough disaster were awful losses that showed the low priority of health and safety and the culture of institutional cover up that continues to blight the nation. The author locates these failings in the wider context of disasters like Kings Cross, Piper Alpha and the Marchioness boat as part of his bid to write a social history of sport.

Yet in a sense, Domeneghetti chose arbitrary parameters. Football in particular was on the cusp of a revolution with the introduction of the Premier League in 1992. Cultural sympathy for the game was about to change with the writings of Nick Hornby in Fever Pitch and Pete Davies in All Played Out. The nasty face of football was to be transformed into a highly marketable model.

The ugliness of the era is laid bare in the prolific and casual racism, sexism and homophobia that coursed through every sport. The Windrush’s second generation broke through in the 1980s, notably in football, but was met with staggering levels of prejudice. Anyone tempted to think this has now been eradicated hasn’t spent any real time at a football ground or on social media. Women’s sport had virtually no profile in the eighties outside of tennis and athletics and as recently as 1978, Lord Denning had ruled that an eleven-year-old girl should not be allowed to play competitive football against boys the same age even though she merited a place in her team. Meanwhile, stars like Justin Fashanu, Martina Navratilova and John Curry were targeted for their sexual orientation. It remains hard for present day athletes to identify as gay, despite the rhetoric of acceptance. Sport then, as now, held up an unerring mirror to our faces.

The sports stars of today have become surrogate saints, held up as an inspiration for what can be achieved and frequently employed as motivational speakers. But there is the gloss of a hyper-individualistic, neo-liberal culture. Sports stars succeed because of a combination of innate gifting (which cannot simply be replicated) and material advantage (too many Olympic medals are still awarded to wealthy and advantaged Britons). I won because I wanted it more is a dishonest assessment of sporting success in the UK and in this way also holds up a mirror to other walks of life.

The powerful personal branding of today’s athletes in many ways have their origin in the 1980s and the way the likes of Ian Botham, Carl Lewis and John McEnroe transcended their sports. The cult of the conquering superstar is a smart diversion from the reality that money usually wins. Just look at the Premier League table.