Dignity,Dialogue,and Care

Wittgenstein L. Philosophical Investigations. Anscombe GEM (trans). New York: Macmillan, 1958. section 11, p. 6e. Among numerous other relevant passages, see especially: section 139, p. 54e.

McDonald M. Dignity at the end of our days: personal, familial, and cultural location. J Palliat Care 2004; 20(3): 163–170.

I borrow this useful phrase from Caputo JD. Against Ethics. Bloomington: Indiana University Press, 1993. Caputo is especially interested in how philosophical ethics becomes a basis for calling the police on the actions of others.

My discussion follows Goffman's distinction between the “protective” and “defensive” orientations that all social interaction depends on: people are responsible for defending the self they claim to be, and others are responsible for protecting the self from embarrassments that become mutual. In preference to dignity, Goffman generally uses the term “face”, as in “saving face” or “losing face.” Goffman E. The Presentation of Self in Everyday Life. Garden City, NY: Doubleday Anchor, 1959. The classic study of situations in which persons are denied the resources necessary to sustain dignity is: Goffman E. Asylums: essays on the social situation of mental patients and other inmates. Garden City, NY: Doubleday Anchor, 1961.

Pullman D. Death, dignity, and moral nonsense. J Palliat Care 2004; 20(3): 171–178.

“I shall also call the whole, consisting of language and the actions into which it is woven, the ‘language game’.” Wittgenstein op. cit., section 7, p. 5e.

Wittgenstein L. Lectures and Conversations on Aesthetics, Psychology and Religious Belief. Barrett Cyril (ed). Berkeley and Los Angeles: University of California Press, n.d., p. 2. Cf. p. 3: “What would it matter if instead of saying ‘This is lovely’, I just said ‘Ah!’ and smiled, or just rubbed my stomach?”

Downie J. Unilateral withholding and withdrawal of potentially life-sustaining treatment: a violation of dignity under the law. J Palliat Care 2004; 20(3): 143–149.

See Alasdair MacIntyre's often quoted statement, “I can only answer the question ‘What am I to do?’ if I can answer the prior question ‘Of what story or stories do I find myself a part?’” MacIntyre A. After Virtue. 2nd edition. Notre Dame, Indiana: Notre Dame University Press, 1884; p. 216. Another understanding of “people like us” is those who find themselves part of the same stories.

Taylor C. Sources of the Self: the making of modern identity. Cambridge, Massachusetts: Harvard University Press, 1989. The continuing discussion of hypergoods begins on p. 63.

Christakis N.A. Death Foretold: prophecy and prognosis in medical care. Chicago: University of Chicago Press, 1999.

Rorty R. Contingency, Irony, and Solidarity. Cambridge, U.K.: Cambridge University Press, 1989; p. xv.

For a detailed discussion of this idea, see: Frank A. The Renewal of Generosity: illness, medicine, and how to live. Chicago: University of Chicago Press, 2004; especially chapter 5 on palliative care nursing.

Taylor C. The Malaise of Modernity. Toronto: Anansi, 1991.