Search

This chapter offers a brief account of the policy statements issued by intergovernmental bodies that appeal to human dignity and focuses on those specifically dealing with bioethics. At the same time, it discusses the cultural challenges that arise from the adoption of universal or transcultural understandings of human dignity and responds to the objection that human dignity and human rights standards are mere products of Western culture and are therefore inapplicable to other regions of the world.

In general, legal responses to endof-life issues are not very different in Switzerland than in most European countries. For instance, active euthanasia (i.e., killing on request) is illegal, although it is treated as a lesser offense than murder or manslaughter. Article 114 of the Swiss Penal Code reads, ‘‘Every person who, for honourable reasons, especially mercy, kills another person on his or her serious and pressing request shall be punished by imprisonment for a maximal term of three years or with a fine.’’ Also, like in most European countries, the administration of medication (for instance, morphine) to relieve serious pain of a terminal patient, even though it may lead to the unintended consequence of hastening his or her death, is accepted, in both moral and legal terms. Similarly, like in many other countries, the withdrawal or withholding of life-sustaining treatments, even if they are not covered by any specific legal provision, is not treated as a criminal offense provided that certain conditions are fulfilled. The peculiarity of Switzerland regarding end-of-life issues only relates to assisted suicide. This practice, which is permitted, has two significant differences when compared to the situation in the other (few) European countries that allow it: 1) Nonphysician-assisted suicide is permitted. Whereas in the Netherlands and Belgium only physicians are allowed to assist in a suicide, in Switzerland this assistance is providedby(nonphysician)volunteers working for nonprofit organizations. The role of doctors is limited to prescribing the lethal drug and assessing the patient’s decisional capacity; they do not perform the assistance in the suicide themselves. In this regard, the practice of assisted suicide in Switzerland is similar to the one in the U.S. state Oregon. 2) Oneneednothaveaparticularmedical condition (such as a terminal illness or an unbearable suffering) to request assistance with suicide. The only requirement is that the individual must have decisional capacity, because in the absence of it his or her act cannot be considered a ‘‘suicide’’ in legal terms. In fact, at present, according to a recent study, around 25% percent of people who die by assisted suicide in Switzerland do not have any serious or terminal illness but are just old, or are simply ‘‘tired of life.’’

‘‘At Home’’ is a short story by Anton Chekhov about a lawyer, Eugene Bikovsky, who tries to explain to his seven-year-old son, Seriozha, why he did wrong by taking a cigarette from his father’s desk and by smoking it. The story begins with Bikovsky coming home from a session at the court, and with the governess telling him about his son’s wrongdoing. Seriozha is a frail and innocent child; he admires and loves his father, and he had been entrusted to the care of a governess since the loss of his mother. Bikovsky wonders what to tell his son, but before he has time to think of anything to say, Seriozha has already entered the study. ‘‘‘Good evening, papa,’ he says in a gentle voice, climbing on to his father’s knee and swiftly kissing his neck. ‘Did you send for me?’’’ When they began to talk, Bikovsky finds that his son is not at all aware that he has committed any fault. The lawyer first appeals to pure rationality; he tries to explain to the child the conceptual distinction between meum and tuum in property law, and why it is wrong to take things that belong to others. But Seriozha has a world of his own in his mind and pays little attention to his father’s abstract explanations. Next Bikovsky tries to convey his disapproval of his son’s behavior by arguing that smoking itself is wrong, because ‘‘tobacco is very bad for the health, and men who smoke die sooner than they should.’’ But the result is equally fruitless, not least because the father is unable to justify why he smokes himself. The lawyer is now frustrated by his inability to get through to Seriozha, but then he suddenly realizes that to communicate effectively with his son, he must appeal to another strategy. Instead of using a purely objective logic, he has to enter the subjective world of his son in a manner that will enable him to convey the message about the perils of smoking for a child. Bikovsky improvises a story of a king who had a long, grey beard and lived in a palace of crystal surrounded by a wonderful garden with oranges and bergamot pears and wild cherry trees.

This paper argues that some of the misunderstandings surrounding the meaning and function of the concept of human dignity in bioethics arise from a lack of distinction between two different roles that this notion plays: one as an overarching policy principle, and the other as a moral standard of patient care. While the former is a very general concept which fulfils a foundational and a guiding role of the normative framework governing biomedical issues, the latter reflects a much more concrete and context-specific understanding of the patient as a “person”. The importance of dignity as a policy principle will be described by appealing to the distinction between principles and rules as developed by some legal philosophers. The value of dignity as a standard of patient care will be illustrated with the help of concrete examples and by drawing on the taxonomies of dignity proposed by Jonathan Mann and other scholars. The overall scope of the article is to highlight this double and complementary role of human dignity in bioethics.

The Council of Europe has achieved two important milestones in the promotion of patients' self-determination regarding medical care to be implemented in the event of future decisional incapacity: the Biomedicine Convention and the Recommendation (2009)11. This chapter outlines strengths and shortcomings of Article 9 of the Biomedicine Convention, which deals with living wills. It analyzes the Council of Europe's Recommendation (2009)11 on continuing powers of attorney and advance directives for incapacity. The Council of Europe is indisputably the leading intergovernmental organization in the development of common European norms relating to bioethics. The proper role of the proxy in the decision-making process can differ depending upon which modality of surrogate decision is adopted. The definition of "continuing power of attorney" given by the Recommendation (2009)11 is somehow confusing, and needs a clarification. The recommendation leaves to the states to determine other formal requirements for the validity of the power of attorney. Keywords:advance directives; Biomedicine Convention; Council of Europe; power of attorney; Recommendation (2009)11