Article
Assisted dying
Comment
Death & life
Politics
5 min read

The careless conflation of independence, autonomy and dignity

As Jersey begins to legalise assisted dying, there’s keyword confusion.
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 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 dictionary 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
Comment
Leading
Psychology
Theatre
6 min read

Are you a narcissist?

We all have a little bit of narcissism in us – the question is whether we’re a Moses or an Iago
An Elizabethan man holds a dagger up while grinning.
Kenneth Brannagh's Iago in the 1995 film of Othello.
Sony Pictures.

Is everyone a narcissist these days? It sometimes feels so. Google Trends data shows an eleven-fold increase in searches for “narcissism” between 2010 and 2023, and the term has become a social media buzzword. Online quizzes asking, “Am I a narcissist?” are everywhere, offering dubious self-diagnosis at the click of a button. Genuine Narcissistic Personality Disorder, however, is complex and painful – especially for those in close relationships with someone who cannot acknowledge the harm that they are able to cause or feel any sense of remorse. Narcissus, in Greek mythology, was a handsome young man who was cursed to fall in love with his own reflection, but it was not until the early 20th century that the term “narcissism” was then picked up by the emerging field of psychoanalysis. Initially, Sigmund Freud adopted it in a non-pejorative way to describe the stage in child development when an infant is aware only of their own need for love and attention. Eventually, as that infant grows into a child it begins to experiment with showing others love and attention, and if surrounded by the right relationships, the child learns that love can be reciprocal – a back-and-forth pattern of give and take. Freud wrote:  

“Loving, then, contributes to the lowering of self‑regard. Having one’s love returned, however, restores one’s self‑regard and replenishes one’s narcissism.”  

In its healthiest form, narcissism reflects a positive sense of self – a recognition of one’s own needs and a reasonable desire for them to be met, whilst also knowing that we must give of ourselves, again within reason, to meet the needs of others. In this sense, yes, we are all a little bit of a narcissist. It is only occasionally, most commonly when the early bond between a child and their caregivers is inconsistent or unstable, that this self-focus can become problematically distorted, sometimes leading to a personality disorder. For such a person, a constant hunger for attention and affirmation, often combined with a lack of empathy or a tendency to use empathy as a means to manipulate others, leads to a life of take-take-take; one which can cause significant harm to others and ultimately to themselves.  

Estimates for Narcissistic Personality Disorder are that it affects about one to two per cent of the population, a number which is intriguingly high. The unfortunate news is that true Narcissistic Personality Disorder is notoriously difficult to treat, precisely because key tenets of the condition include a lack of self-awareness and an overinflated sense of self belief. The classic response of the one with Narcissistic Personality Disorder is, of course, “How dare my therapist say that I am a narcissist? They must be the problem!” 

However, much more prevalent are what might be called “sub-clinical narcissists” – people who act selfishly, arrogantly, or manipulatively, influencing others to conform to their desires. We all know one or more of those – sometimes we meet one when we look in the mirror. Whilst this may make us feel pretty rotten, whether we are the giver or the receiver of such treatment, it does not always warrant a clinical intervention. Even so, it can still be extremely difficult to process how and why human narcissistic tendencies are able to cause others so much pain. If, as Freud proposes, a certain degree of narcissism is hardwired into human nature, what can we do about its tendency to evil?  

In Shakespeare’s tragedy Othello, the character of Iago is a master manipulator who displays all the cold-hearted indifference of a true narcissist. Early in Act 1 he expresses his indignation that he has been passed over for promotion. Firmly convinced of his own superiority, he slyly boasts that he will play a false self to Othello, feigning loyalty for his own ends and stating: “I am not what I am.”  

These words are a clever and rather chilling inversion of a famous phrase from the Bible. In the story of the Exodus, God meets with Moses in the form of a burning bush, and when Moses asks for the name of God a voice replies: “I am what I am.” As Moses stands before God, barefoot and awestruck, he hears that enigmatic statement and is forced to confront the question of who he truly is – an ashamed murderer, a fugitive, a short-tempered man of slow speech but hasty acts. Moses acknowledges all these awkward truths about himself and declares himself wholly unfit to be called by God as a leader. Yet God uses Moses anyway, and at the end of his life, Moses dies a celebrated hero – a deliverer who is mourned by all his people.  

Not so Iago. As the tale of Othello draws to its tragic close, Iago is wounded, arrested and escorted from the stage. The audience knows that he has been condemned to execution, but unlike pretty much every other character in that fateful final scene, Iago’s death does not take place onstage. He is simply removed, dismissed from everybody’s notice – a narcissist’s worst nightmare.  

One can see the crucial difference between Moses and Iago – whilst Moses is concerned that his own flawed nature makes him unfit to be become a great leader, Iago is driven to grasp at leadership by a belief in his own grandiosity and acts vengefully when passed over. Right to the end, Iago expresses not one word of self-doubt or regret for his actions. Indeed, he refuses to account for himself at all. “Demand me nothing,” he says at the close; “What you know, you know.” 

Seemingly, the problem of narcissism’s tendency towards evil lies not in actions, but in methods of self-evaluation. While we all make regrettable mistakes, and sometimes it can be hard to judge the difference between unreasonable selfishness and reasonable self-preservation, the true narcissist is afraid to explain themselves, unwilling to bear the judgement of outside scrutiny. The narcissist will look only in the mirror.  

But whereas a mirror only reflects light, a burning bush produces it. In the end, the resources of the Christian tradition do not simply diagnose our narcissism, they offer us a way through it. They offer an outside perspective from which we can truly evaluate our own actions – a light that shines through the mirror.  

If you have ever clicked the link for the online quiz, or been tempted to, then that is an encouraging sign of willingness to be open to outside scrutiny. But of all things, would we really want to trust only human voices, especially the unknown and unknowable voices of the internet, as an authoritative arbiter? If narcissism is so inherent to human nature, it logically takes something higher and brighter than our fellow human beings to really bring it into the light. But in any case, you can save yourself the time of completing that dubious online diagnostic quiz since the whole enterprise can be summed up in just one question:  

Have you ever wondered if you have Narcissistic Personality Disorder? If the answer is yes, you probably do not. So demand yourself nothing, what you know you know.  

Support Seen & Unseen

Since Spring 2023, our readers have enjoyed over 1,500 articles. All for free. 
This is made possible through the generosity of our amazing community of supporters.

If you enjoy Seen & Unseen, would you consider making a gift towards our work?
 
Do so by joining Behind The Seen. Alongside other benefits, you’ll receive an extra fortnightly email from me sharing my reading and reflections on the ideas that are shaping our times.

Graham Tomlin
Editor-in-Chief