Human Dignity as a Framework for Shared and Supported Decision Making in Healthcare
David Kirchhoffer1, Queensland Bioethics Centre, Australian Catholic University Brisbane 1Queensland Bioethics Centre, Australian Catholic University, Brisbane, Queensland, Australia
Abstract
A multidimensional conception of human dignity provides a framework for considering both why shared and supported decision making (SDM) are important and how to go about them as a process of moral meaning-making. Shared and Supported Decision Making are frequently invoked as best practice because, it is claimed, they respect autonomy by facilitating valid informed consent. Since Nuremburg, the principle of respect for autonomy has come to dominate medical ethics. However, the kind of autonomy envisioned in the principle is frequently lacking or limited in practice. This is so not only for people living with cognitive impairment, but, in the increasingly complex world of contemporary healthcare, arguably also for everyone seeking care. While is it true to say that SDM may support the exercise of autonomy by people seeking care, this is not a sufficient grounding. A multidimensional conception of human dignity provides a way to situate SDM within a broader and more foundational value that understands the human person as a historically-situated meaning-seeking embodied subject in relationship to all that is. SDM, as moral decision making, should aim at realising the inherent dignity of the human person in ways that both respect that dignity and promote the flourishing of the person’s subjective sense of their own dignity and their capacity to support and promote the dignity of others. All parties (patients, supports and clinicians) engage in this relational process as moral meaning-makers whose own dignity is at stake in finding morally meaningful outcomes.
Biography
David G. Kirchhoffer is the director of the Queensland Bioethics Centre at Australian Catholic University. He is the author ”Human Dignity in Contemporary Ethics” (Teneo: 2013) and co-editor with Bernadette Richards of “Beyond Autonomy: Limits and Alternatives to Informed Consent in Research Ethics and Law” (CUP: 2019). He is a member of the University of Queensland Ethics Advisory Group, the Perinatal Society of Australia and New Zealand ethics group, and the Australian Health Ethics Committee. He is also a Roman Catholic Commissioner on the Faith and Order Commission of the World Council of Churches, where he works on the problem of moral disagreement. Dr Kirchhoffer’s primary research interest is on the meaning and relevance of human dignity for bioethics.