Dignity as honour-wound: an experiential and relational view.

In this paper, we draw on a phenomenological-philosophical foundation to clarify the meaning of dignity as a coherent phenomenon. Consistent with an evocation of its central meanings, we then introduce and delineate seven kinds of dignity that are intertwined and interrelated. We illustrate how these kinds of dignity can provide a useful template to think about its qualities, its 'rupture' and its 'restoration' in human life, particularly in relation to health and social care contexts. We then consider the implications of these relational and experiential views for current debates about the notion of dignity: Is dignity a useless concept? Is dignity objective or subjective? What are the useful ways of characterizing different varieties of dignity? We conclude by pointing to a metaphor that may hold the sense and meaning of our deepest human dignity: The gathering of both value and vulnerability, in which human value does not depend on the eradication of human vulnerability, but occurs within its very context.

Introduction

The term ‘dignity’ has many resonances in human life. People refer to this term in multiple situations and also refer to multiple variations of dignity's absence. It is this variation of its use as a term that has led scholars to question its philosophical, psychological and ethical value as a distinctive phenomenon. Although we do not wish to support a philosophical ‘anything goes’ approach to dignity, we do want to be respectful to the complexity of this phenomenon and how it is shaded in ways that reflect many possible variations and nuances that human beings refer to in a meaningful way. In other words, rather than question its existence as a meaningful phenomenon, we wish to honour its complexity. For us, many of the variations and lived resonances of dignity and indignity appear to be referring to something that can be seen to cohere as the essence of dignity. Although it is not fashionable to pursue this line of thinking, we would like to show how a philosophical clarification of the structure of dignity at its deepest ontological level also offers the possibility for very practical directions for caring for ourselves and others in ways that are up to the task of some of our deepest human intuitions.

This paper is directed towards a number of interrelated concerns:

Drawing on a phenomenological–philosophical style of thinking, we attempt to clarify the meaning of dignity as a coherent phenomenon.

We offer a framework that can show how this coherent phenomenon can be the source of multiple variations of ‘dignity’. Although these variations are interlinked and overlapped, we find it useful to name seven kinds of dignity, at least in relation to our own disciplinary background in health and social care.

In beginning to consider the possible practical directions that this framework may offer, we then focus on the ‘rupture’ and ‘restoration’ of human dignity with specific reference to health and social care situations.

Finally, we offer a number of implications of our view of dignity for current debates surrounding the integrity and nature of dignity.

We hope to show that a phenomenologically oriented analysis is very useful to practice-related concerns in at least two ways: Firstly, that it provides philosophical clarifications about the essence of what this particular term in relation to health and social care could mean within the vocabularies of communities in clinical practice and social care. Secondly, that it does so in a way that tries to stay close to experiences that people can relate to in an everyday way.1

A phenomenological–philosophical approach

In the spirit of Husserl [1], we are interested in articulating the quiddity or ‘whatness’ of dignity. Such a description involves an articulation of the essence of dignity (its most invariant properties) as well as its possible variations (kinds of dignity that are consistent with its essence). And then, in the spirit of Heidegger's phenomenology [2], we wish to ground the human phenomenon of dignity ontologically in Being. It is within this sensibility and ontological view that we articulate the essential structure of dignity as a relational phenomenon between Being and beings. Within such an ontological perspective, dignity exists both ‘out there’ as a relational situation as well as ‘in here’ as an experience; dignity is then to be both experienced and to be considered within relational situations (whether these relational situations are recognized or not). Later, we will consider some of the implications of this ontological view for the conventional debate of whether dignity is subjective or objective. We also want to acknowledge that in naming dignity as a phenomenon, we do so within a Heideggerian understanding of the non-representational nature of language. That is, we want our explication of dignity to be consistent (its ontology), but without limiting the multiple ways it is historically manifested in human and collective life (sometimes referred to as the ‘ontic’ level). Thus different nuances of dignity will be emphasized or de-emphasized in different individuals and situations. The term ‘dignity’ then participates in both a unity of meaning as well as its multiple resonances and meanings (such variations are variations of the unity). Having briefly introduced our phenomenological–philosophical approach, we now present our description of the essence of dignity and its variations. Our style of reflection has been guided by the work of Paul Tillich and Rollo May, both existential philosophers. With reference to Tillich [3], we considered how the phenomenon of dignity is distinctive from or overlapping with his work on the phenomenon of ‘the courage to be’. In meditating on the structure of dignity, we were also influenced by the work of May [4] who understood something of how the complexity of lived phenomena transcend either/or categories.

Essential structure of dignity

Dignity is the affirmation of something valuable in oneself or another as an ‘inheritor of Being’. Dignity is given by the ‘heritage’ of Being and as such, constitutes the deep value of what ‘I am’. In ‘inheriting Being’, one carries the immensity of Being within the limits of being human (embodiment, finitude, sociality and so on). The deep source of self-valuing and other-valuing thus lies in a certain consciousness of the intrinsic value of being per se. Such valuing is also conscious of (although not necessarily thematically conscious of) a certain continuity between one's own being and the sharing of Being possibilities with others and things as they have participated in the deep resonances of temporal being and becoming. In this there is also the consciousness of (whether thematized or not) a sense of the limits of being human with its many vulnerabilities. Dignity thus lies in valuing this conjunction of the limits of being human and the immensity of being. In more metaphoric language we characterize this conjunction of immensity and limits as ‘honour-wound’: The gathering of both value and vulnerability, in which human value does not depend on the eradication of human vulnerability, but occurs within its very context. ‘Wound’, as a metaphor, is thus utilized in a poetic way to describe both existential and literal vulnerabilities that come with the territory of the limits of life. The ‘wound’ nuance resonates with allied terms such as vulnerability, finitude, frailty, unprotected, assailable, exposed, susceptible, limited.

The ‘honour’ nuance resonates with a number of other allied terms: uprightness, worth, value, stature, recognition, salutariness, self-standing. So dignity as ‘honour-wound’ thus holds vulnerability together with great foundational value. This essential conjunction of ‘vulnerability’ and ‘value’ participates in all modes of being-in-the-world whether it be an experience of self, or a perception of others or situations, or an activity that occurs in relation. You can imagine dignity as an experience in that one may have a feeling of one's own intrinsic worth; or as a perception of others, one can imagine seeing someone else as dignified in their comportment or bearing. And then, you may imagine how one can describe a situation as dignified or not. And again, one may imagine forms of dignity that exist even though they are not recognized by others. In all these forms of life, dignity can be understood as real.

One of the implications of dignity as ‘the affirmation of something valuable in oneself or another as an inheritor of Being’, is that such affirmation can be ruptured, or restored. Many of the reasons why dignity has become such a topical discourse in public life is because of the realization that dignity can be painfully ruptured and in need of restoration. At this stage of explication, we thus want to say something about the nature of rupture and the nature of restoration. The rupture of dignity is constituted by a devaluation of what ‘I am’, what others are, and what things or situations are. Such modes of rupture or devaluation can occur within a great range, from private self-judgement, to passive neglect, to inhospitality, to ‘a slight’, to humiliation, to insult, to violation. And it can be literally or existentially enacted; it has that degree of range. The restoration of dignity refers to the recovery of ‘something valuable’ in what I am, or what others are, or what situations and things are. Within the uniqueness of individual life situations, the restoration of dignity requires different ranges of response from private self-affirmation, to bearing witness, to apology, to public or social reintegration, to repatriation, and to reparative and reconciliative systems of justice. And we would like to acknowledge that some degrees of rupture are very difficult, if not impossible, to restore.

Having articulated something of the essence of dignity and its ontological roots, we would now like to move to a consideration of possible variations of dignity in human life. There are many ways that one can ‘cut the cake’ here, but we have found that it is very useful to use lifeworld constituents as developed by Husserl [5], Heidegger [2] Merleau-Ponty [6] and Boss [7]. In what follows we name these lifeworld constituents and add some indications in brackets, which although philosophically problematic2, may grant the reader some experiential reference for these notions. These lifeworld constituents refer to the following domains: spatiality (a sense of place), embodiment (living as this body), temporality (a sense of continuity), intersubjectivity (interpersonal relating), mood (the ways the world can be qualitatively felt), identity (a sense of self) and finitude (vulnerability).3 We are aware that different phenomenologically oriented philosophers differ in their opinion about some of these dimensions, for example, Heidegger including ‘finitude’ and Merleau-Ponty including ‘identity’. But we have found that all of these dimensions add value to the articulation of differing emphases of dignity. So, informed by this existential–phenomenological tradition and its family resemblances [10], we offer a view of human dignity that articulates a certain unity to its essential features, but which also encompasses a multiplicity of variations, or kinds and levels of intensity and range. The seven ‘kinds’ of dignity are not intrinsically separate categories, but exist in a seamless multidimensional way; that is, they are all implicated in one another but with different relational and experiential emphases.

We now demonstrate how this framework enables us to carry forward the essential structure of dignity into a number of different kinds of dignity. It is our view that the following seven kinds of dignity form a useful template within which to think about the full breadth of relational and experiential dignity, ruptured dignity and restoration possibilities.

Kinds of dignity

Spatial dignity

There is a dignity experience and relationship that emphasizes a sense of the dignity of one's place in the world. When one's place in the world is bright, the person is tuned into how their own identity is continuous with, and supported by, the depth and breadth of their spatial environment. As human beings, a sense of place and the ways that our places support us, appears to be important for the kind of affirmation that is part of the mix that we draw upon when valuing ourselves as an inheritor of being. In this sense, Being is not just given by the temporality of history, but also by the spatiality of place and environment – like the road that winds out of a familiar town or the playground where my children played. Such a sense of place can be both very personal and more collective, and such attachment appears to be one of the central variations of dignity: the dignity of being at home in my place. Such spatial dignity may be different for different people, and when such continuities are lost or taken away, a person may feel this as an indignity that ruptures a sense of settled inheritance. From a third-person perspective, seeing someone who is engaged in their place of settled inheritance, one may notice a certain fittingness and valued, un-preoccupied relationship between what they are doing and the place that supports that – the place dignifies their activities.

Temporal dignity

There is an experience of dignity that is attuned to one's sense of history and possibility, as well as to the present ongoing temporal rhythms of night and day, of natural seasons, and of the phases of one's life. As human beings, in different ways, we value some sense of historical heritage, whether this is cultural, ecological, familial, occupational and so on; there is a sense of dignity ‘in the feel’ of sensing support from these valued continuities. These affirmations of continuity can be lost or taken, and can constitute a challenge to the self-affirmation of Being. As human beings we also value the many literal and metaphorical ways ‘we walk’ towards our meaningful projects and futures. There is a certain kind of dignity that is connected with the felt competencies of ‘I can’ that we either enact and affirm, or that are granted to us by others and by life. In the rhythms of the present moment, there appears to be a self-affirming value to a sense of ‘rightness’ in the way that things unfold and move on; a musicality, if you will, to temporal possibilities. Here, there is both a cyclical returning to familiarity, as well as ‘the feeling of progress’ given by novelty and the possibilities of life. Any disruption of this rhythm has potential to undermine the dignity that a historical being can give. So, for example, such ruptures to temporal dignity may include: being disconnected from our heritage, being denied recognition of where we came from or who we are, and a feeling of groundlessness and discontinuity. From a third-person perspective, when temporal dignity stands out, one may notice a certain temporal eloquence in the rhythms of the ways people act and conduct themselves; like the dignity of dancing.

Embodied dignity

There is a dignity experience that emphasizes a sense of one's bodily dignity. When one's sense of bodily dignity is grounded, the person is affirming the value of their carnal nature. There is a sense that their own body is somehow connecting them with all their embodied heritage and bodily connections to earth and the historical continuity of embodied being-in-the-world. It announces both the privacy of one's bodily life as well as a public face that announces ones bodily participation in a world with others. A sense of bodily dignity gives us the bodily ‘I can’ and the bodily ‘I am’; in this we have a lived sense of the potentials of competent bodily functioning, which is intrinsic to a sense of bodily worthiness. Experientially the body ‘screams out’ in painful awareness when one's bodily privacy is invaded, or when one's bodily presence in the face of others is shamed. When we see another who carries themselves with embodied dignity, we may notice a comportment in which the person carries or bears both a sign of self-accepted vulnerability and a certain honour in this; the body in dignity pre-reflectively knows itself as ‘honour-wound’.

Interpersonal dignity

There is a dignity experience that emphasizes a sense of one's interpersonal value and worthiness. When this sense of interpersonal valuing is bright, one is participating in an interpersonal world of mutuality in which we gift one another as intrinsically ‘mattering’ to one another, and within community, in mutual ways. When human beings fall from the possibility of mutual intrinsic valuing, we can easily assail dignity. This mutual valuing is not a passive, effortless given; rather, it is something that requires an attentiveness and some guarding. The need for this kind of attentiveness and guarding of interpersonal dignity arises because the vulnerability that comes with being participates in the ambiguities of darkness and light, harmony and strife, where we love and destroy each other. An experiential sense of interpersonal dignity thus appears to carry a certain ‘common humanity’ in the ways we attend to one another's existential vulnerabilities. When interpersonal dignity is present in this way, one may notice a certain respectful character in the way social relations are regarded and conducted. This is not to deny, however, that there are some standards of dignity in different social/cultural situations that may be unjust and even harmful to others. Thus these standards of interpersonal dignity are always open to moral contestability and other considerations of justice and humanity. So, although this dimension or emphasis of interpersonal dignity can be misused and perverted, its deep reality balances an appreciation of human vulnerability with value; and as such, leans towards the deepest appreciation of our common humanity.

Mood dignity

Mood is a fundamental characteristic of any experiential moment. Dignity can be carried in many moods; in solemn sadness, celebratory joy, poignant love, defiant determination and simple ‘here-I-am peacefulness’. So, if dignity is not just one mood, should we then articulate dignity without recourse to a mood dimension and define it only relationally? We do not think so. There appears to be a common ‘feel’ to dignity that threads through all these different moods. This felt thread through all the mood variations mentioned earlier, such as solemn sadness and so on, is one that straddles the complexity of both ‘felt vulnerability’ as well as that of ‘felt value’. This is the complex mood of ‘honour-wound’, the felt aspect of valuing Being because of its vulnerability rather than in spite of its vulnerability. Honour-wound – a certain feel of ‘upholding-in-vulnerability’, a felt knowing and a showing of this. From a third-person perspective, when the mood of dignity is noticed, one may see a number of variations as indicated earlier; however, there is a certain awareness that the other is valuing Being in this way.

Identity dignity

As human beings, we appear to carry a coherent and deep sense of everything that is gathered for us, how things are for us, spatially, bodily, temporally, in mood. This ‘self-gathering’ is core to our sense of identity and has deep implications for dignity. So, there is a dignity emphasis that refers to this gathered deep self-identity, and this can be affirmed, lost or stripped away at different levels. When a sense of the dignity of identity is challenged, one is faced with a rupture or threat to the ‘something valuable in or as oneself’, and a need for restoration is acutely felt. Such rupture can often be felt pre-reflectively as an immediate threat to the coherence and value of one's identity, whether personal or social. Many of our experiences of everyday dignity refer to an experience of one's own identity that meets our personal standards of self-value of a particular kind. As a corollary, we may experience an everyday indignity when we experience ourselves as feeling less than our personal standard of a particular kind. This can be very simple and personal, such as when one walks into a room realizing that one is underdressed or overdressed for the dignity required of a particular situation. We want to emphasize that the nature of this personal standard in relation to dignity is not necessarily a moral standard (although it can be), but more centrally a standard about our perception of what is ‘fitting’ for ourselves to be. These variations are many, and although very personal (and subjective), also participate in collective and cultural contexts. Thus, certain groups have particular nuances regarding certain standards that other groups may not understand (or which may be difficult to condone, such as the highly shocking standards that make use of dignity as a rationale for honour killings). From a third-person perspective, when identity dignity stands out, one may notice in different ways how an individual or group may be deeply attached to their standard for what is valuable regarding self-value or group-value. So, for example, when a particular occupational group, usually unnoticed in the background are given recognition in a public way for their contribution, a certain dignity identity is given to the members of that occupation. In dignity, identity is honoured.

Finitude dignity

There is a dignity experience that is particularly attuned to the potential of our existence to ‘not be’: the potential of personal death. Such an attunement gives dignity its poignant face, the delicate beauty of its vulnerable affirmation in spite of potential non-being. This fragile affirmation of the value of being is sobering, but in a way that gives being its preciousness. On the downside, we may wish to run away (take flight) from this beautiful soberness by turning away from each other in various ways, thus leaving one another existentially alone (as in examples of death denial). On the upside, when this dimension of vulnerability is personally accepted to some degree or interpersonally affirmed, there is a certain ‘standing out’ ‘with’ vulnerability that feels worthwhile and meaningful. In such moments one may feel emotionally moved by the, ‘this is how it is’, worthwhileness of human existence in spite of it all; the dignity of embracing life's limits.

Intensity and range of indignities: possibilities for restoration

All these previous kinds of dignities can be ruptured at various levels of intensity and range. By ‘levels of intensity’ we mean how deeply the rupture of dignity occurs, as well as how difficult it is to restore such rupture. Thus, intensity refers to rupture and restoration. Further, the range of indignities refers to how many of the above dimensions of dignity are implicated if dignity is ruptured.

Based on this notion of intensity and range, we would like to propose that it is useful to conceptualize three levels or degrees of intensity derived from a consideration of how easily dignity is established, ruptured or taken away. Such intensity is also derived from a consideration of how easy or difficult it is to restore.4 So, for example, within the spatial-dignity emphasis, one's connection to place can be violently ruptured, or alternatively, can be mildly interfered within a way that can be easily restored. But the rupture can also occur, for example, not only in the spatial dimension, but in a way that implicates more and more of the other dimensions such as temporality, identity and so on. Therefore, in deep indignity, there is both a depth of intensity and a breadth of range. There is a very practical reason as to why we wish to delineate the range and intensity of indignities, and this concerns pointing to practical directions for care. Practical ways to restore dignity then needs to appropriately meet both the intensity of the indignity as well as the range of dimensions that are implicated in any indignities: this is what it would take to restore dignity. So for example, if in a situation of interpersonal indignity a person's sense of inner identity has also been ruptured, one would need to be sensitive to the fact that just restoring the interpersonal situation may not have the range needed to also restore the inner identity-indignity that the person is now carrying. In other words, beyond the interpersonal situation, there is now also an ‘inner wound’ that carries further into new situations that may not look undignified from a third-person perspective. This way of thinking about the rupture of both intensity and range of indignity can act as a sensitizing framework to help attune professionals to the potential threats to dignity for people in our care.

Consistent with our analysis of the essence of dignity, the ‘restoration' of dignity is the restoration of a certain sense, given by Being’, of the ‘something valuable in what I am’, that comes from one's heritage. Here we mean ‘heritage’ in the deepest ontological sense of being-in-the-world, but also a ‘heritage’, which includes the existential kinds of dignity already named, and which include cultural belonging, sense of place, and the shared humanity given by finitude. The restoration of ‘something valuable in what I am and what others are’ thus involves finding, re-finding or re-membering one's ‘goodness of fit’ or harmony with these dimensions.

Having articulated the ‘bare bones’ of our relational and experiential view of dignity, its essence, variations, possible ruptures and restoration, we would like to now consider the implications of this phenomenological–philosophical view for current debates surrounding the notion of dignity.

Implications for current debates

We believe that our approach to naming and delineating the essence of dignity and its variations can make a contribution to three specific debates within the philosophical and professional literature.

Dignity as a ‘useless concept’

The notion of human dignity has been, historically, a highly contested idea bound up with very different stances in value and application [12]. Pinker [13] worried about use of dignity to support a conservative agenda that discourages forms of medical innovation such as genetic manipulation. Pinker was following Macklin [14] who also questioned whether dignity as a concept was necessary, and recommended that we replace dignity with the principle of personal autonomy. Macklin argued that dignity adds nothing. Pinker [13] goes further than this as he is concerned that, not only is dignity a useless concept, but that it can be colonized by a religiously inspired agenda that co-opted the notion of dignity to justify what he calls ‘an obstructionist bioethics in relation to medical progress’. He refers specifically to the President's Council on bioethics as an example, where the notion of dignity can, in his view, be harmful and used to pressurize and pervert public agendas and the progress of a free society. So, within a concern to emphasize democracy and individualism, one can see that ‘autonomy’ has become an attractive alternative for such thinkers.

Another suggested alternative to the concept of dignity occurs in the work of Statman [15]. Philosophically, he problematizes the concept of dignity, and focuses on the concrete problem of humiliation as the preferred context from which ‘dignity’ is the proposed solution. In his view, when considering the context of humiliation, ‘self-respect’ is sufficient as a pragmatic concept, one that does not seek recourse to the more philosophically vague notion of dignity. According to Statman [15], within this context, we do not need the vaguely descriptive notion of dignity, as the normative notion of self -respect is a sufficient response to the problem of humiliation.

Using a similar line of argument within a health care context, Wainwright and Gallagher [16], believe that an appeal to the concept of respect is more important for nursing than an appeal to dignity. In other words, they do not believe that an understanding of what dignity is has much import for practice. And there are other thinkers who provide further alternatives to dignity beyond the notions of autonomy and self-respect. Shotton and Seedhouse [11] progress an argument within the context of healthcare ethics and consider what it means practically to care about peoples' rights to be valued as persons.

So given these arguments, is the notion of dignity a useless concept, in that, at best it alludes to a vague impractical notion, and at worst supports a conservative agenda? Our phenomenological articulation of the essence and variations of dignity provides a perspective in which dignity has a centrally important reason for being: it opens up a lived perception of a deep common humanity in which we participate in both vulnerability as well as honourable kinship. The philosophical grounding of this perception has a very practical normative possibility in that it points to the meaningful source of the ability to care, to respect, and to grant autonomy and beneficence to others. In other words, it provides the possibility of a living basic intuition or perception that is deeper, that ‘gives juice’ or lived authenticity to respectful caring behaviours which could otherwise easily become instrumental without such perceptual-intuitive sustenance. So our claim is that alternative concepts to dignity such as respect, autonomy, beneficence are given their meaningful life by the ontologically prior notion of dignity as honour-wound; and this is not just a concept, rather it is a phenomenon that calls.

Dignity as objective or subjective?

The question about whether dignity is objective or subjective occurs within a much larger philosophical heritage that is sometimes referred to as the debate between realism and idealism [17]. Recent thinking however has generally moved beyond this Cartesian dualistic split, but this ‘habit of thinking’ does not lie down easily. Such thinking still encroaches into debates about whether dignity is really ‘out there’ or whether, being only psychological, is whatever we construct it to be. For example, a new way of re-importing the subjective/objective split can be seen in Statman's [15] arguments. Statman [15] acknowledges certain objective features of dignity in a descriptive way as referring to something that ‘belongs to all members of the human species irrespective of their rationale or their moral capacities and irrespective of the exercise of these capacities’ (p.525). He uses this objective account of dignity to refer to a level of universality that is so abstract that all it can say is that all human beings are entitled to dignity. Therefore dignity as an objective phenomenon can be raised as a meaningful principle, but it has no meaningful application in the real world of particulars, and as such, is deemed to be unhelpful in everyday life. On the other hand, Pinker's [13] argument is an example of the possibility that dignity exists as a subjective phenomenon. Such subjectivity is highly relative to cultural and individual context and he contends that its only value is to encourage a greater attentiveness to situations where respect and autonomy are required. The approach of Shotton and Seedhouse [11] is also consistent with an approach that emphasizes the subjectivity of dignity. They link what is usually called dignity to the subjective experience of feeling capable to achieve what one would normally achieve. They thus emphasize a sense of personal agency based on relative individual and social standards. To quote them, ‘… this analysis suggests that dignity always has to do with being in a position in which one is capable’ (p. 249). Our phenomenological articulation of the essence and variations of dignity does not make hard and fast distinctions between objective and subjective dignity, yet wishes to acknowledge the terms of the debate in a different way: Instead of objective and subjective, we talk of relational and experiential. In other words, dignity as a relational phenomenon acknowledges that there is something out there, which we can call dignity, that can be viewed from both a second- and third-person perspective, and whose meanings thread through all its variations. And dignity as an experiential phenomenon acknowledges multiple individual, cultural and social variations of dignity, and thus can be a highly personal experience. In accounting for relational and experiential dimensions of dignity, the phenomenologically oriented ontology on which our analysis is based also indicates the complementarity of the ‘relational’ and the ‘experiential’. However, within the traditional discourse of objective and subjective, the ‘objective’ is usually seen as an alternative to the ‘subjective’ (as in: it's ‘only subjective’). Within a phenomenologically orientated ontology, relational and experiential dimensions of dignity are seen as co-constituting one another or are seen as necessary implications of one another as in ‘figure and ground’. Thus dignity as ‘honour-wound’ is relational in that it connects this highly unique individual beyond themselves to the essential source of dignity given by the self-standing of Being. And dignity as ‘honour-wound’ is also uniquely experiential in that such possibility of self-standing with both vulnerability and honour can be experienced in highly unique ways, even according to highly unique standards. So our contribution to what is called the subjective/objective debate involves a ‘reframe’, which moves the terms of the debate from a conflict model to a complementary model. Therefore, dignity is neither objective nor subjective in itself, but is both a relational state of affairs as well as uniquely experiential.

While we may not refer to dignity often in everyday life, we know it when we see it, and we identify with it when it is assailed. One example of this relational and experiential state of affairs is given by Lingis [18]. He eloquently describes that what we see and call dignity, is noticed more clearly and honoured in the poignancy of death. Here dignity is not an intentional seeking, rather it is manifest through an endurance of a time (one's death bed) without any future. In this situation, one of no future, the person is facing nothingness, their projects cease, the past can no longer offer its resources and the person ‘awaits what cannot be foreseen or confronted’ p.268. Here Lingis [18] is acutely and sensitively attuned to how dignity is ontologically announced in this marginal situation; how dignity can come through a kind of letting-be in the face of everything falling away. Our approach overlaps with Lingis in that, he is pointing to what makes dignity ontologically possible in a very radical way. And by using dying as an example, he is powerfully articulating a ‘bearing witness’ to honour-wound. Here, honour-wound is both a relational state of affairs as well as a felt experience.

Variation in naming kinds of dignity

In this section we focus on some attempts by scholars and researchers to delineate different kinds of dignity. We have chosen these papers because they raise some fundamental issues about naming kinds of dignity that we believe can be fruitfully addressed by our ‘honour-wound’ articulation of dignity.

Statman [15] provides an example of a conceptual clarification that divides dignity into two notions: the descriptive and the normative. For him, dignity at a descriptive level of analysis is so abstract as a principle that it appears to have no discriminating value in everyday practical life. He separates this descriptive account from a normative account, which does have discriminating value and use in everyday practical life. Within this normative account of dignity, dignity refers to ‘… obligations incumbent on oneself or on others with regard to oneself’ [[15], p. 525]. He essentially argues in a nuanced way that it is only the normative account of dignity that has any useful value in human discourse because it is at this level that judgements can be brought to bear about whether situations are dignified or humiliating. But even then when he looks in a rigorous way at what is going on when these norms are appealed to, he asserts that the concept of respect is sufficient as an explanatory concept and that one needs no recourse to a vague concept like dignity. So the word dignity can be eradicated in normative analyses (replaced with the term respect) and the descriptive analysis of dignity has no meaningful relation to this. This is an ontology that separates the descriptive from the normative. In other words, it does not see a connection to how the normative is grounded in, and given life by, its descriptive depth and breadth. Our ‘honour-wound’ approach sees an intimate connection between what Statman [15] calls the descriptive and normative levels of analysis. For us, the more ontological (descriptive) articulation of dignity as the ‘affirmation of something valuable in oneself and others as an inheritor of Being’ is a crucial intuition or perception that has great import for the way that we define a number of kinds of dignity with their normative possibilities for everyday life. So for us, ontic variations and kinds of dignity cannot be separated from the essence of dignity (its ontological level). And that is why we cannot reduce a number of different kinds of dignity to the notion of this one kind, that of ‘respect’. Given our ontological description of the essence of dignity, and referring to the kinds of dignity that we have articulated, we find a number of ways in which self-affirmation occurs that is not simply encompassed by the singular notion of self-respect (e.g. dignity in space, dignity in temporal rhythm etc.). The interdependence of our ontological–ontic approach, thus, retains the value of defining dignity as dignity essentially, while also indicating the complexity of its multiple variations, which still retain this essential quality of dignity as dignity.

Shotton and Seedhouse [11] are further examples of scholars who are concerned about the ‘vagueness’ of the way the concept of dignity is used. They take this concern towards a practice-related direction by considering situations of indignity and how such kinds and levels of indignity affect one's psychological experience of agency and competence. In other words, in taking this practical lens, they consider situations in which a human being fails to achieve what they would normally achieve and be capable of. To quote them ‘… dignity always has to do with being in a position in which one is capable’ [[11], p.249]. There is merit in the way they focus on agency and how they derive different levels and intensities of dignity loss. However, from our point of view, in emphasizing agency and competence (becoming), they de-emphasize the kinds of dignity that are associated with belonging, heritage and connection (Being). In other words they have a dignity of ‘I can’, but not a dignity of ‘I am’. Therefore their ‘kinds and levels of dignity’ is limited to these possibilities of competence and agency. And this also determines the range of restoration possibilities that they recommend. Drawing on our ‘honour-wound’ approach to kinds and levels of dignity, indignity and restoration, we would say that Shotton and Seedhouse have forged a welcome step forward in that they have opened up the agency-related forms of dignity with some interesting practical directions. However, our approach complements these kinds and levels with those that tap into a deeper existential level that is not necessarily agency-related (being, belonging, etc.), and this opens up possibilities for restoration of dignity at this Being level where a larger ontological identity can be experienced as part of the possible givenness of Being.

So far, in considering variations in naming kinds of dignity, we have pointed to thinkers or scholars who, in our view, practice a kind of partiality in principle in the way they define the boundaries of dignity. And by implication, the practical directions that they take would be restricted by these definitional interests, for example, autonomy, competency, agency. We now wish to consider a few other contributors to this debate that enact a different kind of partiality, a partiality about the range of dignity and indignity possibilities that are derived from a focus on a particular patient group or clinical context or where empirical data takes primacy in deriving a typology of dignity. In other words, the following contributors do not restrict the definition of dignity at a philosophical level, but rather restrict it at an enacted level because of necessary disciplinary preoccupations.

Nordenfeldt [19], derives varieties of dignity from his empirical research programme that includes the dignity of ‘Menschenwürde’ (intrinsic dignity), dignity as merit, dignity of moral stature, dignity of personal identity. These varieties overlap substantially with what we see in our own approach at both the ontological and ontic levels. However, Nordenfeldt notes that his development of the kinds of dignity he articulates were largely derived from empirical research he carried out with colleagues and this is perhaps why he did not have as full a spectrum of the kinds of dignities that we have offered through deriving these philosophically.

Likewise, Leget [20], who also displays a wide philosophical range informed by Ricoeur [21], provides a framework that includes subjective dignity, social and relational dignity, and intrinsic dignity. In focusing on the implications of this for end-of-life care, Leget [20] opens up a depth of focus that provides practically relevant insights for caring interactions in such circumstances. The advantage of focusing on the pragmatics of this professional context is that it provides detail and depth to specific stories of dignity, rupture and restoration. A limitation of this analysis is that it puts aside the definitional issues too early to focus on the practical issues, and this constitutes a partiality of breadth; breadth is necessarily sacrificed for depth. Other contributors [22-26] provide examples of research studies that name the characteristics of dignity through empirical exploration or metasynthesis of the literature in nursing. These professional contexts include, for example, paediatric care, rehabilitative care and dementia care. Again, a depth of insight in these specific practice contexts emerge in relation to particular nuances of dignity and indignity, such as feelings of shame, challenges to autonomy and self-management. For example, Delmar [26] was able to highlight that an overemphasis on autonomy can obscure patients' need for help and in turn negatively impact their sense of dignity. But in our view, these empirical studies and professional concerns that generate depth and detail would best be complemented by a wider context of definitional breadth. And this is what we believe our philosophical analysis offers: a framework of seven dimensions that could be usefully considered within any research project or professional context. For example, when considering the dignity of a loved one with Alzheimer's disease, the framework would not just focus on interpersonal dignity, but would wonder also about spatial dignity and allow consideration of how to help a person feel dignified in place and so on.

We hope that we have indicated some benefits of our ‘honour-wound’ approach to dignity for current debates: dignity is not a useless concept, dignity is both objective and subjective; and the seven kinds of dignity provide philosophical range and breadth for both studies and practice contexts in relation to dignity, its rupture and its restoration.

Conclusion

We would like to end this contribution by making a move that is consistent with an aesthetic emphasis within the phenomenological tradition [8,9,27-29]. This direction at times employs more evocative language in order to facilitate ‘embodied relational understanding’ [30], a kind of knowing that may be more up to the task of ‘keeping alive’ the sense and presence of a phenomenon. The use of poetic and metaphoric language can thus be seen to express existential realities that people can relate to in a personal way: ‘Poetic language with regard to experience is “truthful” in that it attempts to retain the prereflective qualities of experiential structures – concrete, embodied, mooded, sensed, interrelated, and always full of the imagination gathered from other times and places. In poetic discourse, one's relatedness to existence is revealed in that it asks the listener to move towards the speaker or the text and to find the body of the occasion, its taste or mood in his or her own’ [[31], p. 12].

So we invite you to participate for a moment in the following partial pointers.

Dignity is a holding and an upholding – a gathering of both common ‘wound’ (vulnerability) and common honour (value). It is an upholding of honour while holding wound; such gatherings, whether individual, interpersonal or communal also give us clues as to its restoration. The loss of dignity is especially noticed in its rupture. Its path of loss is through vulnerability. Its path of restoration is through honour and value. We are given to bear and uphold the vulnerable values of ‘being ourselves’ in place, rhythm, with others, heritage, body, being-affirming moods and life – many kinds of dignities – but all cohering in their ‘honour-wound’ character – our ‘goodness of fit’ with all of these dimensions.

And here are some lines from the poem, Wild Geese by Mary Oliver [32] evoking both common vulnerability and great value-in-being (ecologically and more):

… Whoever you are, no matter how lonely,

the world offers itself to your imagination,

calls to you like the wild geese, harsh and exciting. …

Over and over announcing your place

in the family of things. (p. 14)

Further, Leonard Cohen [33] also evokes vulnerability and great value in his poem/song, Here It Is.

And here you are hurried

And here you are gone

And here is the love

That it's all built upon. (p. 199)

And we conclude with an image of our own.

She stands in tatters. They cut off her hair. This was not her choice and she shuffles along in hunger. Rupture. But where does the glow in her eyes come from when she meets your gaze? More than defiance: Dignity. Here it is. All the way down. Honour-wound.