Power, Suffering, and the Struggle for Dignity. Alicia Ely Yamin

      Nothing can compare to those family groups who were tortured often together, sometimes separately but in view of one another, or in different cells, while one was aware of the other being tortured. The entire affective world, constructed over the years with utmost difficulty, collapses with a kick in the father’s genitals, a smack on the mother’s face, an obscene insult to the sister, or the sexual violation of a daughter. Suddenly an entire culture based on familial love, devotion, the capacity for mutual sacrifice collapses. Nothing is possible in such a universe, and that is precisely what the torturers know.⁶

      Torture destroys any possibility of human agency in the victim through its physical effects; but it also destroys the narrative we construct to make sense of ourselves emotionally and psychologically.⁷ It is this shattering of human agency—and, in turn, of human dignity—that lies at the core of torture and makes it the quintessential abuse of human rights.

      In this chapter, I discuss understandings of human dignity, the link between health and human rights, and why human rights matter. The equal dignity of all people is the basis for the notion of universal human rights. Dignity requires the conditions that enable one to govern one’s self and exercise ethical as well as physical independence within a specific social context; it also requires us to respect the humanity in others.

      There is an important link between torture—the classic violation of human rights and dignity, defined in more detail later in this chapter—and health, in terms of both the severe physical and psychological impacts on victims as well as the frequent use of specialized knowledge by health professionals in carrying it out. Moreover, some abuses in health care—through the manner in which services are inflicted and through the denial of treatment—rise to the level of what is considered “torture or cruel, inhuman, and degrading treatment” under international law. The common thread among these different facets of torture and inhuman treatment is that they stem from, and result in, a denial of the full humanity of the victim.

      I go on to argue, however, that confining our focus on torture to the actions of state agents, whether police or health personnel, reflects an inadequate conception of human rights and state responsibilities—especially if we are concerned about the health of women and children. Women and children overwhelmingly face abuse in the private sphere, and applying a human rights framework to health must enable us to redress that suffering. The annihilation of self that occurs when an adult is tortured by strangers is only one kind of assault on dignity; it can be just as awful when children are raised to internalize a sense of themselves as inferior or defective—a sense of themselves as less than fully human or even deserving of abuse—before they are able to acquire any degree of autonomy. Thus, human rights frameworks need to be empowering, as well as protective, of agency across multiple spheres.

       Human Dignity: A Universal Concept with Varying Conceptions and Implications

      Recognition of the dignity inherent in all human beings is the basis for human rights.⁸ Across countless cultures and philosophical as well as religious traditions, there is a concern for the “equal dignity of the human person,” which is set out in the Universal Declaration of Human Rights and in many other international documents. Dignity has been assailed as meaning different things to different people. As the late legal philosopher Ronald Dworkin argues, dignity has fallen into “flaccid overuse.” Yet, at its core, the principle of dignity is most often explained in terms of requiring that people be treated as ends and not mere means. Thus, torture is the ultimate example of reducing victims to being means—means to obtaining information, exacting revenge, or expressing discrimination toward or contempt for a certain group.

      The liberal philosopher Immanuel Kant was a leading articulator of this meaning of human dignity: “Everything has either a price or a dignity. Whatever has a price can be replaced by something else as its equivalent; on the other hand, whatever is above all price, and therefore admits of no equivalent, has a dignity. But that which constitutes the condition under which alone something can be an end in itself does not have mere relative worth, i.e., price, but an intrinsic worth, i.e., a dignity.”⁹ Kant’s insight has implications for how we relate to others as well as to our own lives. That is, if life has objective, intrinsic value, then it follows that both your own life and the lives of others have that value. It is not just you who can possess dignity while other human beings are slaves. Out of respect for your own dignity, you must treat yourself as an “end”—or an independent subject. At the same time, out of respect for the dignity of others, you must treat them as ends in and of themselves, and not as means for your own benefit. Kant’s notion that we should be able to universalize how we wish to be treated implies that achieving dignity in one’s own life requires respect for humanity itself, which is fundamental to the concept of universal human rights.

      Many scholars have pointed out a conceptual dilemma here: if dignity is intrinsic, it should not need protection through laws and policies.¹⁰ Yet violations of human rights, such as torture, clearly constitute affronts to dignity, and the purpose of reflecting human rights in law both at the national and international levels is to protect people’s dignity. Despite this theoretical dilemma, I believe that, on a commonsense level, the notion that every human being possesses an intrinsic worth and that this worth should be recognized by other human beings and enshrined in our laws and social arrangements can be compatible with the idea that, sadly, too often it is undermined in practice.

      Much has been written critiquing the Westernized individualism of modern human rights, sometimes with ample justification. However, this concept—the fundamental dignity of all human beings and the prescription to treat people as ends and not means—is not just a Western philosophical concept. Kant’s proposition that we cannot adequately respect our own humanity unless we respect the humanity in others has strong resonances with a number of religious and cultural traditions. The Bible’s “Golden Rule,” for example, calls on people to treat others as they would want to be treated. Similar notions regarding seeing others as full human beings can be found in the beliefs of Jewish thinkers, such as Martin Buber, as well as in Sufi and Hindu traditions. Buber writes about the distinction between relationships grounded in treating others as “Its” or objects—and fuller “encounters” with others as subjects or “Thous.”¹¹ In a similar vein, the rule of dharma in Hinduism basically states, “One should never do that to another which one regards as injurious to one’s own self.”¹² “Namaste,” the common Indian salutation, is a humbling acknowledgment of being on equal standing with the person greeted.

      In African traditions, there is the notion of “Ubuntu,” which can be roughly translated as “I am because we are.”¹³ Ubuntu is found in diverse forms in many societies throughout Africa; among the languages of East, Central, and Southern Africa, the concept of Ubuntu captures a world view about what it means to be human.¹⁴ Desmond Tutu, the South African archbishop emeritus and Nobel Peace Prize laureate, explains that, on an interpersonal level, Ubuntu means that every person’s humanity is bound up in each other.¹⁵ For his part, the scholar Kwame Anthony Appiah, who has West African—Ghanaian—roots, associates his attachment to the idea of dignity with his father, “who grew up in Asante, at a time when the independence of its moral climate from that of European Enlightenment was extremely obvious.”¹⁶ Appiah goes on to note that those Asante conceptions depended on a sense of one’s own dignity being connected to the dignity of one’s fellow citizens.¹⁷

      In stressing universality, I do not want to overstate the claims to uniformity: the essential human qualities that support a claim of worth, dignity, and shared humanity vary across philosophical and religious traditions. In some, there may be a concern for the sentience and the capacity of fellow humans to suffer (and in some philosophers’ arguments this would extend rights to animals as well);¹⁸ in some religious traditions, there may be a focus on the quality of having a soul. In a modern human rights framework, dignity is reflected in the human capacity for agency, or self-government, which enables a person to make (and take responsibility for) choices and decisions about one’s self and the course of one’s life.

      The kind of self-government necessary for human dignity need not—and, in my view, should not—be understood