Sapporo Conference for Palliative and Supportive Care in Cancer Conference Organizer:Higashi Sapporo Hospital

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A New Year's Message from the PresidentCan the concept of “dignity” be an episteme in the near future?

A symposium on “euthanasia” is being planned for the end of the third day of the 3rd & 4th Joint Sapporo Conference for Palliative and Supportive Care in Cancer, which will be held in April 2023. Dr. Chochinov from Canada, renowned for “Dignity therapy”, will take the role of chairperson, with Dr. Gaind, a leading figure in the Canadian psychiatry world, giving a lecture titled “Missing Goldilocks and Killing Kant: The price of Canada's headlong assisted death expansion”. Canada legalized active euthanasia in 2016 and expanded legislation to cover cases of mental illness in 2021. An additional lecture, in which Canadian doctor recount their struggles with “human dignity” is also planned.
There is currently a debate as to whether the concept of “dignity” can be considered to be an episteme (a system of recognition or fundamental “knowledge” that underlies the entire culture of an era as coined by Foucault ) in the 21st century.
Although the concept of “dignity” originated with the “formation of virtue” in Plato's “Defense of Socrates,” it was not until Kant, through the historical concept of “the chosen one” such as the noblesse oblige. From this, Kant advocated the “dignity as an absolute value” in a moral sense given to human beings was philosophically grounded. Kant defined “human dignity” as “justice derived from the people” and established it as an egalitarian, universalist concept in which everyone involved in the formation of the personality is equally respected. According to Kant, in the relationship between law and morality, the concept of “human dignity” functions as a moral source that provides the substance of basic human rights. In contemporary philosophy, a Kantian interpretation of “dignity” has developed mainly in the Western world, with Schopenhauer, Nietzsche, Habermas, Hobbes, and Darwall, among others, all involved in the long-running debate. However, there is almost no research on the conceptual history of “dignity” outside the Western world. On the other hand, due historical developments, the concept of “dignity” is being universalized as a legal concept in the 20th and 21st centuries. It has become a legal reality through its proclamation in the 1945 United Nations Charter, the 1947 Japanese Charter, the 1948 Universal Declaration of Human Rights, the 1949 Basic Law of the Federal Republic of Germany, the 1999 Swiss Constitution, the 1999 United Nations Global Compact, the 2004 EU Constitution, and the 2015 SDGs (MDGs). Moreover, the Covid-19 pandemic and the Russo-Ukrainian War have both brought the world to tears over the severe damage done to “human dignity”. Today, now that the philosophies central to globalization, such as Rawls' notion of “justice as fairness,” have collapsed, there is no question that the concept of “dignity” has a hidden importance as a unifying philosophy, as its history shows.
On the other hand, the concept of “dignity” is also being discussed as a core value in palliative care and other medical care, but it seems necessary to deconstruct its structure. For example, the term “dignity of life” originated in Japan; however, in East Asia, including Japan, it tends to be accepted relatively naturally, and cultural anthropological differences between “human dignity” and “dignity of humanity” must also be discussed. In addition, the Swiss Constitution introduced the concept of “dignity of creation”, which extends beyond humans to include animals and plants.
In the context of “benevolent medical care” that we have been thus far aiming for, “dignity” is a moral norm inherent in oneself that cannot be separate oneself from others; in other words, it represents the “autonomy” of the will to secure “basic human rights.” “Autonomy” is a prerequisite for “self-actualization” as well as a guidepost to well-being. Kant's “autonomy”' also states that “a duty to self” directly requires “a duty to others”.
If we short-circuit “autonomy” with “self-determination”, Foucault's “biopower”' becomes a reality. The triage seen during the Covid-19 pandemic, the report at UICC/World Cancer Congress 2022 that Australian doctors will abide by the law and carry out euthanasia, and even Russia's intent to invade Ukraine have all been denounced.
(Human dignity is inviolable. It is the duty of all state powers to respect and protect it. ——Basic Law of the Federal Republic of Germany 1949)
In consideration of the chaos currently impacting the world, everyone is asking themselves what kind of episteme will arise in the near future. I have a feeling that the concept of “dignity” is one of the most important candidates. If this should occur, the concept of "dignity" will replace the concept of "Quality of Life," which has been the episteme in the field of health care for the last half a century.

Immanuel Kant
Groundwork of the Metaphysics of Morals. Translated by Hideo Shinoda. Iwanami Bunko, 1976.
Critique of Pure Reason. Translated by Sumihiko Kumano. Sakuhinsha, 2012.
Critique of Practical Reason. Translated by Sumihiko Kumano. Sakuhinsha, 2013.

Otfried Höffe.
Philosophy of Freedom; Kant's Critique of Practical Reason. Translated by Tetsuhiko Shinagawa et al. Hosei University Press, 2020.

Kunihiko Ishitani
President of The International Research Society of the SCPSC
President, Higashi Sapporo Hospital
Asian Editor, BMJ Supportive & Palliative Care
January 6th, 2023