Let me start out by saying unequivocally that I support Initiative 1000, the "Death with Dignity" ballot initiative being promoted in Washington State. I have no doubt that it is the right thing to do, and I do not wish to debate its merit here.

But ever since I first heard about it, I've been troubled by the "Death with Dignity" moniker. Of course, it is tempting to criticize the use of the word death as too direct or negative sounding, but that would be too easy and too obvious. Definitely not my style.

No, my problem is with the word dignity.

There was always something a little off-kilter about it. Perhaps it's because some religions place a great deal of emphasis on the dignity of the person in their dogma, and that moralizing feeling carries into the initiative through the title. Perhaps by adopting this title, the proponents hoped to take on the moral nature of dignity as a way to protect themselves from the inevitable attacks that would come from those who feel religiously compelled to fight it. Whatever it was, I couldn't put my finger on it but it didn't feel quite right.

Not until I read Steven Pinker's May 28, 2008 piece in the New Republic entitled "The Stupidity of Dignity" did I gain a firm grasp on the funny feeling I had. In it Mr. Pinker explains how the Bush administration stacked the President's Council on Bioethics with religious conservatives so that it would issues reports like this spring's 500+ page report called Human Dignity and Bioethics, in which they argue that human dignity should lead us to prohibit many of the biomedical advances we are seeing today.

Pinker's point, which I wholeheartedly agree with, is that dignity is an intangible and subjective notion that cannot be used to support or oppose any particular public policy. According to him there are three reasons.

The first is that dignity is relative. It is a sensibility that changes over time, and at any given time what is dignified for one group of people is not for another. Dignity is a cultural norm, and in today's heterogeneous America, it is one that takes on many different dimensions depending on which culture one subscribes to: some think it is undignified to get into a fist fight over insulting words, while others think nothing of starting one for an offending glance. No, dignity is not the absolute measure we would like when considering the merits of a law allowing people to choose the place, time, and manner of their passing.

The second reason is that dignity is fungible. By this, Mr. Pinker means that we trade our dignity by the acts we commit and allow to be perpetrated upon us daily. Just about everyone has been subjected to the indignity of medical procedures or airport security for a benefit that usually makes it seem worthwhile. Many of us even voluntarily engage regularly in highly undignified acts, such as procreating or visiting a public restroom. No, dignity is certainly not the absolutely sacrosanct principle that must remain inviolable if it is to establish a law allowing people to choose the place, time, and manner of their passing.

The third reasons is that dignity can be harmful. Mr. Pinker cites numerous examples of dangerous habits and behaviors founded on distorted notions of dignity, such as the ostentatious displays of dictators, or the brutal penal systems of some third-world countries. In a free society, the government is restrained from granting to itself the power to decide what is and is not dignified. This is the foundation of freedom of speech principles that permit satirists to poke fun at our leaders. No, dignity is definitely not the safe framework from which we can justly administer a law allowing people to choose the place, time, and manner of their passing.

This is not to say that dignity is useless or inappropriate in the conduct of human affairs. Dignity is an essential metric many people use to circumscribe their own behavior, and to understand what behavior is reasonable when engaged in social interactions with other. But the notion of dignity is not helpful in understanding what is so important about Initiative 1000.

So naturally, if dignity is not the appropriate notion we must ask what is appropriate. Mr. Pinker gives us a hint when he mentions Ruth Macklin's 2003 editorial in the British Medical Journal when she points out that autonomy is a much more appropriate term.

Ms. Macklin specifically calls attention to California's 1976 Natural Death Act, which uses the language of dignity in affirming a person's right to given physicians directives to withhold care in the event of a terminal condition. She argues that dignity is a slogan and in the context of biomedicine it is based on religious notions that interfere with a proper understanding of what is at stake. It is therefore is intrinsically unfit for use in legal and medical matters.

The reason that many people prefer to use the notion of dignity is that it allows for the application of a sort moral action at a distance, which many conservatives in America fondly desire (and an approach some liberals have unfortunately adopted too). They wish to make decisions about the lives of others based on their own moral compasses, as though their right to be free from seeing something which offends them trumps the rights everyone else to act in a manner which befits their personal sense of wellbeing. This is the basis for their opposition to same gender civil unions, their opposition to abortion, their opposition to stem-cell research, and their opposition to end-of-life decisions.

In contrast, autonomy is much more well defined concept, one that has always served us well, not only in securing our right to end-of-life decision, but in all decisions we make throughout life. It is founded on the principle that I am free to make any decision that does not infringe on the freedom of another person to make theirs.

Ultimately, I believe that Washington State will get a law like Initiative 1000, and I sincerely hope it will get this one. But as far as the name given this one, I remain concerned that those organizing this initiative have not chosen well. They should seriously consider an alternative name before the campaign gets into full swing this summer, one that emphasizes more the concrete notion of legal autonomy from the tyranny of life-extending medicine and the preservation of our inalienable right to exercise more control over the quality our lives than we have over its quantity.

Perhaps the Medical Autonomy Initiative would be a better name for Initiative 1000.