While individual autonomy is inherent in the notion of dignity, humans are social beings who inherit from the past, live in community in the present, and perceive themselves as having responsibility to the future. Humans are free to pursue their own goals as long as they do not interfere with others, a negative right. There is a generally recognized corollary that humans live in community with a positive obligation to contribute to the common good and share others' burdens. Personal responsibility is indicated not only for the sake of the person but because "no man is an island," and his or her well-being or disorder has social ramifications. Maintenance of health and function is significant not only to the individual but also to all who are part of his or her social network. Aristotle has been credited with teaching that a just society is one in which burdens are shared by equals equally and unequals unequally in accord with capacity and need.
The pluralistic nature of contemporary society makes it easier to identify when and where ethical issues occur than to apply universally accepted approaches to their solution. Yet, at least at the societal level, decisions have and will be made through the democratic process, largely driven by self-interest but often with appeals to a sense of fairness and decency. However, a recent study of policy makers' use of ethicists' advice concluded that persons who emphasize ethics "will always be disappointed by the politics of policy making in any countries that are fit to live in" (Fox and Klein). On the more personal level, however, such decisions are made, for better or worse, on a daily basis, either easing the burden of chronic illness or leaving the chronically ill person ever more isolated in his or her distress. Decisions of fairness and decency and those that ease the burden become ever more vital as the number of people affected by chronic illnesses increases in the first half of the twenty-first century.
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