Poverty, human rights & dignity

Poverty is not an original state, nor are the poor the victims of their own faults and weaknesses. Nor is it due to shortcomings in personality or morality, or failures in family or upbringing. Poverty is about exclusion, physical and economic insecurity, fear of the future, a constant sense of vulnerability. Poverty is created by societies and governments. Poverty is experienced as individuals, family and communities. Poverty is embedded in complex of policies, interactions and relationships.

• Poverty is self-sustaining. In the modern economy, once a person or group is caught in its trap, it is hard to escape the cycle of poverty. It destroys self-confidence and the capacity to organize collective action and response. 
• Economic globalisation, which include the privatisation of state resources and functions, and the introduction of charges even for the most basic needs reinforce the cycle of poverty by cutting off possibilities of social mobility. 
• A powerful economic and political class emerges on the back of this poverty, with no interest in social reform, creating further obstacles to equitable distribution of resources. In this way poverty leads to social exclusion.
• Poverty negates the realisation or enjoyment of human rights. The purpose of human rights, a life in dignity, is rendered impossible by poverty. The daily struggles of the poor constantly humiliate them. 
• There is no real possibility of poor people enjoying rights, whether civil and political or social, economic and cultural, without resources such as education, physical security, health, employment, property, participation, and due process - all of which poverty negates. In poverty there can be no control over one’s life chances or even everyday life.
• Existence in hovels without the basic amenities of life allows no time or ability for self-reflection, essential for identity, self- realisation, or making moral judgments. Poverty generates habits of subservience and docility that denies the premise of the equality and dignity of all persons. 
• Poverty also forces persons into slavery and bondage, and stories of parents selling children into slavery out of desperation are now common place in states like India, Bangladesh, and Nigeria - and many other parts of the world. 
• A poor man cannot support his family and tends to draw away from it, burdening the wife with additional responsibilities to sustain the family.
• Poverty creates or reinforces divisions within the family, in which the male members get priority over scarce family resources. In this way poverty subverts decent and fulfilling family life. 
• Family is the natural and fundamental group unit of society which is entitled to protection by society and the state.
• Poverty not only deprives and demeans the poor but also affects the affluent and society. It sharpens inequalities and leads to crime, law and order, as the poor resort to various forms of self-help to eke out a living, including thefts and robberies. Security becomes an obsession for the middle classes, turning their suburbs into fortresses. The slums that grow out of poverty breed diseases and environmental degradation that can scarcely be contained within the confines of the slums. 
• In the modern age poverty poses a major threat to social consensus and political stability. Poverty erodes the moral fibre and the moral cohesion of a society. It destroys the self-confidence of the people caught in the cycle of poverty, and leads to the waste of resources. 
• Ideology is used to justify the limits on the role of the state in providing social welfare. Disparities of opportunities and incomes have increased in recent years. The poor can make themselves heard only by irregular demonstrations, to limited effect. 
• We need fundamental social and economic reforms to ensure all its residents a decent life in dignity which is so eminently within reach, based on its wealth and resources.

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Dignity

Dignity is defined as the quality or state of being worthy, honored, or esteemed. Dignity is as essential to human life as water, food, and oxygen. The stubborn retention of it, even in the face of extreme physical hardship, can hold a man’s soul in his body long past the point at which the body should have surrendered it. Without dignity, identity is erased. In its absence, men are defined not by themselves, but by their captors and the circumstances in which they are forced to live. Apartheid was a clear case of direct attacks on individuals’ dignity and this was not limited to a few individuals but on multiple generations of native South Africans. How an individual reacts when his or her dignity is violated. The most common reaction is to keep reliving the torment through flashes and nightmares and eventually convincing oneself that the only way out is to seek revenge. Loss of dignity is a gradual loss of individuality.

• The saddest thing in the world is not poverty per se; it's loss of dignity.
• Those at the bottom of the economic ladder lack dignity, and it is the job of the rest of the world to help give it to them.
• Some of the poorest people are the most dignified. And some of the richest lack dignity. If I fail to treat someone with dignity, it is me, not them, who is undignified.
• Extreme poverty is undignified – sometimes communities or individuals do find themselves helpless and in need of crisis or ongoing assistance. Whether in city or countryside, very poor people tend to work for a better life.
• Former president of Haiti Jean-Bertrand Aristide has pleaded “help rebuild the country, moving from misery to poverty with dignity".
• Amartya Sen (and others) defined development as freedom rather than just economic or social progress, and the concept of dignity takes us a step further along that road.
• It is said that if you can’t measure it you can’t manage it. While most poverty measures are disputed, dignity is perhaps the one thing that humans across the globe, in myriad different contexts, most instinctively recognize and long for.
• Dying with dignity is the greatest shift in morality in this generation. If a person is diagnosed with a terrible terminal illness, or is in intolerable pain, why force that person to suffer? There is a big difference between suicide, euthanasia, and dying with dignity. Suicide is self-inflicted. Euthanasia is ending life without consent. Dying with dignity is neither suicide nor euthanasia; it is respect for the individual. An adult who, for very good reasons, consents to die should have that right. Frostbite would not be a good reason. 
• Each person has a sense of worth or value, sense of the price of his personality, his dignity. Personality, dignity, is the center of attention in people’s relationships. Demeaning of dignity is almost the only reason for conflict. Those who lost it are humiliated.
• The genuine price of a man is the truth about him. Everything that increases a man’s dignity is goodness, everything that decreases it – evil. 
• Internal freedom is freedom from fear of being judged, of being charged a low price, and freedom from doubts about dignity. The only fear an internally free man has is fear of going against his conscience. Society knows freedom when its people know dignity.

We all deserve to die with dignity

Modern medicine has advanced a lot but “death by intensive care” in isolation, with ventilator and life support systems is all the more painful and frightening. No one would like to die that way. While certain amount of pain is inevitable at the time of death, palliative treatment will help minimize pain, avoid the distress caused physically and monetarily.

• Death is the one certainty in life. About 10% die due to a sudden death. The remaining will have to go through a bed-bound stage before going finally. Half of them end up in ICU's and one-third with ventilator and other life support systems. These people die miserable death in isolated hygiene rooms with no loved ones on bedside at the time of death.
• Every human being yearns for a peaceful death. People who are terminally ill or bed-ridden at least expect a dignified death, but most of them are denied that privilege owing to certain misconceptions. People should be made aware of the real situation.
• Palliative care is about giving empathetic treatment to patients and the concept of spending one's final days largely at peace with oneself and then dying with dignity.
• It is true that we cannot always fully control the disease and pain of our loved ones, but we can certainly mitigate their level of pain through palliative care options.
• About 8.4 million people die in India every year. At least 5 million of them will have significant suffering during the bed-ridden state — pain, breathlessness or a host of other symptoms, not to mention the emotional and social distress that may be associated.
• In India, the poor die in agony in neglect, the middle-class die in agony in ignorance, and the rich die in agony on a ventilator. No one gets a dignified and pain-free death.
• The poor are rejected by hospitals and told that “there is nothing more we can do, so go home”; the middle class gets futile treatment that breaks the family financially; those having resources are imprisoned in intensive care units and put on meaningless artificial life support measures that often cause intense physical, psychological and financial distress.
• This suffering is unnecessary. Palliative care can relieve distress and enables the person to live, and when the time comes to die, with as much comfort and dignity as possible.
• In 2015, in a study of 80 countries on Quality of Death Index, India was ranked among the 15 worst countries to die in. The denial of access to pain relief, if it causes severe pain and suffering, constitutes cruel, inhuman or degrading treatment or punishment. 
• In the absence of palliative care, treatment of incurable diseases becomes inappropriate. The implications on the family are seldom recognised or discussed. In the absence of any form of support, family members have to leave their jobs and the next generation is forced to drop out of school.
• Even today, the basic principles of modern pain management are not being taught to medical and nursing students.
• Many elderly people and their children want aggressive treatment, advanced tests, and the latest remedies — which may not really enhance the quality of life. Everything that can be done will be done in a major hospital, whether it is necessary or not, at a cost. Patients may fall into an endless loop of irrevocable conditions, extending their suffering.
• People should set down on paper their well-considered preferences with regard to the kind of treatment that should be given to him/her in case they become at some point too incapacitated to take a decision and express it. This will make it easier for their children, caregivers and relatives to take a decision on their behalf.
• Governments have neglected health care and private sector exploiting and pushing 4 crore people annually below poverty line is a matter of national shame. 

A solution at the national level seemed promising when the Ministry of Health of the Government of India created a National Programme for Palliative Care (NPPC) in 2012. However it lacked budget allocations.