Preserving patients' dignity lends value to end of life
Expert says respect more than just courteous
Preserving a patient's dignity is more important than some doctors think, according to a palliative care expert who points out that loss of dignity is one of the most common reasons patients seek out physician-hastened death.
"When patients experience a radical unsettling of their conventional sense of self and a disintegration of personhood, suffering knows few bounds," says Harvey Max Chochinov, MD, PhD, a Canadian palliative care expert and professor at the University of Manitoba Department of Psychiatry. "To feel sick is one thing, but to feel that who we are is being threatened or undermined — that we are no longer the person we once were — can cause despair affecting body, mind, and soul."
Some physicians neglect dignity in care because they feel they don't have the time to address it, or because they feel they lack the expertise, Chochinov says. In response, Chochinov has written a guide that provides an A-B-C-D mnemonic of dignity-conserving care.1
ABCDs preserve patient dignity
Chochinov says health care providers have a profound influence on how patients experience illness and their sense of dignity. He says a lack of attention to dignity-conserving care — variously referred to as spiritual care, whole person care, or psychosocial care — can lead to patients feeling they are not being treated with respect and dignity, which can undermine their sense of worth and result in the feeling that their lives no longer have meaning or value.
Chochinov suggests bearing in mind four main ideas — attitude, behavior, compassion, and dialogue — to keep patient dignity high on the list of priorities in health care:
- Attitude is the attitude and assumptions health care providers have toward their patients. This can mean a predisposition to behave in a consistent way toward a particular class of people, or a tendency to react to people not as they are, but as they are conceived to be, says Chochinov. An example might be to assume that a patient with disabilities has a poorer quality of life than someone without disabilities.
- Behavior toward patients should be "predicated on kindness and respect." Don't discount the value of small acts of kindness — getting the patient a glass of water, adjusting pillows, and commenting on personal photos, greeting cards or flowers are some examples. "These behaviors convey a powerful message, indicating that the person is worthy of such attention," says Chochinov, who adds that such acts are particularly important when the patient is suffering from advanced disease.
- Compassion is a "deep awareness of the suffering of another coupled with a wish to relieve it," Chochinov's guide states. Physicians are encouraged to examine the feelings that are evoked by their contact with patients, and to consider how it shapes their approach to care.
- Dialogue can be, Chochinov argues, the most important component of the framework for dignity-preserving care. The exchange of information between patient and caregivers drives the delivery of care, and should begin with acknowledging the patient as a person beyond his or her illness.
Chochinov writes that his guide has its origins in palliative care, but applies across all medicine because it's based on empirical evidence demonstrating that kindness, humanity, and respect are core values of medicine, not just "niceties of care" to be offered when time and circumstances allow.
- Chochinov HM. Dignity and the essence of medicine: The A, B, C, and D of dignity conserving care. BMJ 2007; 335:184-187.
For more information, contact:
- Harvey Max Chochinov , MD, PhD, professor, department of psychiatry, University of Manitoba. CancerCare Manitoba, Winnipeg, MB, Canada R3E 0V9. E-mail: firstname.lastname@example.org.