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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:
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.
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