5.6 Dignity and palliative end of life care

Question 1

Dignity has been difficult to define. The idea dignity must be earned is referred to as meritorious dignity. What is the relationship between dignity and the practice of medicine?

Answer 1

Dignity: The quality of being worthy or honourable; associated with virtue (meritorious)

Within healthcare, dignity connected with how people perceive themselves as reflected through the attitudes and behaviours of others towards them

Question 1

What are four guiding principles that underlie dignity in medical care?

Answer 1

dignity in care is inseparable from the wider context of dignity as a whole

dignity is about treating people as individuals

dignity is not just about physical care but also psychological and spiritual care

dignity thrives in the context of equal power relationships

dignity must be actively promoted

dignity is more than the sum of its parts

Question 2

In the model of dignity in the care of the terminally ill, what are the three major categories that influence a sense of dignity?

Answer 2

Table 5.6.1

Illness related concerns

• symptom distress - physical distress, psychological distress (medical uncertainty, death anxiety)
• level of independence (cognitive acuity, functional capacity

Dignity conserving repertoire
Dignity conserving perspectives - continuity of self, role preservation, generativity/legacy, maintenance of pride, hopefulness, autonomy/control, acceptance, resilience/fighting spirit

Dignity conserving practices - living in the moment, maintaining normalcy, seeking spiritual comfort

Social dignity inventory - social issues, relationship dynamics affecting dignity - privacy boundaries, social support, burden to others, aftermath concerns

Question 3

What are two major types of illness concerns that influence dignity

Answer 3

symptom distress and level of independence

Question 4

What are five examples of dignity conserving attitudes or practices that can help to maintain dignity in the setting of terminal illness

Answer 4

continuity of self
role preservation
generativity/legacy
maintenance of pride
hopefulness
autonomy/control
acceptance
resilience/fighting spirit
living in the moment
maintaining normalcy
seeking spiritual comfort

Question 5

The patient dignity inventory assesses a patient’s sense of dignity. What are five major factors that are assessed by the inventory?

Answer 5

symptom distress
existential distress
dependency
peace of mind
social support

Question 6

What are three social concerns and relationship dynamics that can enhance or reduce from a sense of dignity in terminal illness?

Answer 6

privacy boundaries, social support, care tenor burden to others, aftermath concerns

Question 7

Physicians need to be careful of how they conduct themselves with patients because of how a patient views themselves is reflected in how they perceive that they are seen by the provider. What does the ABCD model remind us of in this context?

Answer 7

attitude
behaviour
compassion
dialogue

Question 8

List three beneficial outcomes of dignity therapy

Answer 8

significant reduction in depression/anxiety
helps with sense of purpose or meaning
increased will to live
enhanced sense of dignity and help for families in their grief

Question 9

Describe the process of dignity therapy

Answer 9

Dignity Therapy
trained professional guides the therapeutic encounter, helping the patient to elicit memories, hopes, and wishes for family members, life lessons they might wish to share, and legacy-related content they want to leave behind.
meant to enhance sense of meaning and purpose, sense of self, and overall sense of dignity.