Consensus on dignity
Cultural differences do not affect the view of dignity in care and nursing, as shown in a large European study based on interviews with more than 1,300 people.
“The same kinds of problems and needs must be accommodated, regardless of where you live, in order for people’s dignity to be respected,” Lennart Nordenfelt asserts.
Nordenfelt is a Professor of Medical Philosophy at LiU and for the last thirty years he has studied basic concepts in health services, such as health, illness, handicaps and the need for care. He is also one of the researchers in Dignity and Older Europeans, the European project on the dignity of older people.
The study is being carried out by philosophers, doctors, nurses, psychologists, behavioural scientists, and social scientists from six countries: France, Ireland, Slovakia, Spain, Great Britain, and Sweden. Over 1,300 people ranging from 13 to 95 years old were interviewed in focus groups about how they experience dignity both on a daily basis and in health care. A third of them worked in elderly care.Prior to the study, researchers thought dignity wasn’t highly regarded in health care. The study also documents many examples of undignified treatment due to thoughtlessness, abuse, or contempt, and complaints that the technical medical aspects rendered care impersonal. But there are also uplifting stories that illustrate good actions.
Most of all, it was clearly apparent that the idea of human dignity is a fundamental and universal. In several countries, a conspicuous hierarchy of care and insufficient resources influenced the view of dignity in care and nursing, but in general the cultural differences were few.
Two kinds of violations constantly surfaced in the focus group.
“…that people continually talked as if they weren’t there and about them in the third person, which they felt was the most demeaning facet. The respondents from all 6 countries also felt it that the actual loneliness and that it wasn’t taken seriously was undignified,” claims Nordenfelt.
He was responsible for the Swedish part of the project, but mostly worked with the model of dignity used to analyse the discussions in the focus groups.
“We know that good treatment in care, where the patient’s human dignity is respected, gives a good health outcome. But if the concept of dignity is not to degenerate into a catchphrase, it is important to know what it means and how it is realised.
Dignity is divided up into four variants. There’s human dignity on the one hand, which is the same for everyone throughout life; on the other are three variants, which can change between individuals and various periods in life. There is the dignity of moral stature, the dignity of merit, which has to do with status and position, and the dignity of identity, which deals with integrity and self-image.
Nordenfelt argues that there is, moreover, a special kind of dignity in older people that means we should treat them with particular respect.
“Wisdom is part of it - that is, knowledge about life - and the vulnerability that nearing the end of life implies. Gratitude for what older people did as citizens and parents is also a reason to show them particular respect.
Dignity is an important concept in Swedish health care law; it has been on the political agenda for the last ten years. Quality of life is another important concept that is also used to promote what is not contained within the biological and technical aspects of medicine. Nordenfelt points out that quality of life and dignity do not have the same meaning, even if there are connections between them.
“Respecting a person’s right to say no to treatment, for example, doesn’t need to increase the quality of life, but is important for the right to make one’s own decisions, which in turn has to do with human dignity.”
The research project concludes with a challenge to invest more resources in elder care.
“Dignity in and of itself certainly does not always demand resources; it costs nothing to stop treating people badly. But it needs tremendously better training of health care staff to raise awareness of the significance of dignity,” Nordenfelt says.
He has recently published a book, Värdighet i vården av äldre personer, which builds on things like the European study on dignity and addresses itself to nurses, both current and future, and other occupational groups within elder care.
Text: BIRGITTA WEIBULL
Foto: PETER MODIN
Last updated: 2012-12-10