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Background: The literature on professionals’ perceptions of dignity at the end-of-life (EOL) shows that there is a need for studies set in different cultural contexts. Lithuania represents one of these little-studied contexts. The aim of this study is to understand professionals’ attitudes, experiences, and suggestions concerning EOL dignity to provide knowledge upon which efforts to improve EOL care can be grounded. The research questions are “How do Lithuanian health care professionals understand the essence of dignity at the end-of-life of terminally ill patients?” and “How do they believe that dignity at the EOL can be enhanced?”. Materials and Methods: The study was exploratory and descriptive. It employed an interpretive phenomenological method to understand the essence of the phenomenon. Lightly structured interviews were conducted with professionals who had EOL experience, primarily with elderly and late middle-aged patients. from medicine, nursing, social work, and spiritual services. The interviews were primarily conducted by audiovisual means due to pandemic restrictions. Using a constant comparative method, the research team systematically codified text and developed themes by consensus after numerous analytic data iterations. Results: Four primary themes about EOL dignity were identified: Physical Comfort, Place of Care and Death, Effects of Death as a Taboo Topic, and Social Relations and Communication. A fifth, overarching theme, Being Heard, included elements of the primary themes and was identified as a key component or essence of dignity at the EOL. Conclusions: Patient dignity is both a human right and a constitutional right in Lithuania, but in many settings, it remains an aspiration rather than a reality. Being Heard is embedded in internationally recognized patient-centered models of EOL care. Hearing and acknowledging individuals who are dying is a specific skill, especially with elderly patients. Building the question “Is this patient being heard?” into practice protocols and conventions would be a step toward enhancing dignity at the EOL.

Background and Objectives: Investigation into forms of behavior that violate dignity is not the typical way to look for means of dignity preservation, but it may be the optimal way to prevent improper behavior. Numerous studies document that maintaining and improving patient dignity at the end of life require an understanding of factors posing threats to dignity in health care organizations. This study aimed to assess associations between dignity-violating behaviors and barriers to the assurance of dignity in health care settings from the perspective of health professionals. Materials and Methods: An anonymous survey of health professionals was conducted in Lithuania in May 2021 by using a convenience sampling method (N = 168). Two scales were developed and included in the questionnaire. One scale measured respondents’ perceptions of Dignity Violations that they had witnessed. The other scale measured their opinions about Barriers to Dignity Assurance of terminally ill patients in clinical settings. Data analysis began with descriptive statistics, followed by exploratory principal component analysis (PCA) to identify the underlying structure of each scale. The variables assigned to distinct components in the PCA were combined into reflective latent variables in a path model. The path model of the relationships between the latent constructs was tested for significant links by implementing the partial least squares structural equation modeling technique. Results: Dehumanization, Humiliation, Inattentiveness, Control, Demonization, and Manipulation were identified as major forms of dignity-violating behavior. In addition, Organizational Barriers and Patient as an Obstacle were identified as two major types of barriers to the assurance of patient dignity. Both organizational and patient-oriented barriers were directly or indirectly associated with all forms of violations of patient dignity. Conclusions: The Dignity Violations scale showed potential for estimating professionals’ observations of dignity violations in health care settings. Perceived high workloads, staff shortages, insufficient resources, and lack of organizational support were identified as negative organizational factors that may result in increased risk of seeing patients as obstacles to providing care that preserves the dignity of terminally ill patients.

Žmogaus teisių ir laisvių apsaugos klausimai sveikatos priežiūros srityje yra itin aktualūs ir reikalaujantys ypatingo dėmesio, ypač dėl to, kad senėjanti visuomenė, biomedicinos mokslų pažanga, geresnė sveikatos priežiūros paslaugų kokybė ir visa eilė kitų veiksnių sąlygoja ilgesnę gyvenimo trukmę, reikalauja daugiau sveikatos resursų ir tuo pačiu atveria naujas teisines bei etines dilemas sprendžiant žmogaus gyvenimo pabaigos klausimus. Įvairūs tyrimai rodo, jog sunkiomis ir nepagydomomis ligomis sergantys asmenys susiduria su įvairiomis kliūtimis, kaip kad atskirtimi, diskriminacija, esminės priežiūros ir paslaugų neprieinamumu. Todėl vienas esminių klausimų šioje srityje -kaip paskutiniuose gyvenimo etapuose užtikrinti sergančių asmenų orumą, kurio pagrindu suponuojamos ir esminės pacientų teisės.Atsižvelgiant į Europos Tarybos rekomendacijas dėl nepagydoma liga sergančiųjų ir mirštančiųjų žmogaus teisių bei orumo apsaugos, straipsnyje siekėme išsiaiškinti rekomendacijose pasiūlytų priemonių įtvirtinimą tarptautinėje bei nacionalinėje teisėje, o taip pat ir praktinio įgyvendinimo ypatumus.1 Straipsnis parengtas vykdant LMT finansuojamą projektą "Sunkiomis ir nepagydomomis ligomis sergančių asmenų orumo gyvenimo pabaigoje užtikrinimas Lietuvoje: sampratos, lūkesčiai, galimybės ir kliūtys", sutarties Nr. S-GEV-20-2.2 Vytauto Didžiojo universitetas, Teisės fakultetas.3 Lietuvos sveikatos mokslų universitetas, Visuomenės sveikatos fakultetas. 4 Lietuvos sveikatos mokslų universitetas, Visuomenės sveikatos fakultetas.5 Lietuvos sveikatos mokslų universitetas, Visuomenės sveikatos fakultetas. 6 Lietuvos sveikatos mokslų universitetas, Visuomenės sveikatos fakultetas.