The particularity of dignity: relational engagement in care at the end of life

Abstract

This paper articulates dignity as relational engagement in concrete care situations. Dignity is often understood as an abstract principle that represents inherent worth of all human beings. In actual care practices, this principle has to be substantiated in order to gain meaning and inform care activities. We describe three exemplary substantiations of the principle of dignity in care: as a state or characteristic of a situation; as a way to differentiate between socio-cultural positions; or as personal meaning. We continue our analysis by presenting cases on dignity in care related to us in focus groups with medical professionals. Our empirical ethical lens is in this paper is to analyse, not the meaning of dignity, but the way in which it emerges in practices where it is pursued, within relationships between people, technologies, places, regulations, and the values cherished by or embedded in them. We show that professional caregivers recognize in the dignity of the person they care for their own dignity; giving up on the one implies no less than giving up on the other. This ‘mirrored experience’ of dignity expresses itself in professional’s engagement with the situation. The value of this engagement, we argue, lies not primarily in realizing the particular content of the values at stake. We point to the importance of engagement itself, even if the values engaged with cannot be realized to the full, and even if competing versions of dignity are at stake simultaneously. In this way the caregivers provide us with interesting examples of moral actorship in situations of conflicting values.

Swedish eldercare within home care services at night-time: perceptions and expressions of ‘good care’ from the perspective of care workers and care unit managers

“…Theories of dignity are often focused on the individual instead of on the relational connectivity of care ethics (Miller 2017). We therefore approach good and dignified care as relational because it emerges in concrete care practice in a social context through relationships with others (Pols, Pasveer, and Willems 2018). Early Scandinavian care research has been influenced by the care ethicist Noddings (1984) feminist approach to care where she argued for the relationship as the foundation to ethics of care.…”

Comparison of the Concept of Patient Dignity in Islamic and Nursing Texts

“…For example, there is a kind of dignity achieved by individuals due to their exceptional capabilities and high social status 4,7,8,11,25,42 In fact, nursing theories emphasize maintaining, upgrading, improving, and treating these two kinds of dignity. Therefore, patient respect should include aspects that directly affect their intrinsic and extrinsic dignity 27,40,41,44,[49][50][51][52][53][54][55][56][57][58] .…”

Dynamics of dignity and safety: a discussion

“…Because healthcare organisations are complex sociotechnical systems where cause and effect are not related in a linear way, there is far more to patient safety and quality of care than the following of measurable policies and interventions with predetermined definitions of safety. Pols et al 13 describe a complex situation wherein different versions of dignity aligned with or threatened safety. A man insisted he be allowed to die at home despite poor economic circumstances which meant electricity and gas supplies had been terminated.…”

“…Pols et al explain that dignity may also be understood as a state that can be violated, for example, when patients are not assisted to the toilet in a timely manner and soil themselves. In such cases, the lack of dignity is often used to expose poor care situations 13. In countering these indignities, dignity is often promoted by encouraging practitioners to adopt a more attentive attitude towards patients and clients.…”