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• Letter of response to the commentary by Trussardi and Gott on the common aspects of dignity in end-of-life care
  Qiaohong Guo
  Published on: 31 August 2017

• Published on: 31 August 2017

  Letter of response to the commentary by Trussardi and Gott on the common aspects of dignity in end-of-life care

  • Qiaohong Guo, Postdoctoral Fellow

  Dear Editor,

  Trussardi and Gott[1] provide an insightful commentary on our integrative review paper on dignity in end-of-life care.[2] They raise some interesting points about the definition of dying with dignity in end- of-life care, some with which we concur and others would view differently.

  People in different cultural, social and historical contexts may understand the concept of dignity differently. H...

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  Dear Editor,

  Trussardi and Gott[1] provide an insightful commentary on our integrative review paper on dignity in end-of-life care.[2] They raise some interesting points about the definition of dying with dignity in end- of-life care, some with which we concur and others would view differently.

  People in different cultural, social and historical contexts may understand the concept of dignity differently. However, instead of proposing a standard definition that applies to everyone, the concept of dignity should be understood as consisting of an inherent value, a personal and social dimension. Dignity is inherent to our humanity, meaning everybody has the right to die with dignity. Each individual perceives dignity according to his or her personal culture, beliefs, values and wishes.[2] As such, dying with dignity is a subjective experience that is mediated by social influences, comprised of relationships and encounters developed over the course of ones life.[3]

  To support dignity in end-of-life care, health professionals should keep in mind whose dignity they are going to support; what patients consider important and how they understand dignity, rather than assume they can apply their own professional perspective. Our paper did not separate patients, family members and health professionals perspectives of dying with dignity, since the majority of themes were identified in all three groups. While health professionals' understanding of dignity should not be substituted for the opinions of patients, their understanding can affect the delivery of service to patients and families. Furthermore, it appears that health professionals view dignity according to how their patients and families understand it; and based upon their professional experience in hospice.[4]

  As Trussardi and Gott indicate, the process of dying happens with or without professional support. Family members are often the primary caregivers for patients dying at home. The care they offer to support patient dignity deserves study, but was not within the scope of our review paper. We examined dying with dignity in the context of hospice and palliative care, where health professionals are the primary caregivers. With diminishing independence, the dignity of dying patients is increasingly affected by care. Hence, qualified professional services are essential within hospice and palliative care.

  Trussardi and Gott try to deemphasize the importance of autonomy as a key characteristic of dignity by citing the notion of "interdependence". However, autonomy and interdependence are not mutually exclusive. Autonomy refers to the extent to which patients have a sense of control over their life circumstances.[5] Interdependence occurs when two or more autonomous individuals rely on and are responsible for each other; it implies a reciprocal relationship rather than a solely dependent relationship. For example, dying patients and their families are emotionally interdependent, but patients may still have a strong sense of autonomy so long as they are able to make their own decisions. The dynamic of interdependency between dying patients and their families might be better understood as a meaningful relationship, which while interdependent, can strive towards maintaining patient autonomy and dignity.

  Acknowledgments

  The author would want to thank Dr. Harvey Max Chochinov for his valuable feedback and comments on an earlier draft of this paper.

  References

  1. Trussardi G, Gott M. Clarification of the common aspects of dignity in end-of-life care. Evid Based Nurs Published Online First: 4 February 2015. doi: 10.1136/eb-2014-102007

  2. Guo Q, Jacelon CS. An integrative review of dignity in end of life care. Palliat Med 2014;28:913-40.

  3. Pleschberger S. Dignity and the challenge of dying in nursing homes: the residents' view. Age Ageing 2007;36:197-202.

  4. Guo Q. A preliminary model of dignity management in hospice. PhD Thesis, University of Massachusetts Amherst, Amherst, MA, 2014.

  5. Chochinov HM, Hack T, McClement S, et al. Dignity in the terminally ill: a developing empirical model. Soc Sci Med 2002;54:433-43.

  Conflict of Interest:

  None declared

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  Conflict of Interest:
  None declared.

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