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Dignity in palliative care

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Dignity in palliative care Palliative care must take the individual into account

A dignified death is a phrase familiar to health professionals. But do we know what it means?

I ask because I recently came across the book How We Die by surgeon Sherwin Nuland, where he states that a dignified death is an illusion since 'the quest for true dignity fails when our body fails.'

My support for Nuland's point of view is shaped by my experience of trying to summon help for my hospitalised father who lay in agony the day before he died because of an incorrectly inserted urinary catheter. 'Death with dignity' evokes a romantic Victorian-style death-bed scene, and I guess that many nurses would agree that an individual's dignity is better safeguarded by dying at home in the community than in a busy ward.

But while the demands of modern hospital life mean that dignity may not always characterise the last hours of a dying patient's life, it seems reasonable to expect that dignity will be accorded due consideration and prominence by well-trained health professionals in relation to patients who are very much alive.

But what is dignity? Nursing professionals might answer that dignity is defined by its absence, as was apparent, for example, at Winterbourne View. But for a more rigorous definition, the Social Care Institute for Excellence suggests that 'dignity is a state, quality or manner worthy of esteem or respect; and (by extension) self-respect.' The RCN considers dignity to be concerned with 'how people feel, think and behave in relation to the worth or value of themselves and others'.

Those of us of sound mind and body are soon aware if we are being treated with a degree of respect that accords with our own sense of dignity. However, those 850,000 people in the UK who are living with dementia – a condition which will affect over 1 million by 2025 – are not in such a fortunate position.

My guess is that dignity whether approaching death or in life is not something that nursing professionals feel they should have to be taught about in a seminar room. Rather, it is something that is part of the common currency that comes from living in a civilised society.

George Winter, freelance medical writer

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