Dignity is a Moral Imperative

British Medical Journal

Editorial Reprint

Published December 25, 2003

The term “dignity” may indeed be cliché, but it is a fundamental
 necessity in the practice of effective and caring medicine. Dignity, like
 religion, does not have to be operationalized or empirically studied. This
 construct transcends the hypothetico-deductive analysis of the
 experimental method and provides powerful meaning to both the clinician
 and the patient.

Dignity is a core value and a core clinical competency; it is a
 necessary ethical obligation that provides the foundation for medical
 practice, healing and successful palliation. Dignity is more that an
 affirmation of one’s autonomy. It consists of a psycho-spiritual connection
 with the patient: a connection that involves empathy, presence and
 compassion. I submit that this connection can and should remain even after
 the patient dies. Cadavers are no less human because they are devoid of
 life. On the contrary, cadavers remind us of the finality of life — the
 existential reality- that we are mortal creatures temporarily existing and
 experiencing the world. The cadaver was the vehicle in which the patient
 experienced the awe and wonder of life. Certainly, this vehicle, replete
 with a history and identity, should be respected.

The empathic clinician actively appreciates the patient’s suffering
 and attempts to experience the world from the unique prism of the patient
 with sensitivity and compassion. Clinicians provide presence when they are
 authentic, deeply aware of the fragility of life and affirm the human
 essence of the person they are treating. Moreover, they treat the patient
 with regard and respect. Dignity, I believe, is correlated — anecdotally
 at the very least — with greater patient comfort and responsiveness to
 treatment. The shocking reality is that without dignity, clinicians often
 develop a sterile stoicism towards the suffering and a needless aloofness
 or alienation from those they serve. Even worse, the absence of dignity as
 a core value in medical practice can lead to depersonalization where the
 patient’s identity and personhood are reduced to an insurance account
 number, hospital room number or a diagnosis. For instance, one of the most
 shocking examples of this is when I overheard a nurse refer to a patient
 as “The urinary tract infection in room 306.”

Perhaps, instead of eliminating this construct, the medical
 profession can remove the vagueness of the concept by revisiting
 palliative care theory and developing universally accepted standards of
 dignity-based practices.

Stanley M. Giannet, Ph.D.