Recent progress in neurosciences has improved our understanding of chronic disorders of consciousness. One example of this advancement is the emergence of the new diagnostic category of minimally conscious state (MCS). The central characteristic of MCS is impaired consciousness. Though the phenomenon now referred to as MCS pre-existed its inclusion in diagnostic classifications, the current medical ethical concepts mainly apply to patients with normal consciousness and to non-conscious patients. Accordingly, how we morally should stand with persons in minimally conscious state (...) remains unclear. In this paper, I examine whether the notion of human dignity could provide us with guidance with the moral difficulties MCS gives rise to. More precisely, I focus on the question of whether we are justified in holding that persons in minimally conscious state possess human dignity. (shrink)

As the world population is rapidly aging, stakeholders must address the care of the elderly with great concern. Also, loss of dignity is often associated with aging due to dementia, mobility problems and diminished functional autonomy. However, dignity is a polysemic term that is deemed useless by some ethicists. To counter this claim, we propose four concepts to define it better and make use accurately of this notion. These are human dignity, dignity of identity, dignities of excellence and attributed dignities. (...) Finally, we explain the importance of solicitude and human dignity in the care of the elderly. This will ensure the respect, friendship and dignity of the elderly in providing geriatric ethical care. (shrink)

Introduction: Dignity is one of the most important values sensitively perceived by patients in nursing care. Older patients have been identified as having a high risk of losing their dignity in institutional care. To promote optimum nursing care, a deeper insight into the problem of older patients’ dignity is needed. Aim: The aim was to identify, analyse and synthesise the qualitative evidence of dignity views and factors affecting it from the nurses’ and older patients’ perspective in the context of nursing (...) care and to compare synthesised finding from the both perspective. Methods: A literature review of qualitative evidence was chosen as a study design. The ENTREQ statement was implemented to enhance transparency. The CASP – Qualitative checklist and the thematic synthesis for synthesised findings were used. The electronic databases Academic Search Complete, CINAHL, Health Source: Nursing/Academic Edition, MEDLINE and PROQUEST were used to gather information for qualitative studies. Results: A total of 306 papers were retrieved. Fourteen qualitative studies met the inclusion criteria and were included in the review after methodological quality assessment using CASP. Four main themes of dignity from nurses’ perspective were synthesised: seeing the patient as a unique person, communication and privacy, involving the patient, and working culture and environment. From the patients’ perspective, six main themes were synthesised: autonomy and control, privacy, relationships, care and comfort, communication and identity. The comparison shows that the key difference is that older patients highlighted the theme relationships and nurses underlined the theme working culture and environment. Conclusion: The model structures of the older patients’ dignity from both the nurses’ and patients’ perspectives support the idea of a multidimensional structure of human dignity. The resulting model might be used in a nursing self-reflection, in the management of the institutions providing all-day care for the older people and in the education and practice. (shrink)

Background: A key message in the World Health Organization’s report on dementia emphasizes the need to improve public and professional attitudes to dementia and its understanding, while acknowledging the fact that the workforce in dementia care is becoming increasingly diverse culturally. Objectives: To explore possible differences among formal caretakers from varied cultural background in their attitudes toward the autonomy and human dignity of patients with dementia. Research design: Semi-structured interviews and content analysis, utilizing two fictional vignettes for eliciting caretakers’ attitudes (...) toward dignity and autonomy of their patients. Participants and context: A total of 20 formal caretakers of patients with dementia from three different cultural groups in Israel (“Sabras,” “Arabs,” and “Russians”), working in nursing homes and a hospital. Ethical consideration: Approvals of relevant research ethics committees were obtained and followed. Findings: In comparison with the other groups, most Arab caretakers offer markedly richer perceptions of human dignity and autonomy. Their human dignity’s conceptualization emphasizes “person-centered approach,” and their perception of patients’ autonomy includes provision of explanations and preservation and encouragement of independence. Discussion: The differences found in the attitudes toward the meaning of autonomy and human dignity between the Arab caretakers and the other caretakers stand in contrast to previous studies regarding human dignity, emphasizing the common nature of these attitudes. Offering a linkage (theoretical and empirical) between the Arab perceptions of dignity and autonomy, the study strengthen and further the importance attributed in existing literature to person-centered care in enhancing the quality of care for patients with dementia. Conclusion: The conceptualization of human dignity may vary among different cultural groups. It may also influence the extent to which the caretaker holds a full-fledged perception of the patients’ autonomy. (shrink)

This article examines the nature of human dignity against the background of old age and introduces the novel idea of treating human dignity as a formal principle related to the more foundational notion of indignity. The discussion starts with the objection that the notion of human dignity can be used to justify contrary positions and is therefore inconclusive. This pitfall can be averted by appealing to the notion of indignity rather than dignity in one's moral reasoning and decision‐making. Cases of (...) indignity are more primary and indicate the violation of the very core of a human being. The verifiable property of vulnerability is central to this identification of indignity, as is illustrated by reference to the experiences of elderly people. The article argues for applying the concept of human dignity to reverse the conditions that existed before a particular indignity emerged, rather than trying to define positively the notion of human dignity in the first place. (shrink)

Scholars have demonstrated that common ways of performing charitable food aid in high-income countries maintain a powerless and alienated status of recipients. Aiming to protect the dignity of recipients, alternative forms of food aid have taken shape. However, an in-depth understanding of dignity in the context of food aid is missing. We undertook a scoping review to outline ways in which the dignity of recipients is violated or protected across various forms of food aid in high-income countries. By bringing scientific (...) results together through a social dignity lens, this paper offers a complex understanding of dignity in the context of food aid. The online database Scopus was used to identify scientific literature addressing food aid in relation to the dignity of recipients in high-income countries. The final selection included 37 articles representing eight forms of food aid in twelve countries. Across diverse forms of food aid, the selected studies report signs of (in)dignity concerning five dimensions: access to food aid, social interactions, the food, the physical space, and needs beyond food. Research gaps are found in the diversity of forms of food aid studied, and the identification of social standards important for recipients. Bringing the results of 37 articles together through a social dignity lens articulates the complex and plural ways in which the dignity of recipients is violated or protected. In addition, this review has demonstrated the usefulness of a social dignity lens to understand dignity across and in particular food aid contexts. (shrink)

In many Western countries, studies have demonstrated extensive use of coercion in nursing homes, especially towards patients suffering from dementia. This article examines what kinds of strategies or alternative interventions nursing staff in Norway used when patients resist care and treatment and what conditions the staff considered as necessary to succeed in avoiding the use of coercion. The data are based on interdisciplinary focus group interviews with nursing home staff. The study revealed that the nursing home staff usually spent a (...) lot of time trying a wide range of approaches to avoid the use of coercion. The most common strategies were deflecting and persuasive strategies, limiting choices by conscious use of language, different kinds of flexibility and one-to-one care. According to the staff, their opportunities to use alternative strategies effectively are greatly affected by the nursing home’s resources, by the organization of care and by the staff’s competence. (shrink)

There are roughly two meanings attached to the concept of dignity: humanitas and dignitas. Humanitas refers to ethical and juridical notions of equality, autonomy and freedom. Much less understood is the meaning of dignitas, which this paper develops as peoples’ engagement with aesthetic values and genres, and hence with differences between people. Departing from a critical reading of Georgio Agamben’s notion of ‘bare life’, I will analyze a case where aesthetics are quite literally at stake: women who lost their hair (...) due to cancer treatment. The analysis shows a complicated interplay between varying evaluations of female baldness by the self and others, mediated by (often strongly negative) cultural imaginaries, and aesthetic genres depicting conventional ways of ‘looking good’. The paper concludes by arguing for a reconnection of the two notions of dignity, and for a rehabilitation of aesthetics in daily life and care as fundamental values for organizing our societies. (shrink)

The paper is a preliminary examination of the origin and role of psychological perception or “feeling” of dignity in human beings. Following Ayala's naturalistic account of morality, a sense of emotional dignity is seen as an outcome of processes of natural selection, cultural evolution, and above all a need for social inclusion. It is suggested that the existence of emotional dignity as part of a human species-related continuum provides an explanation of why we treat those in a persistent vegetative state, (...) the severely and hopelessly mentally impaired, the senile demented, cadavers and archaeological remains with dignity and respect. For older Europeans, dissonance between physical and mental abilities, unfamiliarity with social and cultural changes and relative proximity to death may influence their emotional dignity and hence vulnerability. (shrink)

People with dementia have previously not been active participants in research, with ethical difficulties often being cited as the reason for this. A wider inclusion of people with dementia in research raises several ethical and methodological challenges. This article adds to the emerging debate by reflecting on the ethical and methodological issues raised during an interview study involving people with dementia and their spouses. The study sought to explore the impact of living with dementia. We argue that there is support (...) for the inclusion of people with dementia in research and that the benefits of participation usually far outweigh the risks, particularly when a `safe context' has been created. The role of gatekeepers as potentially responsible for excluding people with dementia needs further consideration, with particular reference to the appropriateness of viewing consent as a primarily cognitive, universalistic and exclusionary event as opposed to a more particularistic, inclusive and context relevant process. (shrink)

Purpose: This study aimed to explain and understand the existential meaning of the finality of life from the perspective of healthy older adults. Method: Participants were recruited from a major project on older adults’ life situations. They were interviewed about their thoughts on the end of life, and their responses were interpreted using a lifeworld hermeneutic approach. Results: The findings showed that thinking about the inevitable finality of life involves feelings of liberation, frightening thoughts, a comforting promise of something beyond (...) death, acceptance of the concept of death as a companion in life and a desire to live. Philosopher Simone de Beauvoir’s existential ideas about ageing and death were then used to further explain and understand the meaning of the finality of life and to support a comprehensive understanding. de Beauvoir suggests that when the temporal horizon of existence shrinks, one lives closer to the finality of life. For a comprehensive understanding, attributing meaning to the finality of life required the intertwining of reconciliation and displacement. The interpretations were further discussed using ideas from the fields of existential philosophy and caring science in order to develop a basis for caring practice. Conclusions: The conclusions suggested that professional health care for older adults would benefit from a lifeworld-led caring science approach that includes readiness for a caring dialogue that focuses on existential issues. (shrink)