To have dignity means to have a feeling of being worthy – to be worthy of respect, esteem, and honor. It is a multidimensional concept with multiple meanings. Every culture defines dignity in a different way. Indeed, each individual has their own personal sense of what it means to have dignity. Each person’s background, upbringing, experiences, and values affect how they understand dignity.
The Model of Dignity
Since 1995, a team of Canadian palliative care researchers led by psychiatrist Dr. Harvey Max Chochinov has studied this less-than-tidy concept of dignity. They found that dignity is a central, powerful actor in ensuring quality of life for individuals facing terminal illness.
Their research developed a Model of Dignity that unfolds the construct of dignity into tidy categories and themes. I want to hone in on one of the three main categories – the “Dignity Conserving Repertoire” – which is rich with powerful concepts to consider when facing terminal illness or declining health. Each person has their own recipe for dignity. Every person will hold different amounts of each of these ingredients in their own sense of dignity.
The Eight Dignity-Conserving Perspectives
The Model defines eight dignity-conserving perspectives:
- Continuity of self is the sense of your self – do you still feel like you? How does your diagnosis affect your sense of who you are? Having a strong identity separate from just being a “patient” is a source of dignity.
- Role preservation refers to the degree to which your roles in life remain intact despite your illness. The more you consider what you do as who you are, the more changing roles may impact your sense of personhood. Preserving that role in a new way, with modifications, can help keep that part of your identity intact.
- Your legacy can be a great source of dignity. Your legacy is your guidance for the next generation, which allows you to exist beyond death.
- Maintaining pride, or positive self-regard is a basic source of dignity. Each person has their own sources of pride. Consider examining what makes you feel proud and dignified. What are your expectations for others’ treatment of you? What are your boundaries? Make a list and find ways to ensure these items are upheld and opportunities for expressing your pride are available.
- Hope may be elusive in facing dire health circumstances. Dr. Chochinov found that in these times, hope is “intimately connected to notions of meaning and purpose.” Often, meaning and purpose tie into spiritual beliefs and practices. “[A]n effective antidote to hopelessness is reconnecting . . . with something that may provide . . . a continued sense of meaning and purpose.”
- Autonomy under this model refers to the persistence of the mind. Even as physical independence wanes, the integrity of the mind to make decisions and hold onto the self is a valuable source of dignity.
- Acceptance refers to the “ability to adapt to changing health circumstances.” The American cultural approach to any adverse news is often to “accept it and move on” – an abrupt command that must occur quickly. However, the concept of acceptance under the Dignity Model means allowing yourself to come to understand your changing health or your prognosis at whatever pace is right for you.
- Resilience is a great source of dignity. This resilience is not a belief that things will get magically better or a denial of the illness altogether. This resilience is an internal sense of safety and continuity. No matter what comes, your resilience will be a foundation of calm and composure.
Dr. Chochinov also provides three practices that can help uphold the characteristics described above – maintaining normalcy, seeking spiritual comfort, and living in the moment. Continuing daily routines in whatever form you are able, exploring mindfulness practices, and exploring spiritual resources may promote dignity.
Dr. Chochinov offers resources on his website to read more about the Dignity Model. If you or a loved one are often under a doctor’s care or live in a facility, there is information on his website to help providers improve their dignity-promoting practices. You could present the information to your caregivers to start a conversation about the best way to take care of you or your loved one.
If you are interested in Dignity Therapy for you or a loved one and you live in the area of Fayetteville, NC, please contact me at 904-321-9013. We can discuss doing this treatment in your home.
This blog post is based on the book Dignity Therapy: Final words for final days by Harvey Max Chochinov.