While death hastening policies are emerging in various constituencies around the world, it behooves us to understand the complexities of what motivates people to seek out these life ending options. Some of the earliest studies in the Benelux countries identified a connection between choosing euthanasia or assisted suicide and loss of dignity. More recent studies have affirmed this association, suggesting that an appreciation of dignity may provide insights into how best to understand and be responsive to the needs of those expressing the wish for a hastened death.
Dignity, defined as the quality or state of being worthy of honour, respect or esteem, conveys the essence of medical professionalism regarding how patients should be treated. Such treatment, or dignity conserving care, can help patients deal with existential issues, maintain their dignity, and lessen psychological distress. Failure to acknowledge dignity by lack of acknowledgment of personhood can undermine patients’ sense of self-worth, quality-of-life and will to live. Fractured dignity is further associated with feeling a burden to others, no longer feeling like the person they once were, and loss of autonomy, all of which have been identified as drivers in the wish to die.
Our program of research has explicated the construct of dignity, developed and empirical model of dignity in the terminally ill; outcome measures to track dignity related distress; and trialed psychotherapeutic approaches designed to improve end-of-life experience and achieve death with dignity. The connections between this body of empirical work and the issue of desire for death, loss of will to live, and coveting a hastened death will be further explored.
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