Care-dependency constitutes an important issue with regard to the approval of end-of-life decisions, yet attitudes towards assisted suicide and euthanasia are understudied among care-dependent older adults. We assessed attitudes towards assisted suicide and euthanasia and tested empirical correlates, including socio-demographics, religiosity, physical illness, psychological distress and social isolation. A nationwide cross-sectional survey among older care allowance recipients in private households in Austria was conducted in 2016. In computer-assisted personal interviews, 493 respondents were asked whether or not they approved of the (...) availability of assisted suicide and euthanasia in case of long-term care dependency and whether or not they would consider using assisted suicide or euthanasia for themselves. Multiple logistic regression analysis was used to assess the impact of potential determinants of attitudes towards assisted suicide and euthanasia. About a quarter of the sampled care-dependent older adults approved of the availability of assisted suicide and euthanasia respectively indicated the will to make use of assisted suicide or euthanasia. Attitudes towards assisted suicide were most favourable among care-dependent older adults living in urban areas, those who did not trust physicians, those who reported active suicide ideation, and individuals with a strong fear of dying. With regard to euthanasia, living alone, religiosity and fear of dying were the central determinants of acceptance. Positive attitudes towards and will to use assisted suicide and euthanasia were expressed by a substantial minority of care-dependent older adults in Austria and are driven by current psychological suffering and fear of the process of dying in the future. Community-based psychosocial care should be expanded to address psychological distress and fears about end-of-life issues among care-dependent older adults. (shrink)

Background Care-dependency constitutes an important issue with regard to the approval of end-of-life decisions, yet attitudes towards assisted suicide and euthanasia are understudied among care-dependent older adults. We assessed attitudes towards assisted suicide and euthanasia and tested empirical correlates, including socio-demographics, religiosity, physical illness, psychological distress and social isolation. Methods A nationwide cross-sectional survey among older care allowance recipients in private households in Austria was conducted in 2016. In computer-assisted personal interviews, 493 respondents were asked whether or not they approved (...) of the availability of assisted suicide and euthanasia in case of long-term care dependency and whether or not they would consider using assisted suicide or euthanasia for themselves. Multiple logistic regression analysis was used to assess the impact of potential determinants of attitudes towards assisted suicide and euthanasia. Results About a quarter of the sampled care-dependent older adults approved of the availability of assisted suicide and euthanasia respectively indicated the will to make use of assisted suicide or euthanasia. Attitudes towards assisted suicide were most favourable among care-dependent older adults living in urban areas, those who did not trust physicians, those who reported active suicide ideation, and individuals with a strong fear of dying. With regard to euthanasia, living alone, religiosity and fear of dying were the central determinants of acceptance. Conclusions Positive attitudes towards and will to use assisted suicide and euthanasia were expressed by a substantial minority of care-dependent older adults in Austria and are driven by current psychological suffering and fear of the process of dying in the future. Community-based psychosocial care should be expanded to address psychological distress and fears about end-of-life issues among care-dependent older adults. (shrink)

The proportion of older people in the total population is increasing in most countries because of advances in medical technology and resulting longer life expectancy. The role that older people play in our communities does not reflect this. Sometimes they are reduced to mere statistics and stereotypes in economic and political discussions on the financial burdens of care for older people. I argue that we need to rebuild inclusive communities in which older people are respected as valuable members. I suggest (...) that this can be done by studying the characteristics of past communities and by learning from the work of environmental ethicists who advocate the preservation of our heritage. Nurses share with them a holistic perspective on complex issues such as ageing. They are therefore in a position to empower older people to play a role in our communities as unique individuals with integrity and wisdom. (shrink)

This article aims to deconstruct the concept of dignity in a way that is meaningful, in particular to nurses and other health workers who seek to promote the dignity of children in their care. Despite the emphasis in a variety of codes and policies to promote dignity, there is a lack of a clear definition of dignity in the literature. In particular there is little reference to dignity, theoretically or empirically, as it relates to children. Without clarity it is not (...) possible to act in an ethical way on behalf of children whose dignity could otherwise be compromised. The theoretical position taken has evolved from the medico-nursing and philosophical discourse concerning the nature of human dignity and more recent sociological texts that discuss the social construction of the child and childhood. The article is further influenced by additional insights derived from an ethnographic pilot study at a large district general hospital. This study was undertaken in an attempt to appreciate the subjective experience of dignity by children, and to begin to address the empirical gap in the literature and promote discussion. The concept of a macro and a micro dignity is discussed, together with the role of the nurse in articulating the relationship between the two. The importance of control and witnesses in the experience of dignity is discussed and, finally, also the ethical implications when seeking to promote the dignity of children. (shrink)

The overall purpose of this cross-country Nordic study was to gain further knowledge about maintaining and promoting dignity in nursing home residents. The purpose of this article is to present results pertaining to the following question: How is nursing home residents’ dignity maintained, promoted or deprived from the perspective of family caregivers? In this article, we focus only on indignity in care. This study took place at six different nursing home residences in Sweden, Denmark and Norway. Data collection methods in (...) this part of this study consisted of individual research interviews. Altogether, the sample consisted of 28 family caregivers of nursing home residents. The empirical material was interpreted using a hermeneutical approach. The overall theme that emerged was as follows: ‘A feeling of being abandoned’. The sub-themes are designated as follows: deprived of the feeling of belonging, deprived of dignity due to acts of omission, deprived of confirmation, deprived of dignity due to physical humiliation, deprived of dignity due to psychological humiliation and deprived of parts of life. (shrink)

Respect for human dignity is a basic and crucial component of nursing care. Illness with restricted physical ability and being confined to bed can compromise the dignity of patients. The views of adolescents regarding dignity in care have not previously been researched. This article details a descriptive-analytic study in which survey data was collected from all nurses and compared with a convenience sample of 180 hospitalized adolescents in two hospitals in Iran. The data was analyzed with SPSS software. A significant (...) difference between nurses and hospitalized ill adolescents’ perceptions was identified in relation to: understanding the importance of privacy (p < 0.001); observance of privacy (p < 0.001); importance of interaction between nurses and patients (p = 0.019); and the observance of interaction between nurses and patients (p < 0.001). Attention to adolescents’ views about dignity can help nurses to improve quality of care for this group. (shrink)

Much is known about the phenomenon of dignity, yet there is still a need for implementing this understanding in clinical practice. The main purpose of this study was to find out how persons suffering from multiple sclerosis experience and understand dignity and violation in the context of a rehabilitation ward. A phenomenological-hermeneutic approach was used to extract the meaningful content of narratives from 14 patients with multiple sclerosis. Data were collected by personal research interviews. The findings revealed three main themes: (...) (1) ‘invisibly captured in fatigue’; (2) ‘fighters’ law: one who does not ask will not receive’; and (3) ‘dignity is humanity’. The essence of the findings in this study is that dignity is humanity. According to the participants, dignity requires time and is experienced only in a context of empathy and mutual confidence. (shrink)

Nurses are exposed to bullying for various reasons. It has been argued that the reason for bullying can be political, meaning that the behavior occurs to serve the self-interests of the perpetrators. This study aims to identify how nurses perceive the relevance of individual and political reasons for bullying behaviors. In February 2009 a survey was conducted with nurses working in a research and training hospital located in Turkey. The results showed that the aim of influencing promotion, task assignments, performance (...) appraisal, recruitment, dismissal, allocation of equipment and operational means, together with allocation of personal benefits and organizational structure decisions, were perceived as potential political reasons for bullying by nurses. Moreover, the reasons for the various bullying behaviors were perceived as relevant to individual characteristics, namely, the perpetrators’ need for power, and their psychological and private life problems. (shrink)

The aim of this study was to understand how nurses experience patients’ dignity in Swedish medical wards. A hermeneutic approach and Flanagan’s critical incident technique were used for data collection. Twelve nurses took part in the study. The data were analysed using hermeneutic text interpretation. The findings show that the nurses who wanted to preserve patients’ dignity by seeing them as fellow beings protected the patients by stopping other nurses from performing unethical acts. They regard patients as fellow human beings, (...) friends, and unique persons with their own history, and have the courage to see when patients’ dignity is violated, although this is something they do not wish to see because it makes them feel bad. Nurses do not have the right to deny patients their dignity or value as human beings. The new understanding arrived at by the hermeneutic interpretation is that care in professional nursing must be focused on taking responsibility for and protecting patients’ dignity. (shrink)

Background:Protecting the dignity of elderly residents of facilities and providing dignified care can be difficult. Although attempts have been made from several aspects, dignity is considered an area in which less real impact has been made in both theory and practice.Objective:The objective of this study is to characterize the concept of dignity in care for elderly subjects in residential facilities from a practical perspective through concept synthesis.Research design:This study includes in-depth interviews with residents of elderly facilities and a literature review.Participants (...) and research context:A total of 12 residents of seven facilities in three prefectures in Japan were recruited via purposive sampling, and 27 interviews were conducted. Each digitally recorded interview was transcribed verbatim. The interview data were analyzed based on hermeneutic phenomenological research. The literature was searched using PubMed, CINAHL, and Web of Science with combinations of terms such as dignity, elderly, and residential facilities and then selected according to the predefined inclusion criteria. The descriptions about dignity in the included studies were divided into codes and compared with the results of the interviews.Ethical considerations:This study was approved by the institutional review board of Nagoya University’s Graduate School of Medicine.Findings and discussion:There were 1728 data codes for the interviews from which four themes were generated. In the literature review, 3716 titles were searched, and 28 articles were selected. Combining these results, five following themes and a conceptual matrix were obtained: individual dignity not affected by others; dignified care in a narrow sense; elements of the staff side; dignity in relation to family members, friends, society, and other residents; and dignity in relation to nursing care facilities and the nursing care system.Conclusion:According to the established matrix, we must consider the role of the care system, facility, family, and society in providing care with dignity and the individual dignity to residents and dignity in daily care. (shrink)

Through narrative reflections of Jack?s story of inclusive recreational sport, the meaning of dignity in professional practice is explored. Jack?s story is one of respect, strong humiliation and embarrassment, and vulnerability. Through the lens of relational ethics, the aggression of a stranger illustrates how the lack of mutual respect, compassion and knowledge creates experiences of indignity. Jack?s story highlights how relationships can shape, constrain and enable lives. Understanding that which constitutes a dignified recreational sport context for instructors and participants opens (...) opportunities for authentic social relationships based upon respect of oneself, as well as others to emerge. Jack?s narrative further reinforces the need to create pedagogical spaces for discussions of various forms of dignity and ethical professional practice in inclusive recreational sport contexts. (shrink)

It is argued that dignity can be considered both subjectively, taking into account individual differences and idiosyncrasies, and objectively, as the foundation of human rights. Dignity can and should also be explored as both an other-regarding and a self-regarding value: respect for the dignity of others and respect for one’s own personal and professional dignity. These two values appear to be inextricably linked. Aristotle’s doctrine of the mean enables nurses to reflect on the appropriate degree of respect for the dignity (...) of others and of respect for themselves. To develop an understanding of the rationale for and the significance and implications of dignity in health care practice, a view of human nature is proposed that implies vulnerability and fallibility, and that urges that an ethic of aspiration is embraced. Anonymized vignettes are included to illustrate points about the everyday nature of dignity. (shrink)

Declarations of the importance of dignity in health care are commonplace in codes of practice and other mission statements, yet these documents never clarify dignity’s meaning. Their vague aspirations are compared to comments from staff and patients about opportunities for and barriers against the promotion of dignity in elderly care institutions. These suggest that while nurses and health care assistants have an intuitive understanding of dignity, they either do not or cannot always bring it about in practice. Thus, despite stated (...) intentions to promote dignity, it appears that the circumstances of at least some elderly care institutions cause patients to experience avoidable indignities. Such institutions are “undignifying institutions” because they fail to acknowledge dignity’s basic components, focus excessively on quantifiable priorities, and have insufficient resources available to assure consistently dignifying care. As a partial solution, we argue that health workers should be taught to understand and specify the components of dignity, which will better prepare them to challenge undignifying practices and to recognise opportunities for dignity promotion. (shrink)

When mental health service users are detained under a Section of the Mental Health Act (MHA), they must remain in hospital for a specific time period. This is often against their will, as they are considered a danger to themselves and/or others. By virtue of being detained, service users are assumed to have lost control of an element of their behaviour and as a result their dignity could be compromised. Caring for detained service users has particular challenges for healthcare professionals. (...) Respecting the dignity of others is a key element of the code of conduct for health professionals. Often from the service user perspective this is ignored. (shrink)

As people living with Alzheimer ’s disease experience their lifetime of memories slowly slipping away, they become dependent on society’s independent practical reasoners - family, health care professionals and society. Many people grow accustomed to the cognitive decline and begin to view the person with dementia as less than a person. In Dependent rational animals, Alasdair MacIntyre emphasized a moral framework that encompasses two sets of virtues needed for human beings to flourish in society and to achieve genuine common goods (...) - the virtues of independent practical reasoners and the virtues of acknowledged dependence. Virtues of acknowledged dependence are discussed ethically in terms of benevolence towards those who are disabled or dependent upon people who are strong and independent. The authors propose that using MacIntyre’s perspective of the two sets of virtues is valuable in the care of persons with Alzheimer ’s disease. According to MacIntyre, independent reasoners who understand and practice these two sets of virtues will help those people in communities who are dependent and vulnerable, and, subsequently, human flourishing can occur. (shrink)