Editorial: What do we know about dignity in care?

Abstract

During a recent conference on Dignity in Health and Social Care in London, I claimed that we already know a good deal about dignity in care. I was rightly challenged by colleagues from Scandinavia. They suggested that the relationship between philosophical and empirical work in dignity is not at all clear. Their intervention has caused me to reflect on their question and to have it as a theme for this editorial. So what can we say we know about dignity in care? It seems likely that we will agree on the following: that dignity is a contested concept; that philosophical work suggests a wide range of perspectives; that empirical research suggests common themes and subjective elements of dignity in care; that we are, as suggested above, perplexed by the relationship between philosophical and empirical work in dignity; that attempts to measure dignity will not be straightforward; that dignity matters in healthcare for patients, families and professionals; and that we have to understand what contributes to and remedies dignity deficits in care. Writing in the Journal of Medical Ethics in 2003, American bioethicist Ruth Macklin, described dignity as ‘a useless concept’ arguing that autonomy was the more useful and necessary value. In 2008, Steven Pinker argued that ‘the problem is that ‘‘dignity’’ is a squishy, subjective notion hardly up to the heavyweight moral demands assigned to it’. Despite criticism and scepticism about the value and usefulness of dignity, the concept has generated a great deal of philosophical literature and debate. In the USA, the President’s Council on Bioethics commissioned a substantial anthology on Human dignity and bioethics in 2008. A wide range of perspectives on dignity have been published in ethics journals. Writing in Nursing Ethics in 1998, David Seedhouse and Leila Shotton (Toiviainen) defined dignity in terms of the inter-relationship between circumstances and competencies, that is, the maintenance of dignity is dependent on the person’s ability to exercise competencies or to have help to do so. I distinguished between dignity as a self-regarding and otherregarding value in an article in 2004. The philosopher, Lennart Nordenfelt, identified four ‘varieties of dignity’: dignity of merit; dignity of moral or existential stature; dignity of identity; and Menschenwurde and this has been critiqued in relation to nursing practice. More recently, the concept of dignity has been examined through a historical lens by Rieke Van Der Graaf and Johannes Van Delden. They identified four forms of dignity as relational, unconditional, subjective and Kantian forms. Alasdair Cochrane outlines four of the ‘most plausible conceptions of dignity’ as: dignity as virtuous behaviour; dignity as inherent moral worth; Kantian dignity; and dignity as species integrity. These are only some of the many perspectives in the philosophical literature and what is clear is that there is no consensus. Dignity is contested and debate is likely to continue.