Respect for Human Dignity

Write an Essay on “Respect for Human Dignity” an issue of concern to professionals
working in a particular domain of end-of-life.
Explain the issue and present key arguments of relevance, outlining and defending a
potential solution to this issue. In doing so, you will be expected to draw on relevant
empirical research.

Respect for Human Dignity

  1. Introduction
    Respect for human dignity is an issue of concern to healthcare professionals who are
    offering end-of-life care to patients who are suffering from any form of terminal illness (Brien,
    1998; & Bowden and Surma, 2003). The prevalence of deaths as a result of terminal diseases
    such as cancer has been on the rise in Australia in the recent past (Clark, 2017). Some of these
    deaths occur because healthcare professionals do not give their patients an opportunity to have a
    sense of control over the type of care that they want, particularly for patients who are unable to
    make decisions at any point of disease progression (White, Tilse, Wilson, Rosenman, Strub,
    Feeney, and Silvester, 2014). According to Clark (2017), every dying patient wishes that they
    receive the best end-of -life care that places adequate emphasis on their cultural values and
    beliefs about care and death, whether they are in a position to communicate with it or not. To
    demonstrate respect for human dignity, healthcare professionals should plan end-of-life care with
    patients and families in advance, to help their clients to achieve a sense of control over the type
    of care that they wish to receive now and in future (White et al., 2014).
    Although respect for human dignity is of great relevance to all areas of end-of-life care,
    this essay will describe the issue by focusing on achieving a sense of control as one of the
    domains of end-of-life, concerning physician assisted dying. Specifically, the essay will describe
    advance care planning as one of the strategies that are currently used by healthcare professionals
    in Australia to assist terminally ill geriatric patients to achieve a sense of control in physician
    assisted dying. Helping patients to achieve a sense of control in physician-assisted dying is
    ethical because it demonstrates respect for human dignity (Bosshard, Broeckaert, Clark,
    Materstvedt, Gordijn, and Muller-Busch, 2006). In the conclusion section, the author has
    summarized the main points covered in the essay.
  2. Respect for human dignity and achievement of a sense of control in end-of-life care
    The practical meaning of human dignity remains unclear in end-of-life care, despite the
    fact that healthcare professionals universally accept it as being very essential to the well being of
    patients. According to the International Council for Nurses Code of Ethics 2012, the dignity of
    all human beings must be respected irrespective of an individual’s sex, nationality, age, race,
    colour, social status, ethnicity, health status, and creed (Kennedy, 2016). Since health care
    professionals who provide end-of-life care normally deal with culturally diverse patients, they
    must have a comprehensive understanding of human dignity for them to remain ethical in
    practice even at a time when their patients are unable to make their own decisions. Chochinov
    (2006) defines human dignity as an ethical concept that comprises of several attributes including
    communication, empowerment, respect, and autonomy. Prior to making a decision in end-of-life

cases that call for physician assisted dying, health care practitioners must respect their patients’
privacy, involve them in decision making, empower them in order to raise their self-esteem, and
utilize non-verbal and verbal communication to help their patients to effectively understand the
care process (Kennedy, 2016). The need to help patients to achieve a sense of control during end-
of-life care and in physician assisted dying comes out clearly in the definition of human dignity.
In physician-assisted dying, professionals need to be guided by the Dignity Model as they
attempt to demonstrate respect for human dignity. The most important category of the Dignity
Model which relates to the need to help patients to achieve a sense of control is ‘the dignity-
conserving repertoire’ that pertains to the cultural beliefs and the psychological makeup of the
patient Chochinov, 2006). According to Chochinov (2006), healthcare professionals must strive
to conserve the dignity of their patients by ensuring that any approach to care that they take
conforms to their patients’ cultural beliefs and psychological makeup. In this regard, for patients
to be assisted to achieve a sense of control or autonomy in physician assisted dying, they must be
given an opportunity to direct or influence their life circumstance by being allowed to choose the
nature of care that should be given to them (Baily, 2011). In addition, since a majority of
terminal illnesses normally progress to loss of cognitive functionality, it is very crucial that
healthcare professionals engage in practices which are aimed at conserving their patients’
dignity, both at a time when they can make their own decisions and at a time when they shall not
be able to (Rodrigiez-Prat, Monforte-Royo, Porta-Sales, Escribano, and Balaguer, 2016).

  1. The relationship between advance care planning, achieving a sense of control, and
    respect for human dignity in end-of-life care
    There is a close link between advance care planning, achievement of a sense of control,
    and respect for human dignity in end-of-life care. Lund, Richardson, and May, (2015), define
    advance care planning as a means through which healthcare professionals ensure that the care
    preferences of patients and their families are established and recorded early enough before
    patients’ cognitive capabilities are overtaken by a terminal illness. Based on this definition, it can
    be concluded that advance care planning is one of the ways through which healthcare
    professionals help dying patients to achieve a sense of control, and hence a good way of
    demonstrating respect for human dignity in end-of-life care (Lund, Richardson, and May 2015).
    Through advance care planning, health care organizations in Australia have demonstrated
    how respect for human dignity mediates between loss of functionality in end-of-life and
    achievement of self-control (Rhee, Zwar, and Kemp, 2012). According to Rhee, Zwar, and
    Kemp, (2012), advance care planning plays a significant role in guiding end-of-life care in
    Australia because it enhances patient autonomy. In this regard, those organizations, which have
    successfully implemented advance care planning to facilitate end-of-life care perfectly,
    demonstrate their respect for human dignity (White et al., 2014). In a study conducted by
    Rodrigiez-Prat et al., (2016), due to loss of functionality associated with terminal illnesses, a
    majority of dying patients often perceive that their dignity is threatened, especially when they
    will be unable to make individual decisions in the course of disease progression. Such
    perceptions cause emotional distress and hopelessness which impact negatively on patients’
    progress. It is, therefore, the responsibility of care givers to assure their patients that their dignity
    will perfectly be respected in future by allowing them to have a sense of control over the types of
    care preferences that they want.

According to Lund, Richardson, and May, (2015), advance care planning gives dying
patients an opportunity to make their care preferences for the future ahead of time. Terminally ill
patients are allowed to select their most preferred treatment options for their final days of life
through advance care planning, their caregivers find it easy to resolve conflicts that may arise
about their care and to develop the best care plans for them (Sellars, Detering, and Silvester,
2015). Thus, respect for human dignity is realized because dying patients are allowed to achieve
a sense of control of their care sometimes in future when their health conditions deteriorate
(Rodrigiez-Prat et al., 2016).

  1. Arguments for Physician-assisted dying
    Physician assisted dying in end-of-life care is ethical due to two major reasons. First,
    physician assisted dying helps to eliminate pain for dying patients. According to Lee (2002), due
    to extreme pain that dying patients undergo in the course of disease progression, it reaches a time
    when these patients just want to die. Therefore, physician assisted death that is performed on a
    suffering patient is morally justified. Second, physician assisted dying in end-of-life care is
    ethical because it helps to relieve family members of the burden of caring for the affected
    individuals. As Guy and Stern (2006) explain, terminal illness presents a huge economic burden
    to patients and families. Therefore, by preventing prolongation of death through physician
    assisted dying, healthcare professionals eliminate the burden that terminally ill patients may
    bring to their families. Since physician assisted dying is often performed on patients who have
    lost cognitive functionality, it becomes difficult to allow these patients to achieve a sense of
    control before the process (Fraser and Walters, 2002).
  2. Arguments against Physician-assisted dying
    Physician-assisted dying is unethical because it undermines human dignity because dying
    patients are hardly allowed to achieve a sense of control over the type of care that they want
    (Miller and Brody, 1995). Showing respect for human dignity by assisting dying patients to
    achieve a sense of control through advance care planning is extremely fundamental to health care
    professionals who are working in all other domains of end-of-life care. According to RNAO
    (2017), the five domains of end-of-life care include promoting adequate pain and symptom
    management, assisting patients to avoid unsuitable prolongation of dying, strengthening patients’
    relationships with their families and loved ones, helping patients to achieve a sense of control,
    and lessening the burden. As far as promotion of adequate pain and symptom management is
    concerned, caregivers hardly allow dying patients to make preferences of the pain management
    strategies that they would want to be implemented on them (Goldsbury, O’Connell, Girgis,
    Wilkinson, Phillips, Davidson, and Ingham, 2015).
    Also, dying patients are not normally given the power to choose whether clinicians
    should assist them to die early or whether appropriate actions should be taken to avoid unsuitable
    prolongation of life (Trankle, 2014). Moreover, terminally ill patients are not normally allowed
    to select those whom they want to associate with in their last years of life (Rodrigiez-Prat et al.,
    2016). According to Chochinov (2006), it is unethical for health care professionals to perform
    euthanasia on terminally ill patients with a notion of relieving their families of any economic
    burden that they might be causing, without the consent of those patients. Furthermore, preventing
    dying patients from having a sense of control of their health in all domains of end-of-life care is a
    form tends to undermine human dignity (Trankle, 2014). Lack of advance care planning prevents

medical practitioners from assisting their dying patients to achieve a sense of control in physician
assisted dying, thereby preventing them from demonstrating respect for human dignity (Rhee,
Zwar, and Kemp, 2012).

  1. Conclusion
    The major professional ethical issue at the end of life concerns who has the powers to
    choose whether a terminally ill patient should be assisted to die or not. Denying a dying patient
    an opportunity to have a sense of control in deciding either support or deny physician assisted
    death is unethical because it undermines human dignity (Fraser and Walters, 2002; Frankel,
    1989; & Miller and Brody, 1995). Furthermore, performing a physician-assisted death against
    the patient’s will in end-of-life is unethical because it violates professional codes of ethics
    (Brien, 1998; & Bowden and Surma, 2003). As Olsen, Swetz, and Mueller, (2010) explain,
    clinicians who are charged with the responsibility of providing end-of-life care are expected to
    demonstrate professional integrity in all their actions, especially when they are making decisions
    related to physician assisted dying. Moreover, terminally ill patients are very much uncertain
    about the nature of life that they will lead at the end stage. For this reason, those of them who
    may lose their cognitive functionality at the end stage can only receive quality care if their
    caregivers demonstrate respect for human dignity by making ethical decisions, which are aligned
    with professional codes of ethics (Mobasher, Nakhaee, Tahmasebi, Zahedi, and Larijani, 2013).
    To show respect for human dignity at end-of-life about physician assisted dying, healthcare
    professionals should implement advance care planning for their patients early enough before they
    lose cognitive functionality.
    Some healthcare organizations in Australia have implemented advance care planning as a
    strategy towards assisting terminally-ill patients to die with dignity (Rhee, Zwar, and Kemp,
    2012; Trankle, 2014; & White et al., 2014). By preparing the advance care plan, health care
    professionals allow their patients to achieve a sense of control over choosing whether they
    should be assisted to die in future or whether they should be left to die a natural death (Sellars,
    Detering, and Silvester, 2015). Healthcare professionals rely on this information in future to
    deliver care that matches their patients’ preferences. The use of advance care planning as a
    solution to unethical practice in end-of-life care is a self-regulation type of solution. According
    to Brien (1998), unethical practice in end-of-life care can be solved either through government
    legislation or self-regulations. Since professional codes of ethics are applicable in both self-
    regulatory and government legislative situations, they should be used as a standard solution to
    solve the problem of unethical behaviors in end-of-life care. Specifically, professional codes of
    ethics should be maintained, rewritten, and updated accordingly to guide healthcare professionals
    on how they can help their patients to achieve a sense of control and to assist them to die with
    dignity (Rodrigiez-Prat et al., 2016).


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