Respectful care of human dignity: how is it perceived by patients and nurses?

Correspondence to Rahime Aydın Er, Department of History of Medicine and Ethics, Faculty of Medicine, Kocaeli University, Kocaeli 41380, Turkey; [email protected]

Introduction

Measuring and defining dignity is a complex, vague and difficult problem because dignity is a multidimensional concept. The word originates from the two Latin words ‘dignitus’ (meaning merit) and ‘dignus’ (meaning worth) and denotes respect, decency, humanity and status.¹ Dignity can be classified into ‘absolute’ and ‘relative’ dignity. Absolute dignity is a universal value and is based on human rights. All people are valuable, irrespective of their status or conditions, because they are human. Objective dignity is the same for all people and does not change. In contrast, relative dignity can change and is affected by culture, society and education.² Notably, relative dignity can be affected and is sometimes threatened by the healthcare system.³ According to Street, the dignity of a human being is socially built and shaped by relations. Therefore, dignity may change according to perceived personality, values and self-esteem.^{4 5}

Care is the basic responsibility of nursing, and dignity is the deepest value of the ethics of care. Nurses play an important role in promoting and maintaining patient dignity, which is more important than health.⁶ Nurses are expected to provide dignified care to their patients irrespective of gender, age, personality, economic status, lifestyle, culture or race.¹ Dignified care indicates respect and support for the autonomy of the patient. Nursing care that is respectful of human dignity enhances patient-nurse relationships, improves the quality of care, favours a quick recovery, protects the patient’s rights and supports health services that are ethically appropriate.^{1 2}

Jacobson claimed that violations of patient dignity are more common when the relation between two people becomes asymmetric. When one person has more power, wealth, strength, and authority, violations of dignity are more likely to occur. In the hierarchical environments people encounter when they become patients, there is always a risk that this asymmetry is the first step towards violations of dignity. In nearly every situation in which people come into contact with healthcare, they are put into situations that can be embarrassing, humiliating or shameful.³ Additionally, the hospital environment and the behaviour of the health professionals towards patients affects dignified...