Mr S is a 62-year-old man with primary lung cancer diagnosed 18 months ago, with metastases to the liver, brain, and adrenal glands. He has recently developed severe weakness of the left upper and lower extremities with an inability to bear weight, likely related to his brain metastasis. He recently discontinued the use of steroids because of unpleasant adverse effects and completed a 2-week course of antibiotics for pneumonia. His symptoms—which include shortness of breath, seizures, constipation, and occasional agitation—are controlled with ipratropium, phenytoin, senna, haloperidol, and clonazepam, respectively. He now receives comfort care only.
Mr S is a thoughtful and articulate man. He had an unhappy childhood and was later troubled by alcohol abuse associated with extensive difficulties sustaining meaningful, lasting relationships or vocational commitments. He states his life "turned around" 30 years ago, after meeting his wife and joining Alcoholics Anonymous; he has been sober ever since. He and his wife describe a close, trusting relationship. They do not have children. Although he had a variety of jobs over the years, "none of which I liked," he worked most recently as a truck driver. His finances are "difficult," but he indicates that he and his wife manage to make ends meet. Mr S participated in a study of "dignity therapy," a new intervention designed to preserve dignity at the end of life.
Mr S, his wife, and his physician, Dr F, were interviewed by the author.
MR S: Dignity is a state of the soul. Dignity is the sense of peace that passes all understanding. I am sure that there is something beyond this lifetime. As a matter of fact, I believe the consciousness goes on from here. Now what the big plan is, nobody has ever got back to me on that, but I am sure it is wonderful…because in this lifetime, I have been groping around in the dark and making choices; some of them good and some not so good.
MRS S: Our dignity has been maintained because of the care we have been receiving in the hospital. The staff has been marvelous. They have been helping us as much as they can. I think part of dignity is trying to make him feel that he is still of value.
DR F: I think that individuality and dignity may be the same thing in the end. It ends up being what you see as dignity for yourself, doesn't it? It is trying to preserve the person as they are; you know, the sensible things like keeping them clean, keeping them comfortable, but also enabling their way of being, what made that person that person.
Why Is the Notion of Dignity Important?
The basic tenets of palliative care, including symptom control, psychological and spiritual well-being, and care of the family, may all be summarized under ...