Andrew Grey argues that by meeting people’s needs and wishes at the end of their lives, professionals enable them to have dignified deaths.
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‘Dignity’ in death is for many people associated with assisted dying. When the US state of Oregon legalised assisted dying, the law was entitled the ‘Death with Dignity Act’ (1997). The Swiss clinic where people famously have gone for an assisted death is named ‘Dignitas’.
Here in the UK, assisted dying is currently illegal, despite the attempts (most recently by Lord Falconer and Rob Marris MP) to propose a change in the law. If dignity means the choice of assisted dying, it would seem to follow that dignified death is either impossible, or at least rare, in the UK.
Yet many people in the UK do have dignified deaths, at least according to the doctors, nurses and chaplains who care for them at the end of their lives. We interviewed a number of these professionals for our new report, Dignity at the End of Life: What’s Beneath the Assisted Dying Debate?
What made the deaths of those they cared for “dignified”? For the professionals we spoke to it was, above all, that people felt valued: in the words of one consultant, ‘knowing you’re loved as you go’.
These professionals showed people they were valued in the way they communicated with them – listening to them and caring about their lives. An essential part of this was supporting the people who mattered to them, such as their friends, families and partners, but it was also seen in the way they cared for them. This included doing everything within their power to meet people’s needs and wishes for the end of their lives, such as having their pain and other symptoms managed, their spiritual needs being met, and, as far as possible, being at peace.
The professionals saw valuing people as part of honouring their dignity as human beings. This affected the approach they took to caring for the person. It meant listening to people’s concerns, and treating them with the basic dignity most of us would want – especially when they were afraid of being humiliated.
When potentially uncomfortable situations arose, such as incontinence, or being washed, professionals spared their humiliation as far as possible. This included practical measures such as using continence products, but also recognising where the person felt uncomfortable and helping reassure them that their symptoms were simply part of their illnesses, and not something to feel ashamed of.
By meeting people’s needs and wishes at the end of their lives, these professionals enabled them to have dignified deaths. Doing this required investment – in time, patience and resources – but it sent a clear message to people that they matter.
This message stands in stark contrast to that of people who feel that assisted dying is an efficient alternative to the costly and burdensome option of caring for people until they die naturally. This isn’t a ‘straw man’. Indeed, it was a point made by one of Britain’s leading moral philosophers, Baroness Mary Warnock, in 2008, about people with dementia. For Baroness Warnock, if you have dementia, ‘you’re wasting people’s lives – your family’s lives – and you’re wasting the resources of the National Health Service’, and may even have a ‘duty to die’.1
Of course, not everyone who advocates assisted dying does so for this reason – in fact, many people don’t. But what begins as a law change to enable a minority to have this wish granted could trigger a gradual change in culture, whereby terminally ill people who feel they are a burden consider assisted dying a duty.
True dignity at the end of one’s life does not consist in making a choice of when and how one dies. If we are really to honour people’s dignity, we must care for them and the people who matter to them and do all we can to ensure they are at peace, and have their wishes and care needs meet. In doing so we can send terminally ill people a clear message that, in the words of Dame Cicely Saunders (founder of the modern hospice movement) – ‘you matter because you are you, and you matter to the end of your life’.
Andrew Grey studied Theology and Christian Ethics at Oxford and works in the voluntary sector on life–limiting conditions.
He is author (in a personal capacity) of the report Dignity at the End of Life: What’s Beneath the Assisted Dying Debate?