“Personhood,” Not “Patienthood”:
Tips on dignity-conserving practice in palliative care
How does he find the time to fulfill his own tips? Dr. Adzich relies on the skills of other palliative care team members, and their common philosophy of care. Photo used with permission.
By Kim Adzich, MD
IAHPC Board Member
One of Dame Cicely Saunders’ foundational tenets of palliative care is embodied in her words, “You matter because you are you, and you matter until the last moment of your life.”1 Dignity is the inherent worthiness of being human, of mattering until that last breath.
But how do we ensure that we reflect that inherent dignity back to those in our care? Dr. Harvey Max Chochinov, having dedicated decades to researching and teaching dignity-conserving care, tells us, “For anyone privileged to look after patients at whatever stage of the life cycle, the duty to uphold, protect, and restore the dignity of those who seek our care embraces the very essence of medicine.”2
After four decades as a rural GP and community palliative care physician, I offer a few thoughts on how we can foster that sense of dignity and uniqueness in those we care for as they near the end of life.
“You are you”
Try to see each person for who they are as a person (“personhood”), rather than the illness they bear (“patienthood”). It is important to ask how they would like to be addressed, or for permission to use their first name; learning the names of their family members/caregivers, and modeling kindness and respect are also important. I love making home visits. It allows me time to meet them in their world, not mine, to explore aspects of their life that gives meaning, to enquire about the family photos (“How did you two meet? Are these your grandchildren?”), notice the books on the bedside table, and get a sense of the practical aspects of care needs.
I will ask, “I know a lot about your medical illness but tell me about who you are as a person, about your life, and what’s most important to you now.” It pairs with Dr. Chochinov’s Patient Dignity Question, “What do I need to know about you as a person to give you the best care possible?”3, which often has unexpected answers! I am always listening for ways to make meaningful connection with them as a person as they tell their story.
“The essence of dignity in healthcare resides in recognizing the uniqueness of the individual, resulting in them feeling that they are seen, accepted, and embraced for who they are.”4 Listen to their stories and you will hear their human journey.
“You matter”
Turn your phone to silent. Be fully present. Dame Cicely once again encourages us to remember that “suffering is only intolerable when nobody cares.”5 Before I go into a home, I often take a “mindfulness moment” to reground myself, push away other distractions, and set my intention to be a compassionate presence that will make a difference in their journey at this moment in time.
Sit at their level and listen intently. I often try to make a connection through our eyes as they speak—I want to hear their words, and their soul. Speak compassion with your eyes, your touch, your words. Practice the ancient art of “laying on of hands” with gentle examination and the “laying on of ears”6 with curiosity and respect.
Take time to answer all their questions, explore their fears, and hear their needs. Gently, if invited, talk about what dying might look like. Reframe hope to what can be possible in the days ahead.
We are all on a shared journey of being human and facing mortality. In the words of Ram Das, “We are all just walking each other home,”7 with home being a place where you feel that you matter: you are safe, secure, and heard. Symptom management is vital, but so is showing how much you care for the unique person before you who shares their journey with you.
Dr. Kim Adzich is a community palliative care physician and general practitioner oncologist on Vancouver Island, British Columbia, Canada. Read his bio here.
References
1. Oxford Essential Quotations, 4th ed. Oxford University Press, New York, 2016. [Online]
2. Chochinov HM. Dignity and The Essence of Medicine: The A, B, C, and D of dignity conserving care. BMJ 2007; 335(7612): 184-187.
3. Chochinov HM. Intensive Caring: Reminding patients they matter. J Clin Oncol 2023; 41(16): 2284-2287.
4. Dr. Pam Orr, quoted in: Chochinov HM. Dignity in Care: The human side of medicine. Oxford University Press, New York, 2023.
5. Chochinov HM. Intensive Caring: Reminding patients they matter. J Clin Oncol 2023; 41(16): 2284-2287
6. Manning D. Don’t Take My Grief Away From Me. Insight Press, Oklahoma City, 1979.
7. Ram Das Quotes. Ramdass.org. [Online]
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