XI/89. Dignity
Dying with dignity separates us from lesser beings.
Dignity is not temporary cool, nor an aloofness from feeling and human contact. It is an inherent condition derived from character and self-respect that is beyond the reach of cancer.
––John Roberts
Where is there dignity unless there is also honesty?
––Cicero
Perhaps those, who, trembling most, maintain a dignity in their fate, are the bravest: resolution on reflection is real courage.
––Horace Walpole, 1757
Our dignity is not in what we do, but in what we understand.
––George Santayana
Dignity involves the integration of a person’s physical, emotional, intellectual, and spiritual aspects; it is complex, and unique to each individual….An inadvertent and unintended side effect of medicine’s growing effectiveness is that the dying process has been elongated. For those whose quality of life remains high or even satisfactory, this can be a good outcome. But for those who are suffering greatly and those who lose the mental capacity to refuse treatment, it has become harder and harder to die….The patient’s quest for a dignified death should be a fundamental part of the equation for end-of-life medical decisions. This highly personal endeavor has been explored and exalted in great literature and art, yet it is curiously minimized or even ignored by the profession of medicine.
Timothy E. Quill, M.D., Death and Dignity, 1993
The dignity that we seek in dying must be found in the dignity with which we have lived our lives. The art of dying is the art of living. The honesty and grace of the years of life that are ending is the real measure of how we die. It is not in the last weeks or days that we compose the message that will be remembered, but in all the decades that preceded them. Who has lived in dignity, dies in dignity.
Sherwin B. Nuland, How We Die, 1993
We the elders must intend to die with dignity, which involves earning the respect of the younger. Our dignity in death is in their minds as well as ours. Whether we foresee the end as passage or peace, trauma or unawareness, dignity is part of it. As we approach that end, the problems of life fall by the wayside; we seek simplicity, quietude, love, and respect. We become enveloped in a final embrace and understanding with those we leave behind and with our vision of the future.
Most of us have found some version of dignity in the way we live our lives. We try to maintain some kind of maturity and self-respect, and we hope to display it on appropriate occasions if not all the fun-loving time. Dying is certainly one of those. Some of the circumstances and emotions of dying are not at all dignified. Pain and grief will upset the quietude of dignity. Not everyone slips away peacefully in the presence of loved ones. We may not have the choice of time and place. This is not very important if we finish our communication and manage our thoughts.
In addition to a personal demeanor, the dignity of an event implies some degree of ceremony or prepared atmosphere. This may not be possible, depending on the final cause of death. Dying in one’s own bedroom is not the norm today, when hospice care is excellent and covered by Medicare. The patient may not even be a conscious participant, and loved ones may not be present. We should not overdo the situation, which may occur sooner than expected, and we certainly must not regret little problems if everything does not occur as planned. While we grieve and regret, we must also learn to accept and approve of the end of suffering without focus on time.
Dignity in our culture is often applied to persons of high rank or achievement who are entitled to distinction and honor. We may extend this to the dying, whose life is being ennobled as it ends. As we respect that person, we also show respect for the civilization of our culture and society. The link to the past, the image of our distinguished ancestors, sets an example for the living. There is some good in everyone, and last days are the time to recognize those qualities and achievements. There is no better way to raise the self-esteem and sense of peace in the dying. There is no better way to send the survivors back to life with their own inherited and renewed self-respect.
