PURPOSE: The importance of human dignity in care is well-recognized. Care recipients' experiences with undignified care have been reported in many countries. However, few studies have measured these situations quantitatively, especially as there are no tools applicable to inpatients receiving ordinary daily care. This study aimed to develop a valid and reliable Inpatient Dignity Scale (IPDS) that can measure inpatients' expectations of and satisfaction with dignity in daily care. METHODS: We conducted a three-phase research project: item generation and a preliminary survey with 47 items related to patients' dignity in Japan, a main survey with 36 items with deliberate translation into English in Singapore, and a confirmatory survey with 35 items in England, with 442, 430, and 500 inpatients as participants in questionnaire surveys, respectively. Data from each survey were processed using factor analysis. RESULTS: Authors obtained a scale with a four-factor structure with acceptable reliability: (F1) respect as a human being, (F2) respect for personal feelings and time, (F3) respect for privacy, and (F4) respect for autonomy. CONCLUSION: The Inpatient Dignity Scale can be periodically used by hospital administrators or nurses to preserve inpatients' dignity in daily care by monitoring inpatients' views regarding their expectations of and satisfaction with dignity.
England ; Great Britain ; Hospital Administrators ; Humans ; Inpatients ; Japan ; Nursing ; Personhood ; Privacy ; Psychometrics ; Singapore

The Supreme Court decision made on May 21, 2009 about the withdrawal of futile life-prolonging medical care from a persistently vegetative patient provided a legal basis for patients to consent to death with dignity, and also spurred a lively debate in Korea. The legal grounding of this decision was based on the principles of human dignity, worth, and the right to pursue happiness articulated in the Article 10 of the Constitution. The Death with Dignity Act was legislated to regulate decisions about life-prolonging medical care on February 3, 2016, after extensive debate and a focus on consensus that led to two revisions. However, the issue has not been completely resolved. First, the definition of the process of dying is unclear, because the points that determine whether a patient is dying are different from a simple assessment of whether an artificial ventilator should be attached or detached. Second, the purpose of this law is the protection of human dignity, worth, and the right to pursue happiness. However, nutrition, fluids, and oxygen must continue to be supplied, even after cessation of life-prolonging medical care. Is providing a continuous supply of nutrition, fluids, and oxygen a reasonable way to satisfy the goals of Article 10 of the Constitution? Third, if the withdrawal of life-prolonging medical care is possible based on the family's agreement without the patient's input, what is the legal value of advance directives? In conclusion, it may be necessary to partially revise the law regulating decisions on the withdrawal of life-prolonging medical care through further debate.
Advance Directives ; Consensus ; Constitution and Bylaws ; Happiness ; Humans ; Jurisprudence ; Korea ; Oxygen ; Persistent Vegetative State ; Personhood ; Right to Die ; Supreme Court Decisions ; Ventilators, Mechanical

Chapter 9 of the Bioethics Law has several problems due to strict research standards and strong penalties. Therefore, biomedical researchers in Korea have raised several objections to this Law. To make matters worse, the normative power of the Law is significantly diminished because norms and penalties are divergent. Articles 2, 24, 26, 27, 28, and 32 of the Law require amendment because the current regulations on sperm retrieval, sperm management, and sperm use are insufficient. At a minimum, legislation for artificial insemination and in vitro fertilization should be consolidated. It is also necessary for sperm researchers and donors to be notified of their rights and duties. Section 9 of the Bioethics Law should therefore be amended. In particular, its legal formulation should be modified in order to enhance the effectiveness of bioethics law. This is in accord with the spirit of the Constitution. The principle of proportionality should be maintained. The statutory form should be revised to the level of abortion. Not only are the actors in embryo research diverse, including medical personnel, medical institutions, donors, veterans, and mediators, but embryo research involves multiple behavioral aspects, including intentional acts and negligence (violation of state duty). Excessively free-form activity is prescribed. Although the value of life is important, heavy punishment violates human dignity and human values. This legislation should not reflect to be grounded in emotional reactions such as anger.
Anger ; Bioethics ; Constitution and Bylaws ; Embryo Research ; Embryonic Structures ; Fertilization in Vitro ; Humans ; Insemination, Artificial ; Jurisprudence ; Korea ; Malpractice ; Personhood ; Punishment ; Social Control, Formal ; Sperm Retrieval ; Spermatozoa ; Tissue Donors ; Value of Life ; Veterans

PURPOSE: The purpose of this paper is to identify a theoretical basis of end-of-life care by examining attributes of the concept of the nurses' acceptance of patient deaths. METHODS: Walker and Avant's approach to concept analysis was used. A literature study was performed to check the usage of the concept. To identify the attributes of the concept and come up with an operational definition, we analyzed 16 qualitative studies on nurses' experiences of death of patients, published in a national science magazine from 1999 to 2015. RESULTS: The nurses' acceptance of death of patients was identified as having four attributes: acceptance through mourning, attaining insight on life and death while ruminating life, facing with fortitude and practicing human dignity. Antecedents of the concept were experiences of patient's death, confusion and conflict, negative emotions, passive responses, denial of patients' death. The consequences of the concept were found as the holistic end-of-life care and active pursuit of life. CONCLUSION: This study on the attributes of the concept of the nurses' acceptance of death of patients and it's operational definition will likely lay the foundation for applicable end-of-life care mediations and theoretical development.
Denial (Psychology) ; Grief ; Humans ; Periodicals as Topic ; Personhood ; Walkers

Lipuma equates continuous sedation until death (CSD) to physician-assisted suicide/euthanasia (PAS/E) based on the premise that iatrogenic unconsciousness negates social function and, thus, personhood, leaving a patient effectively 'dead'. Others have extrapolated upon this position further, to suggest that any use of sedation and/or opioids at the end of life would be analogous to CSD and thus tantamount to PAS/E. These posits sit diametrically opposite to standard end-of-life care practices. This paper will refute Lipuma's position and the posits borne from it. We first show that prevailing end-of-life care guidelines require proportional and monitored use of sedatives and/or opioids to attenuate fears that the use of such treatment could hasten death. These guidelines also classify CSD as a last resort treatment, employed only when symptoms prove intractable, and not amenable to all standard treatment options. Furthermore, CSD is applied only when deemed appropriate by a multidisciplinary palliative medicine team. We also show that empirical data based on local views of personhood will discount concerns that iatrogenic unconsciousness is tantamount to a loss of personhood and death.
Analgesics, Opioid ; therapeutic use ; Attitude of Health Personnel ; Death ; Deep Sedation ; ethics ; Ethics, Medical ; Euthanasia ; ethics ; legislation & jurisprudence ; Humans ; Hypnotics and Sedatives ; therapeutic use ; Palliative Care ; ethics ; Personhood ; Philosophy, Medical ; Practice Guidelines as Topic ; Suicide, Assisted ; ethics ; legislation & jurisprudence ; Terminal Care ; ethics ; Unconsciousness

PURPOSE: Dignity therapy is a very effective intervention to improve the dignity of end-stage patients. A concept analysis by Walker and Avant (2005) was adopted to define, describe, and delimitate the concept of dignity therapy. METHODS: Nursing literature in the National Digital Science Links (NDSL) and Medline database were searched for the definitions of "dignity" and "dignity therapy". Definitions, uses, and defining attributes of dignity therapy were identified; model and contrary cases were developed; and antecedents, consequences, and empirical references were determined. RESULTS: Through dignity therapy patients and their families share their stories, and that in turn improves the quality of life and death. Five attributes were identified: higher quality of life and death, therapeutic conversation, respect of human dignity and worth, expressing thoughts about life and death and systematic process. CONCLUSION: Patients at the end of their lives feel more comfortable about death. Hospice care providers should try to protect dignity of patients in their care. The attributes of the dignity therapy clarified in this study should be applied for terminally ill patients to improve their quality of life and death.
Hospice Care ; Hospices ; Humans ; Nursing ; Personhood ; Quality of Life ; Terminally Ill ; Walkers

INTRODUCTIONUnderstanding personhood or "what makes you, you" is pivotal to the provision of person-centred care. Yet the manner that personhood is conceived amongst patients varies significantly. This study aims to investigate conceptions of personhood in a multiracial, multicultural, multireligious setting.

MATERIALS AND METHODSA mixed-methods study was conducted at National Cancer Centre Singapore, from January 2013 to April 2013. We used a validated questionnaire where English-speaking oncology patients rated the importance of 26 features of "personhood" on a 10-point Likert scale from 0 to 9, with 9-points being extremely important. This was followed by a semi-structured interview. Analysis of transcripts using the Grounded Theory revealed original data that inspired novel ideas about the nature of personhood, which precipitated a further study in April 2014.

RESULTSOur initial study of 100 patients revealed that personhood is conceived in a unique and novel manner. To study this, we interviewed a further 40 patients using a supplemental question to our original questionnaire. Our data affirmed our initial findings and evidenced a change in conceptions of personhood.

CONCLUSIONOur evidence supports the Ring Theory of Personhood, which suggests that personhood is defined by innate, individual, relational, societal elements. It also evidences that personhood is temporally and contextually sensitive allowing for better appreciation of the evolving goals of care that frequently occur at end-of- life. Most importantly, this study reminds healthcare professionals on the importance of "treating persons" and looking beyond familial interests in maintaining the interests and dignity of the patient.

Cultural Diversity ; Humans ; Interviews as Topic ; Language ; Neoplasms ; psychology ; therapy ; Palliative Care ; Patient-Centered Care ; Personhood ; Singapore ; Surveys and Questionnaires ; Terminal Care

The practice of medicine today is beset with unprecedented challenges which include public distrust in medical profession, increasing market force and strengthened management. Recently medical professional societies in UK & USA are overcoming these challenges in the way that medical professionalism is modernized in a changing society. They set 'a physician charter' and new definition of medical professionalism as a partnership. The principles of new medical professionalism are patient welfare, patient autonomy and social justice. It describes doctors' commitment to integrity, compassion, altruism, continuous improvement, excellence, working in partnership, just distribution of finite resources, maintaining trust by managing conflicts of interest and others. New professionalism support improvement of health care system for the welfare of society and the collective human dignity. Experience of rebuilding medical professionalism in UK and USA will give a lesson to Korean medical profession when they seek for solution to restore public confidence and take the leadership in Korean healthcare system.
Altruism ; Delivery of Health Care ; Empathy ; Humans ; Leadership ; Personhood ; Social Justice

The development of life sustaining treatment technology including artificial ventilation has given us the moral problem, considering the human dignity and futility of medical treatment, until when these treatments could be given to terminally ill patients. In Korea, there were two supreme court decisions a significant impacts on the withdrawal of life sustaining treatment. After these decisions, Korean medical society has developed a guideline for advance directives and has also established a voluntary hospital ethics committee. The patient's right of self- determination right and the paternalistic approach of medicine should be balanced at an optimal level, because benefits of medical advances should be adjusted to take into account the burden of life prolongations. Decision making always has been difficult because related to ethical values, and there a broad spectrum of value-laden attitudes within Korean society. The legalization of end-of-life care should be from the respect of the professional autonomy of medical society. Under these considerations, we should supply alternative methods like hospice care, which can help to manage the withdrawal of life support appropriately, and also make an effort to relieve the economical burden of patients.
Advance Directives ; Decision Making ; Ethics Committees ; Ethics Committees, Clinical ; Hospice Care ; Hospices ; Hospitals, Voluntary ; Humans ; Jurisprudence ; Korea ; Medical Futility ; Patient Rights ; Personal Autonomy ; Personhood ; Professional Autonomy ; Societies, Medical ; Supreme Court Decisions ; Terminally Ill ; Ventilation ; Withholding Treatment

PURPOSE: This study was done to discover the structure of the lived experiences of unresolved suffering of college students and to gather information to develop therapeutic educational interventions for nursing students. METHODS: The research question, 'What is the structure of the lived experience of unresolved suffering?' was examined based on Parse's Human becoming research method. Twelve nursing students were recruited from K University. From May, 1 to June 30, 2009, Data were gathered from writings and engagement in dialog. RESULTS: The structure found in the college students' lived experiences of suffering was as follows: negative self-concept from being discriminated and ignored by parents, feelings against people and difficulties in interpersonal relations, feelings of isolation, betrayal, guilt, and loss. Their suffering was emotional grief and social withdrawal from damaged human dignity and low self-esteem from psychological trauma. Conceptual integration found to be in process of transferring the enabling-limiting, connecting-separating values. CONCLUSION: It is necessary to develop therapeutic educational interventions for college students for further development as individuals and future health professional by developing awareness of the structure and the meaning of their suffering experience.
Grief ; Guilt ; Health Occupations ; Humans ; Interpersonal Relations ; Parents ; Personhood ; Students, Nursing