Lost in translation: dignity dialogues at the end of life

After a diagnosis of life-threatening illness, decisions must be made regarding various treatment options including life-sustaining interventions. The preservation of dignity is commonly invoked in these discussions with patients, their substitute decision makers, and health care providers. Current thoughts on dignity explore two main ideas: dignity as intrinsic worth and dignity as worth judged according to extrinsic socially based constructs. For the most part, both notions of dignity are appealed to in discussions of continuing or withholding/withdrawing treatments and in debates on the legalization of assisted death. These conceptions of dignity are value-laden and frequently biased, and therefore should be used with caution, if at all, in discussions with patients and their substitute decision makers. The fundamental issues in discussion with all patients diagnosed with a life-threatening illness are ones of respect for persons, acceptance, caring, and the value of interpersonal relationships.