Dignity in Care for Older People

Lennart Nordenfelt is Professor of Philosophy of Medicine and Health Care at the University of Linköping, Sweden

Preface viii

Contributors x

An Outline of the Book xii

Preamble: the Case of David and Rebecca xviii

Part I Theoretical and Conceptual Considerations 1

1. Health, Autonomy and Quality of Life: Some Basic Concepts in the Theory of Health Care and the Care of Older People 3
Lennart Nordenfelt

Introduction 3

1.1 Health 3

1.2 Quality of life 8

1.3 Autonomy 18

1.4 Integrity 23

1.5 Final remarks on the basic values 24

References 24

2. The Concept of Dignity 26
Lennart Nordenfelt

Introduction 26

2.1 The definition of dignity 27

2.2 Dignity: towards an analysis 30

2.3 Relationships between the notions of dignity 40

2.4 Further explorations on dignity. A commentary on some other authors 42

2.5 Dignity and older people 46

References 52

3. Being Body: The Dignity of Human Embodiment 54
Jennifer Bullington

Introduction 54

3.1 The objective body and the lived body 56

3.2 The dignity of the human body 64

3.3 Implications for health care 74

References 75

Part II Dignity and Older People: Some Empirical Findings 77

4. Dignity and Dementia: An Analysis of Dignity of Identity and Dignity Work in a Small Residential Home 79
Magnus Öhlander

Introduction 79

4.1 Living together in a residential home 81

4.2 The homelike nature of the residential home 84

4.3 Activities and routines 87

4.4 Identity 89

4.5 Home, sweet home 91

4.6 Dignity, normality and culture 93

4.7 Summary and concluding remarks on dignity work, normality and power 94

References 97

5. Dignity and Older Spouses with Dementia 99
Ingrid Hellström

Introduction 99

5.1 Dignity in spousal relationships 105

5.2 Conclusions 115

Acknowledgements 116

References 116

6. Caring for Older People: Why Dignity Matters – the European Experience 119
Win Tadd and Michael Calnan

Introduction 119

6.1 The Dignity and Older Europeans study 121

6.2 Findings 126

6.3 Discussion 138

6.4 Conclusion 142

Acknowledgements 142

References 142

7. A Dignified Death and Identity-Promoting Care 146
Britt-Marie Ternestedt

Introduction 146

7.1 A dignified or good death 148

7.2 Being allowed to be the person one is and to decide for oneself 149

7.3 Death as a religious, medical and private event 151

7.4 Extended identity close to death 155

7.5 Threats to identity close to death 157

7.6 Identity-promoting care 159

7.7 Conclusion and reflections 164

References 165

8. Dignity and the Dead 168
Göran Lantz

Introduction 168

8.1 The view of the dead person 168

8.2 The dead as persons 172

8.3 Change and continuity 173

8.4 The necessary psychological change 174

8.5 Brain death as a special category 175

8.6 Fear of the dead person 175

8.7 The rights of the dead 177

8.8 Who owns the dead? 181

8.9 Religious aspects 181

8.10 The dignity of the dead 186

References 188

9. Dignity as an Object of Empirical Study: Experiences from Two Research Programmes 190
Lennart Nordenfelt

9.1 General considerations 190

9.2 Basic ethical concepts: a comparison between the DOE project and the Home project 193

9.3 Salient aspects of the care of seriously ill older people in the Swedish context 200

9.4 Conclusions 204

References 205

Index 207