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Dying with dignity according to Swedish medical students

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An Erratum to this article was published on 08 February 2011

Abstract

Goal of work

To die with dignity is an important but ambiguous concept, and it is used in contradictory contexts, both for the promotion of palliative care and as an argument for euthanasia. Our goal was to explore medical students’ definition of a dignified death.

Patients and methods

A questionnaire containing open-ended questions was answered anonymously by 165 first- and fifth-year medical students. The data were analysed using qualitative content analysis with no predetermined categories.

Main results

The students’ descriptions of a dignified death resulted in five categories of death: (1) without suffering, (2) with limited medical interventions, (3) with a sense of security, which implied a safe environment nursed by professional staff, (4) with autonomy, respect for the individual and empowerment to the patient and (5) with acceptance. These findings show similarity to the established concepts of a good death, as well as the view of a dignified death by terminally ill patients.

Conclusions

The data suggest that the students perceive that the medical system is over-treating patients and sometimes causing harm to dying patients. The results reveal a potential misunderstanding and contradiction relating to death without suffering and the use of necessary palliative interventions. These findings are important when planning education as regards palliative care and dignified death.

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References

  1. Balaskas J (1989) Active birth. Unwin, London

    Google Scholar 

  2. Billings JA, Block S (1997) Palliative care in undergraduate medical education: status report and future directions. JAMA 278(9):733–738

    Article  PubMed  CAS  Google Scholar 

  3. Bradbury M (1999) Representations of death: a social psychological perspective. Routledge, London

    Google Scholar 

  4. Chochinov HM (2002) Dignity in the terminally ill: a cross-sectional, cohort study. Lancet 360:2026–2030

    Article  PubMed  Google Scholar 

  5. Chochinov HM, Hack T, McClement S et al (2002) Dignity in the terminally ill: a developing empirical model. Soc Sci Med 54:433–443

    Article  PubMed  Google Scholar 

  6. Clark D (2002) Between hope and acceptance: the medicalisation of dying. BMJ 324:905–907

    Article  PubMed  Google Scholar 

  7. Dekkers W; Sandman L, Webb D (2002) Good death or good life as a goal of palliative care In: ten Have H, Clark D (eds) The ethics of palliative care: European perspectives. Open University Press, Philadelphia, pp 106–125

    Google Scholar 

  8. DelVecchio Good M, Gadmer N, Ruopp P et al (2004) Narrative nuances on good and bad deaths: internists’ tales from high-technology work places. Soc Sci Med 58:939–953

    Article  PubMed  Google Scholar 

  9. Emanuel EJ, Emanuel LL (1998) The promise of a good death. Lancet 351:21–29

    Article  Google Scholar 

  10. Hart B, Sainsbury P, Short S (1998) Whose dying? A sociological critique of the ‘good death’. Mortality 3(1):65–77

    Article  Google Scholar 

  11. Hickey G, Kipping C (1996) A multi-stage approach to the coding of data from open-ended questions. Nurse Res 4:81–91

    Google Scholar 

  12. Johnson P (1998) An analysis of “dignity”. Theor Med Bioeth 19:337–352

    Article  PubMed  CAS  Google Scholar 

  13. Kissane DW, Clarke D, Street A (2001) Demoralization syndrome—relevant psychiatric diagnosis for palliative care. J Palliat Care 17(1):12–21

    PubMed  CAS  Google Scholar 

  14. Macklin R (2004) Reflections on the human dignity symposium: is dignity a useless concept? J Palliat Care 20(3):212–216

    PubMed  Google Scholar 

  15. Mak J, Clinton M (1999) Promoting a good death: an agenda for outcomes research—a review of the literature. Nurs Ethics 6(2):97–106

    Article  PubMed  CAS  Google Scholar 

  16. Marton F, Dahlgren LO, Svensson L, Säljö R (1977) Inlärning och omvärldsuppfattning (Learning and conception of the world). AWE/Gebers, Stockholm

    Google Scholar 

  17. McDonald M (2004) Dignity at the end of our days: personal, familial, and cultural location. J Palliat Care 20(3):163–170

    PubMed  Google Scholar 

  18. McNamara B (2004) Good enough death: autonomy and choice in Australian palliative care. Soc Sci Med 58:929–938

    Article  PubMed  Google Scholar 

  19. Morgan DL (1993) Qualitative content analysis: a guide to paths not taken. Qual Health Res 3:112–121

    Article  PubMed  CAS  Google Scholar 

  20. The Oregon Death with Dignity Act. Oregon Revised Statutes. Available from: http://www.ohd.hr.state.or.us/chs/pas/statute.pdf

  21. Payne S, Hillier R, Langley-Evans A et al (1996) Impact of witnessing death on hospice patients. Soc Sci Med 43(12):1785–1894

    Article  PubMed  CAS  Google Scholar 

  22. Pullman D (2004) Death, dignity, and moral nonsense. J Palliat Care 20(3):171–178

    PubMed  Google Scholar 

  23. Seale C (2004) Media constructions of dying alone: a form of ‘bad death’. Soc Sci Med 58:967–974

    Article  PubMed  Google Scholar 

  24. Statens offentliga utredningar (Official government commission) (2001) Döden angår oss alla—värdig vård vid livets slut (Death becomes us all—dignified care at the end of life). SOU 2001:6, Fritzes, Stockholm

    Google Scholar 

  25. Street A, Kissane DW (2001) Constructions of dignity in end-of-life care. J Palliat Care 17(2):93–101

    PubMed  CAS  Google Scholar 

  26. Toombs KS (2004) Living and dying with dignity: reflections on lived experience. J Palliat Care 20(3):193–200

    PubMed  Google Scholar 

  27. Yalom I (1980) Existential psychotherapy. Basic Books Inc., New York

    Google Scholar 

  28. Walters G (2004) Is there such a thing as a good death? Palliat Med 18:404–408

    Article  PubMed  Google Scholar 

  29. van der Maas P, van der Wal G, Haverkate I et al (1996) Euthanasia, physician-assisted suicide, and other medical practices involving the end of life in the Netherlands, 1990–1995. N Engl J Med 335:1706–1711

    Article  PubMed  Google Scholar 

  30. Weber RP (1990) Basic content analysis. Sage publications, Newbury Park

    Google Scholar 

  31. Vig EK, Pearlman RA (2004) Good and bad death from the perspective of terminally ill men. Arch Intern Med 164:977–981

    Article  PubMed  Google Scholar 

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Acknowledgements

This study was financially supported by Stockholms Läns Landstings FoUU (Stockholm County Council). Ingela Dellby is acknowledged for the linguistic revision.

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Correspondence to Marit Karlsson.

Additional information

An erratum to this article is available at http://dx.doi.org/10.1007/s00520-011-1109-9.

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Karlsson, M., Milberg, A. & Strang, P. Dying with dignity according to Swedish medical students. Support Care Cancer 14, 334–339 (2006). https://doi.org/10.1007/s00520-005-0893-5

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