University West, Sweden.
Skaraborg Hospital Skövde, Sweden.
Nurs Ethics. 2020 Feb;27(1):104-115. doi: 10.1177/0969733019845128. Epub 2019 May 19.
Dignity, usually considered an essential ethical value in healthcare, is a relatively complex, multifaceted concept. However, healthcare professionals often have only a vague idea of what it means to respect dignity when providing care, especially for persons with impaired autonomy. This article focuses on two concepts of dignity, human dignity and dignity of identity, and aims to analyse how these concepts can be applied in the care for persons with impaired autonomy and in furthering the practice of respect and protection from harm. Three vignettes were designed to illustrate typical caring situations involving patients with mild to severely impaired autonomy, including patients with cognitive impairments. In situations like these, there is a risk of the patient's dignity being disrespected and violated. The vignettes were then analysed with respect to the two concepts of dignity to find out whether this approach can illuminate what is at stake in these situations and to provide an understanding of which measures could safeguard the dignity of these patients. The analysis showed that there are profound ethical challenges in the daily care of persons with impaired autonomy. We suggest that these two concepts of human dignity could help guide healthcare professionals to develop practical skills in person-centred, ethically grounded care, where the patient's wishes and needs are the starting point.
尊严通常被认为是医疗保健中的一个基本伦理价值，是一个相对复杂、多方面的概念。然而，医护人员在提供护理时，往往只是对尊重尊严的含义有一个模糊的概念，尤其是对于那些自主能力受损的人。本文关注尊严的两个概念，即人的尊严和身份尊严，并旨在分析这些概念如何适用于自主能力受损者的护理，以及如何进一步尊重和保护他们免受伤害。本文设计了三个情景案例，说明了涉及轻度至重度自主能力受损患者的典型护理情况，包括认知障碍患者。在这些情况下，患者的尊严可能会受到不尊重和侵犯。然后，根据这两个尊严概念对这些情景案例进行了分析，以了解这种方法是否可以阐明这些情况下的利害关系，并了解哪些措施可以保障这些患者的尊严。分析表明，在自主能力受损者的日常护理中存在着深刻的伦理挑战。我们建议，这两个人的尊严概念可以帮助指导医护人员发展以患者为中心、基于伦理的护理实践技能，以患者的意愿和需求为出发点。
