Although there is lack of consensus on what constitutes a dignified death, the wish to die at home by many people is a strong indication that it is the best available place to achieve this. Any such death in the home brings community nurses into sharper focus and central to the process of dying. To play their role effectively, community nurses need to be clear on what they believe to be a dignified death and equally, how they would help people achieve it. The key skill here is to ascertain whether their belief is also shared by the dying person so that both parties are striving for the same goal. To complete the trilogy, community nurses also need to consider a dignified death from the perspective of close family members. The real problem might arise if there are differing views, in which case the dying person's perspective is paramount.
When I was a clinical practitioner, relatives who visited after their loved ones had died seemed to ask two main questions: was someone with them when they died?; were they in pain? I would argue that answering yes and no, respectively, to these questions would contribute towards achieving a perceived dignified death for them. If we accept this premise, it is logical to suggest that most palliative care nurses would try and answer such questions in the same way.
Questions of honesty and trustworthiness may arise from this if ‘white lies’ are being told. Although unethical, the question remains, should nurses use white lies even after weighing up the pros and cons, and conclude that, in fact, white lies would, in this case, create the perception of a dignified death going into bereavement?
On the other hand, you could argue that the way relatives ask questions may suggest that they too would be glad to hear the answers given above. Otherwise, they would ask more open-ended questions; for example, ‘how was their death?’. This would then be answered in the likes of: ‘as far as we could tell/see, they did not seem to be in any pain’. Such answers are sensitive to the psychological well-being of the bereaved.
Alternative views are welcome as part of creating a dialogue in this column. From this, it leads me to suggest that the concept of a dignified death is merely a perception and subject to vary in accordance with differing perspectives of patients, nurses, families and doctors.
The concept of a dignified death
The concept of a dignified death can also be viewed in relative terms. This could mean taking into account the context in which the death occurs. We cannot afford to use the same factors to achieve a dignified death, but we have to consider the context of the death. The context is also wide-ranging to include such aspects as age of the patient, state of the disease (benign or malignant), their role in society, the deceased's own view of death, just to name a few.
The other point to consider is in whose interest it is to achieve a dignified death; is it for the dying person, close relations or healthcare professionals? This becomes an important question when there are differing perceptions of what a dignified death should look like. One argument is to respect the patient's preferences and their characterisation of dignity. However, another argument is to consider the impact of any death on the bereaved as more important since they will be the ones left behind with memories that often influence their grief and bereavement (Nicol and Nyatanga, 2017). I would like to invite community nurses to discuss these two positions and see if you arrive at a consensus view. This column welcomes your responses and the journal views this as sharing different view points all in aid of our learning. Indeed, our learning will benefit patients and family experiences of palliative and end-of-life care.
Community nurses are in a privileged position as they care for people in their own homes, where they can get to know them better to the extend that they can hold such sensitive conversations with patients for the benefit of the whole family.