Dignity and the essence of medicine: the A, B, C, and D of dignity conserving care

BMJ 2007; 335 doi: http://dx.doi.org/10.1136/bmj.39244.650926.47 (Published 26 July 2007)
Cite this as: BMJ 2007;335:184

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  1. Harvey Max Chochinov, professor, department of psychiatry, University of Manitoba.
  1. CancerCare Manitoba, Winnipeg, MB, Canada R3E 0V9
  1. harvey.chochinov{at}cancercare.mb.ca
  • Accepted 15 May 2007

Kindness, humanity, and respect—the core values of medical professionalism—are too often being overlooked in the time pressured culture of modern health care, says HarveyChochinov, and the A, B, C, and D of dignity conserving care can reinstate them

The late Anatole Broyard, essayist and former editor of the New York Times Book Review, wrote eloquently about the psychological and spiritual challenges of facing metastatic prostate cancer. “To the typical physician,” he wrote, “my illness is a routine incident in his rounds while for me it's the crisis of my life. I would feel better if I had a doctor who at least perceived this incongruity . . . I just wish he would . . . give me his whole mind just once, be bonded with me for a brief space, survey my soul as well as my flesh, to get at my illness, for each man is ill in his own way.”1

Broyard's words underscore the costs and hazards of becoming a patient. The word “patient” comes from the Latin patiens, meaning to endure, bear, or suffer, and refers to an acquired vulnerability and dependency imposed by changing health circumstances. Relinquishing autonomy is no small matter and can exact considerable costs.2 These costs are sometimes relatively minor—for example, accepting clinic schedules or hospital routines. At other times, the costs seem incompatible with life itself. When patients experience a radical unsettling of their conventional sense of self3 and a disintegration of personhood,4 suffering knows few bounds. To feel sick is one thing, but to feel that who we are is being threatened or undermined—that we are no longer the person we once were—can cause despair affecting body, mind, and soul. How do healthcare providers influence the experience of patienthood, and what happens when this …

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