A high-profile Government Commission has recently reported on the need to revolutionise the care provided to older adults in both hospital and community settings. As its title, Delivering Dignity (Commission on Dignity in Care for Older People. 2012. Delivering Dignity. NHS Confederation) suggests, the report advocates that care needs to be provided in ways that are dignified. What exactly do the Commission mean by ‘dignified care’?

Things begin brightly: The Commission wed their account of dignified care to the virtue of compassion. Providing good care involves, at least in part, the humanising of care practices through the expression of a compassionate attitude by the professional carer within his/her work. On this account, dignified care is one component of good care. Professional carers should act with compassion, and they should do so in addition to fulfilling their obligations to, for example, maximise a person’s well-being, or enabling the person to make decisions from a full range of choices in the pursuit of a fulfilling and meaningful life.

It is this narrow account of dignified care within the report that has grabbed the media headlines. This is not least because the Commission draws upon this account to endorse new recruitment and training procedures for professional care staff. These procedures require that a person’s capacity for compassion is ascertained before an offer of employment is made to that person, and that the practice of compassionate care is fostered and evaluated within innovative models of ‘active learning’. Expertise and skills to optimise safe and effective outcomes for older adults acquired in the more traditional setting of the classroom or university are important, but are not sufficient to deliver care that is dignified.

As the report progresses, however, the Commission’s account of dignified care transmogrifies into little more than a placeholder for each and every ethical obligation in professional care work. Dignity in care is adopted as the catch-all phrase that requires, amongst other things, that care a) is ‘person-centred’ rather than ‘task-centred’, b) is responsive to a person’s preferences, c) is provided in partnership with a person’s family, d) increases a person’s independence, and e) makes a person feel happy. The Commission offers no reasons for the claim that respect for dignity is the core value from which all of these other ethical requirements in care can be derived. Perhaps, then, the Commission see dignified care as nothing more than a ‘call to arms’, drawing on the rhetorical force of the expression to aid in better embedding a range of different action-guiding principles into practical care settings.

Which account of dignified care ought to be endorsed? Should dignified care be seen as a neglected component of a robust normative account of good care, should it be seen as the central normative account of all moral obligations in professional care work, or should it be seen as a rallying cry to make things better in a context where the most basic ethical failings remain all too common?

The Commission’s report is open for consultation. Please let them know your thoughts:http://www.nhsconfed.org/OurWork/latestnews/Pages/Call-to-arms-improving-dignity-care-older-people.aspx

Some Responses to this Blog

Response 1

You raise a very interesting point. I've been following the news about the Commissions' report and heard the media discussing dignified care as compassionate care. I believe I fell into the trap of unquestioningly accepting 'dignity' to mean your third option - a catch-all, rallying cry for 'better' care. You've really made me stop and think, however, about what dignity really means. When I worked in human rights, I often talked about the 'inherent dignity and equal rights' of human beings - in fact, 'dignity' is something many international human rights treaties refer to but don't specifically define. I went by the assumption that 'dignity' simply stood for 'respect for persons', but did not focus on unpacking the term otherwise. We believed the phrase 'dignity and human rights' had rhetorical strength and could bring attention to the issues we were involved in. I have a feeling the Commission is using dignity in the same way here - to raise awareness and improve standards in an area that's been found woefully neglected. I don't believe that using 'dignity' as a rallying cry is a problem. The problem is what you raise in your fourth paragraph - when 'dignity' is translated into a list of requirements in care with no proper explanation for how these requirements are derived. At this point, it would be important to pause and think about how to define dignity so that it doesn't become a vague term that's simply synonymous with 'good' care. Dina Bogecho

Response 2

I wonder what a recruitment process that assertains people's 'capacity for compassion' will look like. Based on the Commission's criteria, I am not convinced that the process will necessarily be a dignified one! Rebecca Cooper

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