We can all think of moments at the end of life of people we know, friends or loved ones, when a medical care provider missed an opportunity to recognize the dignity of the person before them. I have seen this happen many times on clinical units in hospital settings. I have also seen it happen in hospice care on rare occasions. From the Zen perspective, all sentient beings have dignity. All sentient beings are constantly in the process of awakening to their true nature, and therefore all of them are dignified.
And yet, in medical systems, we are often struggling to maintain an awareness of dignity in our care. Why does this happen? I can’t always say that I know, though I have studied how and why this happens from numerous perspectives. I have look into it from the management perspective, where empirical studies show that creating cultures of wellbeing and inclusion create a sense of psychological safety grounded in dignity and curiosity. A psychologically safe clinical setting has leaders who practice situational humility and fallibility, which encourages everyone underneath their authority to break toxic silence and offer their point of view, which improves patient care, outcomes, and profitability. Treating others as worthy, as having inherent dignity, improves employee and patient outcomes.
I have also looked at this from the standpoint of the emotionally distancing effect of biomedical language that reduces persons to impersonal biological systems. Biomedical discourse can decompose persons into bits and pieces, fragmenting authority and making it hard for persons to make decisions about what it is best to do with a complex medical situation. Fragmenting language makes dignity hard to recognize, distracting from what matters to persons. It becomes very easy to get into the weeds of technical language and lose sight of what is important. This is one of the reasons why palliative care is so helpful as a person with complex illness processes nears the end of life, because palliative care assembles in one place all the fragmentary storylines of the medical specialties, bringing the pictures of oncology and nephrology and neurology into the same frame.
I think it goes beyond these two ways of understanding the problem though, because I believe that we routinely struggle with offering to recognize the dignity of all persons because of how much of our resources it takes. I say resources to underscore not only the financial resources it takes but the demands that recognizing and respecting dignity places on our empathy, time, attention, and heart. To see dignity in all persons, in all sentient beings, means that I have to recognize and respect the life and unique history of each dying person I meet. I have to see dignity in the unhoused person dying of a heroin overdose. I have to recognize the dignity of each person dying of dementia.
Beyond this, I have to reckon with the dignity of the lifeforms of our shared ecosystems. I have to recognize the dignity of the countless trees piled into a pyre to be burned after the land is clearcut to be developed. I have to listen to the story of hundreds of dying manatees in the Indian River Lagoon and wonder why their lives didn’t matter enough to business and political interests to protect them.
In more politically fraught domains, I have to consider the death of people on both sides the Israel and Palestine conflict as worthy of protecting. I have to honor the worth and dignity of all policemen killed in the line of duty and all persons wrongly violated by police. I have to see dignity in every enemy, because compassion and love have no preference based on my point of view or self-referential stories.
In my hospice chaplaincy work, I had to feel the pain and loneliness of each person in a memory care unit that I encountered. Frankly, at certain points when I consider this proposition, feeling moved to recognize and respect the dignity of all, I feel overwhelmed. After catching myself feeling paralyzed by the scope of this need for care, I name it and accept it for what it is. Then, for me, I can make space for this feeling of overwhelm, heave a sigh before I recognize the inner space of my body and the sensations moving through me. I place my awareness in the feeling of my feet on the ground. I pause and get back to the question, “Why do I need to bring my attention to recognizing the dignity of this person?” Then, I meet the next face with my eyes and care without worrying about who or what might come after this.
