by Karen Wyatt MD
When my mother reached the end of her life she had only two requests: that she be able to die in her own home and that I be by her side. But I knew as well that it would be very important for her to retain her dignity, even as her physical health was declining. Mom had always been a beautiful woman and took pride in how she dressed and presented herself to the world. So I realized it would be important to her to feel she was at her best even in the worst of situations.
In my research as a hospice doctor about providing the best quality care to patients I learned that the word dignity comes from the Latin word dignitas, meaning worth or value. I understood that one of the keys to preserving Mom’s dignity would be to make sure she always felt valued and worthy of the greatest love possible as she was dying. But how could I accomplish that?
According to studies done by Dr. Harvey Max Chochinov,[1] dignity at the end of life can be undermined by inadequately treated pain, lack of support both from family and from professionals, depression or hopelessness, increased dependency, and lack of quality of life. So using those guidelines I set out to make sure that Mom would not question her own value or worth as she was dying. Here are some of the steps I took:
- Enlist the help of a local hospice.
The hospice we worked with provided a nurse who made home visits to assess Mom’s pain and other symptoms and then brought us the medications and medical equipment needed to keep her comfortable. Hospice also provided a home health aide who helped Mom bathe and change her clothes and bed linens when needed. So with the help of hospice Mom had reliable professional support and care for her pain and dependency needs.
- Maintain her self-care rituals.
For as long as I could remember Mom had always had a nightly ritual of applying various cleansers and creams to her face, neck and eyes before she went to sleep. When she could no longer get out of bed I brought in a tray of her facial creams and helped her apply them, just as she had done every night in the past. This simple gesture helped her see that she was still the same person she had always been and that she still mattered.
- Invite family and friends to visit.
A few days before Mom died I set aside some time when her closest friends and family members could stop by for a final brief visit. I fixed her hair, dressed her in her best robe and straightened up her bedroom so that she would feel comfortable having guests come in. She beamed brightly that day at the outpouring of love for her and had the chance to deliver her own messages of love to special people. She knew without a doubt that she was cherished.
- Support her spiritual preferences.
Mom had always been deeply religious but in the last few days of her life she began to wonder why God was still keeping her alive when she was so ready to die. She told me many stories of her prayers for other people and miracles that she had witnessed and I helped her to see that perhaps she was still alive because there were still people who needed her prayers. This thought gave her great comfort and she decided to pray for blessings for the hospice workers who had been caring for her. She went to sleep on her last night of life recognizing that she had a valuable role to play even as she was dying.
Preserving my mother’s dignity in the last days of her life was the least I could do for her after the care she had given to me throughout my life. I learned that when we slow down, take time to listen and be present with our loved ones, they will tell us what they need in order to feel valued and worthy of our love. In the days and months following her death my own grief was easier to bear because I knew Mom had died in peace and love and with her dignity still intact.
[1] Chochinov HM, Hack T, Hassard T, Kristjanson LJ, McClement S, Harlos M.
Lancet. 2002 Dec 21-28;360(9350):2026-30
