REVIEWED BY SR. PATRICIA TALONE, RSM, Ph.D.
Dignity Therapy: Final Words for Final Days
BY HARVEY MAX CHOCHINOV
Oxford University Press, 2012 199 pages, $49.95
The Ethical and Religious Directives for Catholic Health Care Services urge those within Catholic health care to treat every person whom they encounter with the utmost dignity because "the dignity of human life flows from creation in the image of God." The Directives counsel health caregivers to treat patients and clients "in a way that respects the human dignity and eternal destiny of all." Harvey Max Chochinov, a Canadian psychiatrist and international leader in palliative care, affords in this text a method to maximize human dignity, especially for those individuals facing life's end.
The author is no stranger to Catholic health care's palliative care and Supportive Care Coalition communities. A prolific writer and lecturer, Chochinov has published studies in journals like The Lancet, JAMA, the American Journal of Psychiatry and the Journal of Clinical Psychiatry, to name just a few. He has dedicated much of his career diagnosing, addressing and alleviating the depression and anxiety of persons nearing the end of life. His methodology extends far beyond the usual assessment questions to draw forth from patients a rich narrative able to reinforce the meaning and value in each one's life. It furthermore provides an opportunity for the person facing death to have a mechanism through which to share his or her story with loved ones, thus extending dignity to others.
This short but compelling book builds upon Chochinov's broad academic and clinical experience. In it, he defines dignity as "worthy of honor, respect, and esteem." Chochinov sets a tone of sincere affirmation for and attention to each dignity therapy participant. Similar to many of the tenets of the Supportive Care Coalition (in which CHA and many of its members actively participate), the author emphasizes the importance of the here and now in the lives of those facing death. More traditional Catholic theology called this disposition "the sacrament of the present moment." Noting that contemporary studies in the Netherlands reveal that many persons requesting physician-assisted suicide are more likely to be depressed, report less social support and experience serious discomfort than do other end-of-life patients, Chochinov's methodology addresses the first two of these concerns. He intentionally provides an opportunity for the patient to talk about the whole of his or her life and to provide a testimony of that life for loved ones to treasure after the patient's death.
Chochinov's preface to the book witnesses to his deep appreciation for the role of narrative in each life and to the power that narrative has for the living. He brings the reader back to the book of Genesis (chapters 48-50) to the death of the third patriarch, Jacob. The great patriarch summoned all of his children to his side, used his final days to bless them and to express his deepest wishes to them. As is true with almost every family, Jacob's clan evidenced sibling rivalry, tensions and its share of relationship mistakes. Nonetheless, Genesis tells us that the patriarch blessed every one with the blessing appropriate to him. Building upon this theme, Chochinov weaves narratives in the form of verbatims throughout the entire text of this book, illustrating his ideas practically and often poignantly.
Dignity therapy itself is part of a larger methodology about which the author has written in numerous articles. The therapist works with the dying person to assist him or her to reflect upon the whole of life, recognizing that the illness the patient now faces is but one part.
Certain pivotal questions addressed to the patient guide this process. Chochinov's chapters abound with important questions for the patient. Some examples are: "Tell me about your life history, especially the parts that you either remember most or think are most important;" "When did you feel most alive?" "What are particular things that you feel need to be said to your loved ones?" "What are your hopes and dreams for your loved ones?"
Always sensitive to the patient's diminished physical and emotional condition, the therapist insures that throughout the process, the patient can freely stop or pause. Interviews are audiotaped with the therapist transcribing and editing them so that the patient has a mutually agreed-upon document to share with loved ones — a gift and blessing, similar to those of the patriarch, Jacob.
In one sense, this method applies most appropriately to the work of mental health professionals, physicians, psychologists, licensed clinical social workers and hospice counselors. But other health care professionals who minister to dying persons and their families would benefit from reading this text as well. Applying its principles acknowledge and ensure the dignity due to each and every patient and family in need.
Dignity Therapy is a concise book and an easy read, and it also is an excellent resource for further study and reflection. It contains references at the end of each chapter, verbatims to illustrate the author's theses and a comprehensive index. Those hospitals, long-term care facilities and health care systems engaged in the Supportive Care Coalition, palliative or hospice care would do well to have this text in their reference library. Because Catholic health care commits itself to be what the Directives call a "community of healing," our patient care encompasses not only treatment of disease, but embraces physical, social and spiritual dimensions of the human person. Dignity Therapy is a tool to ably assist in offering holistic care to persons facing life-limiting illness.
SR. PATRICIA TALONE, RSM, is vice president, mission services, Catholic Health Association, St. Louis
FROM DIGNITY THERAPY:
FINAL WORDS FOR FINAL DAYS
Although the patient may often ask,"What should I do?" the underlying and more profound question is, "Who am I? In the absence of finding and answer, they might conclude that they are a mere shadow of their former self, the living dead, an inanimate object, or that they are just taking up space. This in essence, is the mindset of patients who feel themselves a burden to others.