Canadian study on the effectiveness of dignity therapy
Anna suffers from an immune reaction that causes the loss of her epidermis. The pain in her hands, feet, and mucous membranes is severe. It is certain that Anna will soon die. When the woman — once an enthusiastic physical education teacher with a different name — is admitted to the palliative care unit, emaciated and in great pain, everything revolves around her suffering. She is no longer perceived as a person.
Dr. Sascha Weber accompanies Anna. The senior physician in psychiatry and psychotherapy at University Hospital Aachen volunteers for the German Society for Patient Dignity, which promotes the concept of dignity therapy. As a founding and board member of the association, he has been working for more than eleven years on the existential suffering that occurs at the end of life.
The “Conspiracy of Silence”
Everyone wishes for a dignified death. Yet when death approaches, we tend to reduce the person to “the dying” or “the patient.” Added to this is what Weber calls the “conspiracy of silence.” It takes hold when family, friends, caregivers, and physicians no longer find words — speaking about the dying person, but no longer with them.
A Canadian approach aims to help patients and relatives better cope with the approaching end: the dignity therapy developed by Professor Harvey Chochinov. Through a structured conversation and its subsequent written transcription, the therapy seeks to preserve and strengthen the dying person’s sense of dignity. The transcribed text from the interview is then given to the bereaved.
Dignity Therapy: Recognizing Coexistence
The core of dignity therapy is a questionnaire available on the association’s website. Using 14 possible questions, memories at the end of life are explored and personal strengths are reinforced. For Dr. Weber, even the very first question opens the door to a deep conversation: “Tell me a little about your life — moments that stand out most vividly in your memory or that were most important to you.”
People often recall milestones such as their wedding or the birth and upbringing of their children. The interviewer records the responses and later transcribes them into a written text. The conversation is deepened with follow-up questions such as: “Is there something special you would like your family to know or remember about you?” and what makes you most proud?”
According to Weber, especially the last question helps make coexistence visible and tangible. From Anna, the patient mentioned earlier, he learned how much she had loved dancing with her husband. “We were able to relieve her pain with medication and make that wish come true,” the doctor recalls. In the hospital corridor, the woman was able to dance with her husband one last time.
Pushing Back the Wish to Die
Later, she said that up to that point, everyone had only talked about her skin — but now, for the first time in a long while, she felt seen as a person again. According to Weber, that reduced her wish to die and strengthened her resilience. Through such experiences, people can realize that there is an “and also”: I am ill, and also the sum of my life experiences and emotions.
“It’s about changing one’s attitude and perception,” says Weber — especially when the dying can leave something meaningful behind. The answers from the interview capture not only their stories but also their hopes and wishes for loved ones, and anything left unsaid that still needs to be shared.
Canadian Study on Dignity Therapy
That dignity therapy works is shown by an initial clinical study from Canada*. 91% of patients were satisfied with the therapy, 86% found it helpful, and 76% experienced an increased sense of dignity. Relatives also found the therapy helpful (95%) and said they would recommend it (95%). For 78%, the booklet provided was helpful in coping with grief or offered comfort (77%).
*McClement, S., Chochinov, H.M., Hack, T., Hassard, T., Kristjanson, L.J. & Harlos, M. (2007). Dignity Therapy: Family Member Perspectives. Journal of Palliative Medicine, 10(5), 1076–1082.
