Personal or emotional dignity is tied to a person’s sense of feeling worthy, esteemed, and respected. This sense of dignity is subjective, varying from person to person, and is influenced by various factors, including interpersonal relations, culture, values, social customs, and religious beliefs (Autiero, 2020; Badcott, 2003). Psychological theories can provide insight into why maintaining dignity at the end of life is essential for well-being and how these values can enhance end-of-life care.

When using terms like “dignified death,” “death with dignity,” “dying with dignity,” or “dignity in dying,” we refer to personal dignity as individuals approach the end of life. This experience is shaped by the individual’s perception of a “good death,” in which they feel respected, autonomous, and connected to those around them, which is essential to the concept of “dying well” (Guo & Jacelin, 2014).

The following theories provide more information on how we can understand the dying process.

1. Impact of Illness on Cognitive and Physical Abilities
   Dignity often depends on the ability to maintain autonomy and self-competence, even as illness may diminish cognitive and physical abilities. Self-Determination Theory (SDT) emphasizes the importance of autonomy, competence, and relatedness in psychological well-being, highlighting that even at the end of life, individuals need to feel in control and capable within their circumstances (Deci & Ryan, 2000). In hospice and palliative care, providers foster autonomy by involving patients in their care decisions, allowing them to retain a sense of control over their journey. This autonomy, even in the face of illness, enables individuals to maintain dignity, as they remain active participants in their care.
2. Sense of Autonomy and Self-Determination
   Autonomy is central to dignity at the end of life. According to Erikson’s Psychosocial Development Theory, the final stage of psychosocial development—integrity vs. despair—emphasizes the importance of life reflection and acceptance (Erikson, 1982). When individuals can make end-of-life decisions that align with their values and wishes, they experience integrity, which helps reduce despair. Hospice care and, where available, Medical Aid in Dying (MAiD) support individuals in this final life stage, giving them the opportunity to end life on terms that reinforce dignity, fulfillment, and self-acceptance.
3. Being Treated with Respect and Understanding
   For dignity to be maintained, caregivers must provide respect and understanding. The Dual Process Model of Coping with Bereavement by Stroebe and Schut (1999) shows that both patients and their families may oscillate between managing grief and maintaining everyday roles as they approach end-of-life. Caregivers support dignity by respecting the patient’s identity and wishes, allowing the patient to feel understood. Respect from caregivers is crucial in enabling patients to feel emotionally intact, preserving their dignity through compassionate and attentive end-of-life care.
4. Ability to Participate in Meaningful Activities
   Participating in meaningful activities that foster a sense of purpose can further enhance dignity. Terror Management Theory (TMT) posits that confronting mortality can create existential anxiety; however, engaging in activities that bring joy and meaning, such as sharing memories or legacy projects, can mitigate this anxiety (Greenberg et al., 1990). Hospice and palliative care settings that encourage patients to find fulfillment in their final days help them achieve a dignified death, one where existential concerns are lessened, and life’s meaningful aspects are honored.
5. Caregiver Role in Dignified Death
   Caregivers, both family and medical professionals, play a vital role in supporting a dignified death. Although caregivers may have personal definitions of “dying with dignity,” dignity in dying requires prioritizing the wishes of the dying individual. Continuing Bonds Theory by Klass et al. (1996) suggests that relationships and emotional connections continue beyond physical death, meaning caregivers who honor the patient’s end-of-life decisions contribute to a lasting, dignified legacy. This respectful approach not only supports the dying individual’s sense of dignity but also offers solace and continuity for those grieving.

Additional References

Deci, E. L., & Ryan, R. M. (2000). The “what” and “why” of goal pursuits: Human needs and the self-determination of behavior. Psychological Inquiry, 11(4), 227–268.

Erikson, E. H. (1982). The life cycle completed. W.W. Norton.

Greenberg, J., Solomon, S., & Pyszczynski, T. (1986). The causes and consequences of a need for self-esteem: A terror management theory. In R. F. Baumeister (Ed.), Public self and private self (pp. 189–212). Springer.

Klass, D., Silverman, P. R., & Nickman, S. L. (Eds.). (1996). Continuing bonds: New understandings of grief. Taylor & Francis.

Stroebe, M., & Schut, H. (1999). The dual process model of coping with bereavement: Rationale and description. Death Studies, 23(3), 197–224.