Tuesday, July 15, 2014

Patient Dignity 04: "Patient Dignity," "Human Dignity," and "Patient Modesty"

 I prefer the term "Patient Dignity" or  "Human Dignity" over "Patient Modesty."
Modesty is defined as behavior, manner, or appearance intended to avoid impropriety or indecency.
Dignity is defined as a concept used in moral, ethical, legal, and political discussions to signify that a being has an innate right to be valued and receive ethical treatment.
Using the term "patient modesty" implies that the patient is asking for consideration that is exorbitant, burdensome, cumbersome, and unreasonable. Modesty is something that the healthcare system will hand out at their convenience after checking that your expectation level falls within normal parameters (set by the healthcare system).

Modesty implies more than your fair share. When we describe someone as being "modest" in their form of dress, it is implied that they are going beyond the norm. A modest skirt comes to the ankles when everyone else is wearing mini skirts. Just as in healthcare, an extreme clothing example would be the Muslim hijab.

The healthcare system justifies blaming the patient for modesty issues. "What is wrong with you, why are you not like everyone else who is normal?" This leads to the solution (you should) "just get over it." Modesty can be traded off for necessity.

Patient Modesty in respect to Patient Dignity justifies the patient's chosen level of modesty (needs) and requires the provider to meet those needs. Using the term "Patient Modesty," while technically correct, connotates something that may be deemed unreasonable.

Dignity is an innate right. By the fact that you are a human being, you carry with you human dignity with you. Dignity affords a certain level of ethical treatment defined by the outcome, NOT the input.

By that I mean that today the healthcare system has sheets for draping, curtains to block accidentally open doors, and same gender providers (the input).  The healthcare system uses drapes, curtains, and same gender providers where feasible and when available (the output).

The Hierarchy of Dignity in reference to the healthcare system.

  • Human Rights ==> Are "commonly understood as inalienable fundamental rights to which a person is inherently entitled simply because she or he is a human being."[2] Human rights are thus conceived as universal (applicable everywhere) and egalitarian (the same for everyone).
  • Dignity ==> The innate right to be valued and receive ethical treatment.
  • Human Dignity ==> The ethical treatment of human beings. Human Dignity is a subset (specific type) of Dignity, AND a specific Human Right.
  • Patient Dignity ==> The ethical treatment of human (medical) patients. Patient Dignity is a subset (aspect) of Human Dignity.
  • Patient Modesty ==> The right to ethical treatment of the patient to determine the parameters (usually dealing with body exposure) that they are comfortable with. The parameters of exposure can include level of exposure, gender of those exposed to, when exposure is necessary. Patient Modesty is a subset (aspect) of Patient Dignity. 
  • Gender Preference ==> The preference of the gender of the provider. Gender Preference is a subset (aspect) of Patient Modesty. 

Self-Determination is a Human Right, defined as the process by which a person controls their own life.
Human Dignity allows for there being different levels of trust. Self-Determination allows the individual to assign levels of trust. A person, group of people, organization, etc. can raise or lower the level of trust a person has in them. (Businesses call it advertising.)

Patient Dignity is no different. An individual patient may place a higher level of trust in a provider, thus increasing the comfort level and reducing the requirements for patient modesty. A good provider, that builds a relationship with a patient builds trust and may lower the patients needs of modesty.

A provider like New York Presbyterian Hospital reduces trust (as in the 2003 forced rectal exam of Brian Persaud), thus patients may require higher levels of patient modesty from NYP.

Negotiations are allowed. Coercion is NOT allowed.
Coercion is defined as the to use force or intimidation to gain compliance.
Coercion is contrary to Self-Determination because the individual is not making choices freely and without duress.

Coercion would be: I will drop you as a patient because you are not complying with me by fact that I am the doctor. To do that, it will cost some large, arbitrary amount. You know catheters come in sizes from small to "fist." So by refusing a DRE, you are refusing all care, so I will let you die.

Negotiation would be: Let's first talk about your expectations... There is an alternative procedure, but your insurance only covers it as out-of-network.  There is an alternative procedure, but  the outcomes are not as good. To have all male providers, we have to schedule that 3 months from now, I can do it in office today, but my nurse is female.

There is a fine line between coercion and negotiation. It comes down to the factual accounting of the penalties or rewards between the choices. If to provide for a all male procedure, a male provider  (nurse) for the procedures is brought in from the outside, the all male procedure is subject to the schedule (comes in once a month) of the "outside" male provider, and the all male procedure schedule is booked 3 months out: negotiation.

If the difference between the penalties and rewards is arbitrary (and sometimes exorbitant), it is coercion. You don't want to do this today with a female, then you have to wait 6 months. (Thinking: the schedule isn't full, but the time frame in long enough and inconvenient enough to FORCE you to comply with my wishes.)

So where are we left? "Patient Modesty" and "Patient Dignity" are technically the same, and interchangeable. As I stated, I prefer "Patient Dignity."

Which do you prefer? Please comment.

Thank you,


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