Dignity as Wisdom at the End of Life: Sacrifice as Value Emerging from a Qualitative Analysis of Generativity Documents

Abstract

End of life and palliative care are viewed in chaplaincy as an important time when spiritual support is considered highly beneficial. Dignity therapy is an important care strategy in this field. This article lends support to the Chochinov protocol using Schwartz's matrix of values. Five dignity therapy Bgenerativity documents^prepared for terminally ill patients using interpretative phenomenological analysis were analyzed using qualitative thematic analysis. The results showed the role of values in the construction of wisdom and confirmed the importance of family relationships. The value of sacrifice, which is supported by various religious traditions, emerged as a perceived factor, indicating personal wisdom. The most significant result is the discovery of sacrifice as a positive value. Since hedonism, another of the values of Schwartz's matrix, is quite common in contemporary culture, it is important that those applying dignity therapy pay sufficient attention to the value of sacrifice, understanding that it could be recognized as a characteristic component of wisdom by those who are terminally ill. The implications, not only for end of life counseling but also for other fields and disciplines focusing on spiritual care, in particular for pastoral psychology, are significant.

The Sense of Dignity at the End of Life: Reflections on Lifetime Values through the Family Photo Album

“…In our study, all participants reported autobiographical themes of great depth and relevance, most of which were previously observed by Chochinov et al [ 6 ], namely, periods of passage, often marked by rituals (e.g., marriages, bereavement), life lessons learned, expressions of remorse, hope, and dreams, requests for forgiveness, challenges that have been overcome, declarations of love for family and friends, and personal development in the context of family life. The latter theme was prevalent in all the texts because most important relationships were experienced within this context, and it encapsulated the greatest number of values [ 30 , 50 , 51 ]. This result confirms the importance of expressing one’s values at the end of life.…”

“…A recent study on generativity documents highlighted the importance of individual values. In particular, it showed how the values that patients considered to be the most important during their lives served as fundamental pivots in their DT narratives [ 30 ]. Based on Schwartz’s intercultural model of values [ 31 , 32 ], which describes the principles guiding people’s behavior as desirable and trans-situational, this study considers dignity as a function of those values that participants cherished over the course of their lives.…”

Crafting Life Stories in Photocollage: An Online Creative Art-Based Intervention for Older Adults

“…Studies have shown how photographs facilitate recollection and allow for a better structuring of the narratives within the Dignity Therapy intervention [ 24 , 62 , 63 ]. Studies indicate how using photographs as therapeutic tools open up ways to recreate the life stories [ 64 ] and engage in the process of meaning making after loss [ 65 , 66 ].…”

“…Studies indicate how using photographs as therapeutic tools open up ways to recreate the life stories [ 64 ] and engage in the process of meaning making after loss [ 65 , 66 ]. The visual stimuli of the photographs can elicit themes that cannot be expressed by words alone, such as emotions, embodied expressions and muted or sensitive aspects of personal experience [ 62 , 63 ]. Moreover, the photographs, and the connections between them, can be presented in the photocollage as a visual generative document [ 24 ].…”

A Portuguese trial using dignity therapy for adults who have a life-threatening disease: Qualitative analysis of generativity documents

“…Although there are a large number of papers using quantitative methods to assess DT's efficacy, across several psychosocial outcomes, qualitative descriptions of themes emerging within generativity documents are still lacking (Goddard et al, 2013; Dose and Rhudy, 2018; Testoni et al, 2019). The latter provides opportunities to explore further and better understand the perspectives of people regarding their end-of-life experience (Johnston et al, 2015; Dose and Rhudy, 2018).…”