Human Dignity: Exploring the Implications of the Dying Patient Act in Home-Hospice Care

BACKGROUND: Human dignity is a vital value in democratic countries, forming the foundation for essential values such as autonomy, informed consent and appropriate clinician-patient relationships. The Israeli Dying Patient Act of 2005 aims to balance the sanctity of life and patient autonomy by standardizing medical care for dying patients. The law mandates that clinicians respect dying patients’ wishes and not artificially prolong their lives, providing palliative care administered by a multi-professional team. This study explores the implications for the human dignity of dying patients in home hospice care in Israel. RESEARCH METHODOLOGY: The study employs a qualitative approach, utilizing 17 semi-structured interviews with multi-professional team members working within a home hospice framework. The collected data was analyzed using a narrative analysis approach. RESULTS: The findings reveal a nuanced understanding of the challenges of implementing the human dignity value in the home hospice, based on the Dying Patient Act. The challenges include managing a care framework that is also the patient's home, dealing with the tension between patients’ wishes and those of their families, and managing patients’ changing wishes, such as when they initially wish to die at home but later ask to be taken to the hospital. CONCLUSIONS: Clinicians should be trained in end-of-life communication to respect patients’ wishes at the home hospice under the spirit of the Dying Patient Act. Patients and families should be partners in addressing these challenges. Human dignity is essential in providing quality care. This study offers insights for policymakers and clinicians to improve end-of-life care in the home hospice setting. KEY MESSAGES: • In the home hospice, human dignity plays a crucial role in delivering quality and ethical care, especially when dealing with the balance between the Inconsistent wishes of patients and families. • Clinicians should be trained in end-of-life communication to respect patients’ wishes, and patients and families should be partners in addressing the challenges to provide quality care.