Recaudación de los ingresos de derecho público

Dignity is the state of feeling important, honored or acknowledged.⁴⁹⁰ Despite the devotion and growing focus on dignity within the Islamic health policy and professional

codes of practice, dignity proves hard to transform into action when caring for a patient, particularly in geriatric care. Respect for the dignity of patients has to be balanced with respect for the practitioners’ self-respect. Several scholars indicate some of the common practices that contribute to the lack of integrity for patients. These cases include leaving patients in poor conditions, and pushing and handling patients in a rough and cruel manner that could result in pain. Indeed, elderly patients need a lot of attention, need to be seen regularly or talked to, so they can feel acknowledged. One of the basic human rights concepts is dignity;⁴⁹¹ it is the upholding of what is wanted by any individual regardless of their status.⁴⁹² Dignity for patients is an essential part of the care that has many years been declared as a fundamental concept in medicine. In a statement on the supporting of patients’ rights, the World Health Organization (WHO) asserts: “Patients have the right to be treated with dignity, which should be rendered with respect for their culture and values.”⁴⁹³ Nevertheless, research have been implemented to explain the description of dignity, yet it is still an intangible concept that is not well-defined.⁴⁹⁴’⁴⁹⁵ In the same way, the United Kingdom Health Department states, “There is no clarity about what dignity is and what minimum standards for dignity should be.”⁴⁹⁶

Also, research and articles have shown that preserving patient dignity in

healthcare is not satisfactorily maintained.⁴⁹⁷’⁴⁹⁸ According to Shultziner, human dignity plays the role of the highest value on which all human rights and responsibilities depend;

however, the meaning, content, and basics of human dignity are never clearly well-defined. Rather, their assertions of human dignity reflect a political agreement among groups that may well have quite different beliefs about the meaning of human dignity, its sources and what it involves.⁴⁹⁹ Human dignity sets out as a placeholder for whatever it is

about people that accredits them with fundamental human rights and self-determinations.

Additionally, advocating patients’ dignity and their rights in health care context has been the goal of the World Health Organization.⁵⁰⁰

Regardless of the fact that nothing particular influences dignity, there are some factors that have been submitted. According to the Royal College of Nursing, institutional culture, physical environment, and worker attitudes may also impinge dignity.⁵⁰¹

However, several studies promote this interpretation by demonstrating that maintenance of dignity in a healthcare context is affected by a mixture of factors.⁵⁰²’⁵⁰³ The academic and experimental works of dignity recommend a collection of theoretical relationships between dignity and other values as respect for autonomy, confidentiality, and self-sufficiency.⁵⁰⁴’⁵⁰⁵

Most research has found that the deterioration of dignity has emerged from the lack and from the change in clinical education.⁵⁰⁶ Currently, a tendency has emerged to reduce the cut on the burden of the health care provision based on individual human rights. Patients are concerned with making decisions on their health, unlike in the past when patients were isolated to suppress the rights of the few for the benefit of the larger population. Now this action is not morally acceptable in the Islamic States or across the globe. This isolation reflected a lack of dignity for patients suffering from various diseases; for instance, discrimination for patients infected with HIV/AIDS was prevalent worldwide; until the United Nations policy prevented isolating those patients. Similarly, the argument for committing a mercy killing still revolves on whether patients have the right to die when they feel they cannot fight anymore. Unlike in some parts of the

Western society, where patients might be given the opportunity to commit euthanasia, the

Islamic society believes that life is a sacred gift to humanity by God, and only He has the authority to take somebody’s life. Instead of letting patients die if they wish to die, Islamic ethics advocates that elderly care is about facilitating quality care and assisting the elderly to live longer through available resources and nursing care towards the aged.

The completeness or roundedness of integrity differs from mere personal self-sufficiency. While referring to the self in its wholeness, integrity also points beyond the self toward the person, the ideal, and the transcendent that gives identity to the individual life.⁵⁰⁷ Some physicians may be able to obscure this reality in polite conversation among themselves or with the general public. But on the receiving end, many elderly patients will paradoxically accept it and even actively collaborate with medical personnel in their mistreatment, because these patients share the underlying social norm that their worth is diminished since they are old and frail. For such elderly patients, demanding the right to die can serve as a final affirmation of their allegiance to the social ideal of youthful, vigorous activity both by actively choosing to die and by lifting the responsibilities of their dependency from others who seem to them intolerant of their reliance. The burdens of adequately caring for frail elderly people extend, of course, beyond directly

participating medical personnel.⁵⁰⁸ Evidence suggests that elderly disabled persons seek death not because they find their impairments unendurable, but because they are trapped in a dehumanizing social setting.⁵⁰⁹ What makes life unbearable for such people is not their impairments, but the social world that subjects them to physical confinement and denies them from even the decision-making power over their lives. Therefore, the

disabled older person’s misery is caused by the choices and policies of other persons. The person may seek death as the only alternative to living without basic dignity. In this view,

the ethical solution is not to allow or assist in the individual’s death, but to free the members of this minority group from the oppressive conditions under which they are forced to live by implementing policies that promote independent living.⁵¹⁰ Therefore, when cultural gaps between health care providers and families are deep, highlighted by language barriers and different experiences formed by social class, discussing the complicated modifications on the path from life to death will always become an intimidating challenge and even more difficult. Furthermore, the challenges are

horrendous when healthcare providers and the patient’s families have entirely different expectations and goals.⁵¹¹

From the 6^th century and the earliest country of Iran, the Cyrus Cylinder, which is a written declaration in the name of King Cyrus the great, is believed to present the oldest code of human rights.⁵¹² The writing states that all people must have autonomy of

thought and choice, and everyone should respect each other. Moreover, it stresses the need to respect human dignity. In 2002, Iran issued the first patients’ bill of rights, similar to the international descriptions but not precisely in agreement with Iranian culture. Even so, the statement indicates respect for individual dignity is located in all hospital areas.

Yet patients are not aware of the concept or its contents, and no facility is responsible to ensure that its precepts are being respected. Even though the studies of patients’ rights in Iran have been increased, and precedence has been set for any quantitative or other aspects, still no qualitative research has been devoted to patient dignity. Just lately, research has begun to form a code of ethics for the nurses in Iran.⁵¹³ In fact, an absence of respect for patient privacy was a frequent subject among elderly people in Iran. This matter covered two kinds: indecent body exposure and mixed-gender places. As reported

in a study presented by Ebrahimi, Torabizadeh, et al., based on elderly perception on dignity, having their body visible to others shows disrespect for their dignity.⁵¹⁴ For example, hospital gowns leave some parts of the body uncovered.⁵¹⁵ Therefore, elderly emphasized the avoidance of unnecessary undressing into an unsuitable outfit that renders their dignity in peril. Several further studies report that elderly people underlined that being uncovered in a hospital or a mixed-gender place, whether to a healthcare provider or a roommate, made them feel humiliated.⁵¹⁶ This fact verifies the outcomes of several studies that respecting privacy is critical in supporting patient dignity.⁵¹⁷’⁵¹⁸

Another issue that elderly people reported and referred to as damaging their dignity is the existence of the opposite sex, whether hospital employees, mates or guests.

Patients felt awkward when they were alone with patients of the opposite gender in the same room. According to the researchers of the study, approximately all elderly patients felt that their dignity had been dishonored while receiving care. ⁵¹⁹ Likewise, in many cases, other researchers have indicated that dignity is not being preserved yet.⁵²⁰’⁵²¹ Some researchers contend that culture has an important role in how dignity is interpreted and sustained.⁵²² In line with the finding of the Iranian study, researchers Matiti, Cotrel-Gibbons, and Teasdale articulate few important subjects that explain how patient dignity is influenced in healthcare settings. First, the unsuitable environment that referred to privacy-related issues, such as body exposure and the absence of private lavatory facilities.⁵²³ As a matter of fact, the importance of physical environment in the safeguarding of dignity has also been highlighted in other research findings.⁵²⁴’⁵²⁵ Moreover, extreme noise, deficiency of hygiene, and a shortage of amenities were also issues that relate to the physical environment. As per The Health Advisory Service 2000

in the UK, indicates that insufficient facilities and weaknesses in the physical

environment and personal hygiene are necessary aspects of providing a dignified care to patients.⁵²⁶

The other finding is related to the communication problems that make patients feel undignified. All participants in the Iranian study specified the importance of good speaking or gestural communication. The results of the research disclosed that only a few patients were pleased with their verbal or nonverbal communication with health care providers, such as education or instructions on care. Most of the participants stressed that ineffective communication had not been an intention, but the outcome of a heavy

workload on health care providers.⁵²⁷ In addition, some patients faced unsuccessful communication due to language and culture barriers. This kind of result is also evident in the work of Jacobs et al.,⁵²⁸ and Julliard et al.;⁵²⁹ in some cases, even the way the

healthcare team talked to the patients disturbed them. According to Marini, addressing patients without prior notice threatened their dignity.⁵³⁰ Furthermore, in addition to workload stress, institutional shortages, such as meager salary, hazardous workplaces, and inadequate accountability for support of the nurses and physicians were documented as some of the issues affecting the practice of patients’ rights.⁵³¹ As examples such as these show, patient dignity in healthcare settings is often devalued due to the lack of awareness and sensitivity about individual need. In addition, despite having a different culture, such as with the Iranian health care practice, patients still face problems that are similar to other countries. Nevertheless, more support and action are essential to increase the protection of patient dignity in the Islamic countries.

Research in Western countries has shown that preserving dignified patient care

involves safeguarding patients’ privacy and respecting their autonomy.⁵³²’⁵³³’⁵³⁴’⁵³⁵’⁵³⁶ Dignified care also includes the patients’ freedom to choose a treatment, telling patients the truth about their illness, emotional support, communicating with patients, maintaining their body image, and respecting their privacy.⁵³⁷’⁵³⁸’⁵³⁹ Respecting human rights and upholding dignity are also described as ethical goals of nursing care, regardless of patient’s race, age, gender, faith, illness, or political, social and economic position.⁵⁴⁰ Overall, dignity is an important individual need; patients have the right to be cared for with dignity, and health care providers are accountable for providing dignified care to patients. According to nursing literature, health care providers have an obligation to protect patient dignity, because the lack of respect for dignity can lead to worsening the patient’s health status. The benefits of protecting patient dignity are likely to include reducing patient stress, better confidence in medical practices, and fulfillment with health care environment; additionally, it could move on to better nursing care, reduced length of stay in hospitals, and improved patient outcomes. As a matter of fact, having regard for the patient’s need to be protected from the unnecessary gaze of others was one aspect of the maintenance of patient dignity mentioned by nurses.⁵⁴¹ Nurses view respect for autonomy, privacy, control, advocacy and time as components of patient dignity. The features that patients accredit to dignity include respect for autonomy, privacy, control, and choice of aspects of their care. Also, respect was shown to patients when they had their self-identity acknowledged, as well as their need for privacy and time. Privacy included saving the patient from the needless observation of others and preserving their confidentiality; for instance, avoiding others knowing that the patient had been

incontinent.⁵⁴²

Vulnerable elderly people such as those with a disability, those at the end of their lives, and those with dementia are experiencing a greater lack of participation.⁵⁴³ Elderly people do not always feel sufficiently involved in their care. They feel a lack of

involvement due to ageist attitudes, the behavior of workers, and an absence of

information, which often leads to inadequate and improper care for their needs. Treating the elderly, as individuals and involving them in their care are essential features of preserving dignity, even if the traditional customs delegate the authority of decision making to the family. Asking the elderly people how they would like to be addressed, what their needs and preferences are, and involving them in their care planning all

contribute to the sense of being valued. With permission from the patient, personal space, for instance, could be entered with no loss of dignity.⁵⁴⁴ The issue of individual hygiene can also infringe elderly people’s dignity. Studies show that this subject has tremendous possibilities for humiliation and suffering to elderly people when they are frail, and not able to do things as they used to.⁵⁴⁵ Moreover, limitations on care services can reduce individuals’ options and wishes about how to be cared for, where and by whom, consequently, damaging their dignity.⁵⁴⁶

4.2.2. The diminished principle of respect for autonomy and elderly health