Dignity Is the Core of the Decent Care Values Approach for Health Care

As Dr. Bruce Chernof from the SCAN Foundation wrote earlier this week (“Dignity-Driven Care as the Driver to Addressing Health Costs,” April 24, 2012), it is time for an innovative approach to health care that originates with assuring the dignity of every human being and carries that value to the entire context of the way in which patients receive and access care. Altarum Institute is exploring as a possible solution an approach called “Decent Care Values,” in which dignity and agency are the core individual level values.

Decent Care Values is an innovative, values-based model supporting transformation of health care at three levels: individual, social and systemic. The values bridge human rights principles with the practice of medicine. For the last few years, Altarum has been engaged in partnering with global palliative care providers to demonstrate the Decent Care Values through demonstration projects that explored the effect of Decent Care Values on actual palliative care services.

After releasing a request for funding to 150 global providers, Altarum and our international advisory committee selected palliative providers in Malaysia and Kenya to implement this values-based model and approach into their services. We supported the two grantees with technical assistance and evaluation guidance for more than a year, ending at the close of 2011. We will soon report the results of this trailblazing demonstration of Decent Care Values into practice.

The six Decent Care Values start with the foundational individual level values of dignity and agency. As Dr. Chernof suggests, dignity is the core principle that should focus all of us on the inherent value of each human being, and should inform and shape each person’s experience of the health care experience. Agency focuses on recognizing the unique needs that each individual has, and on the power—the agency—every individual should have to construct, direct and manage the care he or she receives (or elects not to receive) and especially on how he or she receives it. As the roots of decency, and of Decent Care Values, every patient’s dignity must be honored and every affected individual’s agency must be recognized.

Decent Care Values include four additional principles that address community social systems and larger societal resources. These values are interdependence and solidarity, and subsidiarity and sustainability.

Together, the six Decent Care Values address  Dr. Chernof’s concern that health care should not be viewed or managed in isolation from the wider network of people, organizations, and services that support patients, and must not ignore the confluence of issues and resource priorities in which health provider institutions exist. Instead, to be fully decent, health care should address all the concerns and desires, entities and issues that truly affect patient outcomes, inside and outside the health care service system itself.

Altarum funded and operated its Decent Care Values in a Palliative Care Demonstration Project in partnership with the World Health Organization and The Diana, Princess of Wales Memorial Fund. This global project was the first to explore the ideas of Decent Care Values in actual health care practice.

Results soon to be released show that remarkable changes can occur when these six Decent Care Values are applied in health care settings—even in settings that are resource poor and serve some of the most vulnerable populations in the world. The demonstration projects also showed remarkable changes within very different cultural, economic, religious and regional places—demonstrating the inherent and transferable meaning that values such as dignity have for people and families facing life-limiting illnesses. The demonstrations led to new approaches to care inside the participating palliative care organizations and to new relationships for them to the larger community and region in which they work.

The heart of the Decent Care Values approach comes from the universal Golden Rule known and loved by all: Do unto others as you would have them do unto you. Applying this axiom to the care of people facing life-threatening illness can assure that the care is decent, and that the dignity and agency of each and every person living with any illness, disability or disease is acknowledged, respected and valued.

Altarum Institute experts are ready to explore Decent Care Values with you and learn how to apply them to health care services in the U.S. and around the world. For more information about Decent Care Values, contract our project manager, Antigone Dempsey, MEd at antigone.dempsey@altarum.org.


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