Emergency department overcrowding as a threat to patient dignity.

mergency department (ED) overcrowding is the subject of intense study to evaluate its causes and consequences. However, although implied, there is little mention of the threat that overcrowding poses to patient dignity. This threat is intuitively obvious to health care providers and patients in the ED, yet it is elusive to prove, as there is neither a universally accepted definition of dignity nor a method to measure it. We must, therefore , look to areas such as palliative care, practice guidelines and human rights to help define and quantify the impact of overcrowding on patient dignity. Dignity is a cornerstone of humanity, and as physicians we have a moral obligation to our patients, colleagues and ourselves to preserve and promote it. Patient dignity may represent a new area of research in ED overcrowding and greater awareness could improve patient care and satisfaction. More importantly, overcrowding as a threat to patient dignity could be a powerful motivator to engage others beyond the ED to respond to this crisis. The Oxford Dictionary defines dignity as the " state of being worthy of honour and respect. " 1 In the classical sense, dignity is attributed to an individual as a result of distinction or excellence; whereas in Judeo-Christian tradition, all humans have inherent dignity because they are " made in the image of God. " Kant argued a similar inherent worth based simply on our capacity for rational autonomy. 2 Following World War II, dignity gained prominence as a fundamental principle in numerous national constitutions and international declarations, most notably the Universal Declaration of Human Rights. 3 Despite its central role in these documents and in society, definitions vary depending on the " cultural and subcultural contexts, " 4 of which only the Western tradition will be discussed in this article. Dignity figures prominently in many professional codes of ethics, yet there is little practical guidance for the practitioner. 5 Concept analyses suggest that dignity with care contains the values of " autonomy, truth, justice, and responsibility to human rights, " 6 and is demonstrated by " attentiveness, awareness, personal respect, engagement, fraternity and an active defense of the patient. " 7 One article from the emergency medicine literature defined dignity's attributes as respect, autonomy, empowerment and communication. 8 Unfortunately, these attributes suffer the same ephemeral status as the term they attempt to define. The purpose of this article is not to enter …