Every modern healthcare system claims to protect it. Professional codes of ethics invoke it, human rights frameworks enshrine it, and hospital mission statements celebrate it. Yet according to a new opinion article published in PLOS Aging and Health, one of the most universally endorsed values in medicine—dignity—is almost never measured. Writing in the journal’s inaugural volume, Lorenzo Righi, a nurse researcher responsible for monitoring nursing outcomes at Azienda USL Toscana Sud Est and the University of Siena, argues that this omission has become indefensible at a moment when ageing populations and rising chronic disease are transforming what healthcare actually means. His proposal is deceptively simple: dignity should be treated as a patient-reported outcome, tracked and evaluated with the same seriousness as pain, quality of life, or satisfaction with care.
The demographic backdrop gives the argument its urgency. Europe is undergoing an unprecedented transition, with longer life expectancy and a growing prevalence of chronic conditions reshaping health systems from the ground up. People increasingly live for decades with illnesses such as diabetes, heart failure, chronic obstructive pulmonary disease, and dementia, moving repeatedly between primary care, specialist clinics, hospitals, rehabilitation facilities, home care, and long-term residential settings. Each of these services may deliver technically competent interventions, but the overall experience is often fragmented. Righi contends that repeated transitions, limited continuity, and insufficient attention to personal goals and values can gradually erode a patient’s sense of dignity—and that this erosion is currently invisible to the quality indicators systems routinely collect.
The intellectual foundations for measuring dignity are far stronger than most policymakers realise. The philosopher Lennart Nordenfelt distinguished between an intrinsic and universal dimension of dignity, inherent to every human being, and contingent dimensions that illness, dependency, stigma, or social vulnerability can threaten. Building on that framework, Harvey Max Chochinov and colleagues in Canada demonstrated through empirical research that dignity is not merely an abstract ethical principle but a clinically relevant phenomenon, closely associated with suffering, psychological well-being, and the overall experience of care. Their landmark studies in terminally ill patients showed that dignity-related distress could be identified, characterised, and addressed, giving the concept tangible implications for health outcomes and quality of life rather than leaving it in the realm of rhetoric.
What has changed most significantly in recent years is the recognition that dignity is not an end-of-life concern alone. Studies involving people living with chronic diseases have shown that dignity may be affected by loss of autonomy, functional decline, social isolation, uncertainty about the future, and shifts in personal identity that accompany long-term illness. For many individuals, dignity shapes how they interpret their illness, how they engage with healthcare professionals, and how they evaluate the care they receive. This finding challenges the traditional assumption that dignity matters mainly in hospices and palliative wards. Instead, it supports treating dignity as a central dimension of living with disease across the entire trajectory of chronic illness, from first diagnosis through years of monitoring, treatment, and adaptation.
The measurement gap is particularly striking given the sophistication of contemporary outcome assessment. Healthcare systems across Europe and beyond increasingly collect Patient-Reported Outcome Measures, known as PROMs, and Patient-Reported Experience Measures, known as PREMs, to evaluate clinical results, care experiences, and value generation. Yet the dimension that patients themselves most consistently identify as fundamental to their well-being is rarely assessed systematically. Within the framework of person-centred care and Value-Based Healthcare—the movement that seeks to tie spending to outcomes that genuinely matter to patients—Righi argues that this omission is becoming increasingly difficult to justify. A system can quantify symptom burden, readmission rates, and satisfaction scores while remaining blind to whether patients feel their sense of self, autonomy, and personal worth has been respected.
The tools to close this gap already exist. The Patient Dignity Inventory, developed by Chochinov’s team, has demonstrated that dignity can be assessed reliably and meaningfully, capturing dignity-related distress across multiple domains. Subsequent research has supported the instrument’s applicability beyond palliative care, including among individuals living with chronic illness, with studies confirming its factorial structure in non-end-of-life populations. Righi is careful to note that measuring dignity does not reduce this complex construct to a bare numerical score. Rather, systematic assessment provides a structured means of identifying unmet needs, evaluating interventions, and understanding whether healthcare systems are achieving one of their most fundamental objectives. In this sense, a dignity metric functions less like a laboratory value and more like a diagnostic lens on the relational and organisational quality of care.
Dignity may also prove to be a distinctly nursing-sensitive outcome. Nurses maintain some of the most continuous and sustained relationships with older adults and people living with chronic conditions, often across years of home visits, ward shifts, and care coordination. Through therapeutic communication, emotional support, promotion of autonomy, and relationship-based care, nursing practice can substantially influence how patients experience dignity in everyday encounters. Evaluations of structured interventions such as the Dignity Care Pathway for community nurses suggest that dignity-focused practice can be operationalised and assessed. Incorporating dignity into nursing outcomes research, Righi argues, would open new opportunities to evaluate interventions, organisational models, and care pathways aimed at improving person-centred care—turning a value that currently depends on individual professional commitment into a systematic organisational priority.
Recent scholarship has broadened the concept further, linking dignity to human rights, participation, social inclusion, relational care, and epistemic justice. These perspectives suggest that dignity is not simply about treating people politely; it involves recognising patients as persons whose values, preferences, identities, and goals remain central throughout the course of illness. This framing matters for ageing societies in particular. Dignity, the article stresses, is relevant not only in the context of frailty or care dependency but as a fundamental dimension of the ageing process itself, influencing how individuals experience autonomy, identity, participation, and social inclusion throughout later life. Recognising dignity in ageing means acknowledging older persons not merely as recipients of care but as individuals whose life projects remain meaningful across the entire life course.
The structural challenge, however, is that dignity preservation currently depends more on the goodwill of individual professionals than on systems designed to support it. Across Europe, substantial differences remain in how health and social care services are organised and integrated, and fragmentation between acute care, community services, and long-term care continues to be a major challenge in many countries despite a shared rhetorical commitment to person-centred care. When care pathways fracture, dignity erodes in the gaps between services—no single provider feels responsible, and no dashboard records the damage. Righi’s central question cuts to the heart of this paradox: if dignity is widely recognised as a fundamental goal of healthcare, why is it so rarely measured as an outcome? The answer, he suggests, lies less in technical difficulty than in the absence of accountability structures that would make dignity visible to managers, commissioners, and clinicians alike.
The next step, the article concludes, is to transform dignity from a universally endorsed principle into a measurable and actionable outcome. Within Value-Based Healthcare, dignity offers a rare opportunity to connect ethical values, patient experience, and quantifiable results in a single framework, bridging the gap between rhetorical commitments to person-centred care and meaningful accountability for what truly matters to patients. Adding dignity to outcome assessment would not merely create another indicator; it would make visible one of the most fundamental purposes of care itself—recognising individuals as persons whose values, identities, preferences, and goals remain central despite illness, dependency, and vulnerability. For ageing European societies, and for health systems everywhere confronting the chronic disease era, the argument lands with force: only by integrating dignity into routine measurement can healthcare move closer to care that combines clinical effectiveness, sustainability, and genuine respect for the human dimension of growing old and living ill.
Subject of Research: Measuring dignity as a patient-reported outcome in chronic illness, ageing, and long-term care
Article Title: The missing metric: Why dignity must be measured in chronic illness and long-term care
Article References: Righi, L. (2026). The missing metric: Why dignity must be measured in chronic illness and long-term care. PLOS Aging and Health, 1(1), e0000022. https://doi.org/10.1371/journal.page.0000022
Image Credits: AI Generated
DOI: 10.1371/journal.page.0000022
Keywords: dignity, patient-reported outcomes, chronic illness, long-term care, ageing, person-centred care, nursing outcomes, Patient Dignity Inventory, Value-Based Healthcare, PROMs, healthcare quality, palliative care
News Source: Beatrice Stafford. (October 9, 2026). Dignity: The Missing Vital Sign in Chronic Illness and Ageing Care. Scienmag.
