Preserving Dignity and Epistemic Justice in Palliative Care for Patients with Serious Mental Health Problems

Dignity and preservation of dignity have emerged as a central and mandatory aim to pursue in all the areas of medicine, including palliative care. People with severe mental disorders (SMI) who are at the end of life pose further challenges because of the problem of stigma, which is intrinsically imbued in palliative care, as well as of other the variables including marginalization, alienation, and epistemic injustice typically associated with mental illness and psychiatry. A person-centred approach, which promotes a medicine of the person, for the person, by the person, and with the person, can increase the sense of personal dignity, as the other side of stigma, and epistemic justice for patients with SMI who are at the end of life. Dignity-oriented intervention, such as Dignity Therapy, can also be applied in palliative care settings for people with SMI with the aim to offer them an opportunity to reflect upon crucial existential and relational issues, to review aspects of their lives and of self, and to help in preparing a legacy of memories, words of love and wisdom with significant others.