Understanding the meaning of human dignity in Korea: a content analysis

Abstract

This study aims to understand the meaning of human dignity among adults in Korea. The authors utilized a qualitative study design. Data were collected with non-structured questions in a sample of 74 Korean adults and were then analyzed with qualitative content analysis. There were 4 categories, 31 themes and 106 theme clusters classified. The four categories that emerged were: fullness of dignity, loss of dignity, reinforcement of dignity, and enfeeblement of dignity. The results of this study may contribute to healthcare professionals’ understanding of Korean adults’ human dignity.

Recent advances in biotechnological health care promise to extend human life, but may impair human dignity. ‘The notion of “basic dignity” has been described as a universal moral quality that is internally held and inalienable from life itself’ (Chochinov, 2006 p92). Korean society is entering an era of self-loss in which the human character has changed because of the desire for material things. In Korea, new materialistic values appear in society first through scientific development and industrialization. The cry for the recovery of human dignity is gradually being heard in many parts of Korean society.

Human dignity is of substantial value in health care (Kim et al, 1991; Milton, 2008). Human dignity is highlighted as an essential value in nursing practice by the International Council of Nurses (ICN), which states that inherent in nursing is the respect for human rights, including cultural rights, and the right to be treated with dignity and respect (ICN, 2006). Yet this important aspect of care is challenged by the mechanization of medicine. Health care should focus on respect for the human being cared for (Jo, 2007; Lee and Kim, 2007), especially at the end of life. Nurses are responsible for fostering human dignity through their interactions with their patients and with other healthcare teams. From this point of view, a study of the human dignity at the essence of caring activities is timely, particularly during this period of rapid change in Korean society.

Literature review

Research on human dignity has often focused on palliative or end-of-life care situations (Johnson, 1998; Street and Kissanne, 2001; Chochinov et al, 2006; Pleschberger, 2007) and some research has focused on cross-cultural analysis of dignified dying (Doorenbos et al, 2006). Additionally, there is a literature on dignity and health (Jacobson, 2007) and on dignity for older adults (Anderberg et al, 2007). Research about human dignity in Korea, however, can be found only in philosophy, law and theology; nursing research on human dignity in Korea is lacking.

Literature in other sciences in Korea has contributed in great measure to basic knowledge about human dignity, but because most research related to human dignity has presented only quantified data (Na and Cha, 1999; Kim and Im, 2005; Kim et al, 2007), it has been difficult to determine the relationship between a person’s concept of human dignity and that person’s social and cultural background. In this study, the authors used a qualitative approach to explore the concepts that compose Korean adults’ experience of human dignity. The participants’ reflections on recognition of human dignity allowed for exploration of the diffusion of the concepts of human dignity which satisfy the needs of Korean society today. This research provides basic data in the form of subjective expressions by Korean adults which help them grasp the meaning of human dignity in Korea.

The aim of this study was to grasp how Korean adults experience and accept human dignity. The meaning and experience of human dignity in Korea is revealed through content analysis of participant statements about dignity.

Methodology

A qualitative exploratory descriptive design was employed. Qualitative descriptive research is useful for exploring little-understood phenomena and for investigating new areas or topics (Burns and Grove, 2001), and is frequently used in nursing science. This study employed content analysis using Koreans’ statements on dignity. The qualitative content analysis consisted of a bundle of techniques for systematic text analysis (Miles and Huberman, 1994). Content analysis was useful for this study because it is an unobtrusive method of analysis that can easily accommodate large amounts of data (Shuyler and Knight, 2003).

Sampling and setting

The study was performed in one district of Daegu, a city of 170 000 inhabitants in the south east of Korea. A convenience sampling approach was necessary to access the target population of Korean adults. A research assistant used the telephone directory to identify all listed numbers within the target district of Daegu. The Korean researcher called these phone numbers and asked the person who answered if there was an adult living in the house who would be interested in participating in this research study. During the phone call, the Korean researcher asked if the person would be willing to receive an email with the study questions. A total of 92 initial phone calls were made, and 74 adults gave oral consent to participate in this study. These 74 participants were adults with a mean age of 49 years (range 35–62 years). Of these, 48 participants were female and 26 were male.

Ethical considerations

In the initial telephone contact, the Korean researcher explained the goal of the study and sought participants’ verbal consent. The Korean researcher informed participants that the data collected would not be used for purposes other than research, and that anonymity was guaranteed. The Korean researcher then sent each participant, by email, a research participation consent form. The Korean researcher sent the research questionnaire by email after receiving verbal consent and a signed research participation consent form. Participants were remunerated for their research participation.

Data collection

Data were collected via questionnaires distributed to participants via email. Participants were asked to describe simply and concisely the meaning of the human dignity they felt. The participants stated their experiences following two open and unsystematic questions: ‘In what circumstances do you think of yourself as a dignified and valuable person?’ and ‘How do you recognize your own dignity?’ Participants were asked follow-up questions, such as: ‘What do I have to do if I want to live with dignity?’, ‘What factors prevent treating me with dignity?’

The participants purposely selected examples which reflected the research questions being investigated (Patton, 1990). The Korean researcher read and arranged the submitted data, and she contacted participants the next day through email to query the meaning of responses she did not understand. Data were collected during summer 2008; all data were then translated into English.

Data analysis

Content analysis was performed according to Miles and Huberman (1994). The researchers read the responses and looked for themes and patterns. Qualitative content analysis proceeded according to the following steps:

1. The researchers read the responses carefully to get the feeling from the data. The researchers extracted important statements from participants’ phrases, particularly from sentences that contained the words dignity and human value.

2. The researchers divided the statements into the important categories, themes and theme clusters and then conducted the explanatory integration for the same.

3. The researchers verified the face validity of the statements and the formed meaning through reviews by two content experts who had experience in qualitative research. The experts were asked to identify any further categories, themes or theme clusters.

4. The Korean researcher confirmed validity by contacting the research participants by telephone again to confirm that the results of the analytic process corresponded to the participant’s experiences.

The researchers independently reviewed the participant responses to define categories that spontaneously emerged from the data, then compared and contrasted all of the categories and agreed on a final list of four. The authors then went back to the raw data and independently coded each response based on the final categories: fullness of dignity, loss of dignity, reinforcement of dignity and enfeeblement of dignity. First, a coding scheme was developed using an inductive approach. Themes coded into the first category, fullness of dignity, were based on participants’ descriptions of recognizing their own dignity. Loss of dignity, the second category, was organized around how participants expressed their inability to feel themselves to be dignified. The third category, reinforcement of dignity, was based on how participants described the endeavor to realize the ideal of a beautiful life and their own humanity. Enfeeblement of dignity, the fourth category, includes content in which participants described incidents that obstructed personality development related to personal dignity. Second, ten participant responses were coded independently by both researchers, and intercoder reliability was calculated. For estimating intercoder reliability in qualitative content analysis between two researchers, a Cohen’s kappa value of .72 was regarded as satisfactory (Tabachnick and Fidell, 2001).

Findings

The content statements on dignity that appeared on the 74 research participant questionnaires were divided into four categories comprising 31 themes.

Fullness of dignity

The category of fullness of dignity comprised seven themes, expressed as introspection, rightness, satisfaction, confidence, patience, a sense of justice and transcendence. Participants expressed the experience of fullness of dignity in many ways:

‘The reason is that I am a human being’

‘Because a human being is both the best being on the earth and the lord of all creation’

‘Because I always think and plan how I should live a life’

‘Because one wants to get out of animal desire through self-reflection every day’

‘Because one has the ability to feel the profundity of the universe and enjoy oneself with sensitivity and intellect as a human being’

‘When feeling pride that I am a considerably good person after pursuing truth, goodness and beauty’

‘When feeling able to always recreate the newness in the relation’

‘The experience of a childbirth, gestating a life, was imprinted as human dignity in me’

‘When I am recognized as an essential man by other people’

‘When I can spread my ideal freely and develop it after finding my talent and desires’

‘I feel dignity when I become passionate and express my views boldly by resisting unrighteousness’

‘When I am pursuing righteousness in ethical, religious respects with correct judgment and insight’

‘Because one has the belief that one is God’s loved child’

‘Because I cannot be replaced with any other person and because I am a being to be loved by everybody’

‘Because I make an effort to live according to the sound of conscience’.

One’s fullness of dignity appeared as a positive aspect of human life, through reflective thought, pursuit of justice, and pride in a satisfactory and worthy life. Various factors, such as personal condition and social and cultural relations, affected participant statements on the fullness of human dignity. In particular, the participants were over 35 years old. The authors considered that the abundant life experiences and learning accumulated over a life were sufficient to draw out the bases of self-dignity in terms of individual, social and political recognition, and the formation of relationships and responsibility between family, friends and neighbours. The human dignity that appeared in the participants’ statements was fostered by free determination and reflection based on individual thoughts and actions.

Loss of dignity

The seven themes within the category of loss of dignity were: a sense of disparagement, commonness, wretchedness, a sense of betrayal, a feeling of helplessness, inferiority and a sense of deprivation. Theme clusters related to these themes:

‘When one gets a cold reception from other people, or when given irrational, unequal and forceful treatment in daily life’

‘When daily tasks need to be repeated every day in life, when I am considered to be trivial by myself’

‘When miserable because my mistakes are suddenly visible before God’

‘When treated as if one were a machine adjunct in a big organization’

‘When individuality is neglected for the majority’s profits, and one’s opinion is neither considered nor reflected’

‘When feeling manipulated by other people’

‘When being betrayed by a man’

‘When I feel myself falling down by getting angry excessively under an unrighteous situation’

‘When animal nature, antagonistic to reason, is expressed in myself’

‘By relative poverty and when feeling a sense of inferiority while watching TV’

‘When perceiving myself ignored in words or behaviour from other people’

‘When one is repeating wrong habits every day and cannot determine one’s own habits’.

Participants expressed loss of dignity as both personal and as an effect of social structure. The authors saw these two aspects acting interdependently, through self-devaluation owing to comparisons between other persons and oneself. It appeared that expressing negative emotions and abasing oneself conflicted with the duty of a human being to foster one’s abilities and preserve oneself. Social, structural, psychological and cultural factors affected the dynamic interaction of human relations, so the integrated causal viewpoint of social effects acting through the self-forming process was necessary for a full understanding of human dignity. The authors saw human adaptation and personality changes as based on the social system; individuals acted within the far-reaching network of social and structural effects.

Reinforcement of dignity

The nine themes in the category of reinforcement of dignity were consideration, respect, compassion, autonomy, modesty, harmony, differentiation, spontaneity and sociality. Participant statements that related to reinforcement of dignity are:

‘When considering others in the other person’s shoes, and loving myself and the family; namely, respect and love make me human’

‘I perceive that I am a man when I feel I have human qualities that can make mistakes, such as hatred, envy, jealousy, anger’

‘The courage that can say clearly that yes is yes and no is no makes me human’

‘When living a life sharing beyond one’s desire’

‘The mind not pretending not to see people miserable and in need’

‘When seeing oneself shed tears for another person’s pain’

‘The effort to have right thought and right behaviour’

‘The belief that I was created as God’s image and that there is good in me makes me human’

‘An incessant effort to improve oneself

‘To love and to be loved by being devoted to my role’.

The meaning of dignity was seen in ‘the process itself of making an effort to live a humane life’. For example, ‘I feel I have elegance as a man when looking for what I want and living a free life without regard to public attention’; ‘won’t the effort to live a better life after acknowledging the situation one is placed in and the meaning one lives be humane life?’

The participants expressed dignity by recognizing both human weaknesses within themselves and the importance of coexistence with others. Participants expressed positive human nature to be based on a person’s social being as organized in relations with other people. So, the participants perceived the practice of being human to be realized in links with other existences, with the assumption of self-consciousness and fullness of one’s true self. Both internal reflection on consideration, respect, compassion, autonomy, modesty, harmony, differentiation, spontaneity and sociality, appeared in participants’ statements.

Enfeeblement of dignity

The category of enfeeblement of dignity comprised eight themes: secularism, wealth/greed, hypocrisy, a guilty conscience, a sense being defeated through one’s inferiority, being busy, self-conceit and losses:

‘I come in contact with things, such as the increase of real estate prices, when thinking of a little happiness as being valuable’

‘At a time like this, the virtues I have seen as being valuable in a person are sometimes shaken’

‘The biggest disturbing factors are material and world ambitions for success’

‘When seeing myself tormented by busy daily life without a rest, I get to think of myself as good as an animal that eats, sleeps, and works’

‘The fault to degrade myself according to others’ responses and attitudes toward me’

‘When seeing my weaknesses, I try to cover then up’

‘When having the impression that I can’t do it, it is impossible, it is bothersome and arduous, I feel like giving it up’

‘When getting haughty because of a superiority complex that I am better than other people’

‘It takes a long time to transfer in the value of pain to dignity when an unexpected physical deficiency happens’.

Participants thought enfeeblement of dignity to result from a person’s focus on worldly factors, and to arise more from internal than external factors. For example, feeling oneself inferior could prevent one from perceiving a fact or event as others would. Thus, feeling inferior was recognized to be much more internal than external. In particular, the focus on object comparisons, worldly temptation and wealth/greed suggested that self-dignity can be impaired if evaluated by materialistic values. Korean society has been showing a marked trend toward expansion of materialistic values, including understanding and evaluating human character and dignity.

Discussion

Effects of self-dignity in Korean culture

The concept of fullness of dignity revealed in this analysis is expressed positively in most participants’ responses, according to each participant’s life experience or values. Participants’ attitude for self-dignity is thought to result from individual factors. This attitude is marked by positive and bright affectivity, leading us to understand human dignity as related to the pursuit of happiness. The relationships with family and neighbourhood is thought to affect self-dignity through a feeling of well-being, because in Korean culture the net of intimate social relations is connected closely with personal life (Hahn, 2006).

In relation to the categories of loss of dignity and enfeeblement of dignity, customs of Confucianism in Korea regard self-denial as a virtue. Social activities related to these customs seem to act as factors to cause conflict between quality of personal life and adaptation to society. A Korean social norm that collective culture is predominant seems to result in other persons’ evaluations having a big effect on personal value and self-dignity (Chang, 2004). In particular, because of the Korean social norm toward collective culture and high tendency to compare one’s situation with that of another, self-value is likely to change according to social comparison. Hahn’s (2006) research also reported that the higher one’s tendency toward social comparison, the lower one’s subjective recognition of well-being.

Social comparison also has a negative effect on dignity, especially if the tendency to compare oneself with others is chronically high in society. On the other hand, some two-thirds of Korean college students preferred social comparison with students from the upper class to comparison with those of lower class (Hahn, 1999), which may imply that these students felt increased self-value when satisfying the motive of self-evaluation through upward comparison. But, as the participants of this research mentioned, forced social comparison can hurt one’s pride through experiences of impersonal treatment or negative valuation.

Participants stated that reinforcement of dignity can be found in interpersonal processes that acknowledge one’s weaknesses, and interpersonal processes that recognize one’s homogeneity and coexistence with others. That is, responses to stress-causing incidents and emotions in daily life are shown to affect self-dignity. The results from the reinforcement of dignity category are consistent with the positive affect theme expressed by the Korean participants in Hahn and Pyo’s (2002) research, often cited in Korea. People do not, however, judge an individual’s humanity solely with emotion terminology. So, to examine concretely the emotion terms expressed by Koreans, it is necessary to consider the social and cultural backgrounds at the foundation of Koreans’ emotion formation.

Population-sociological variables, personal course factors, interpersonal processes and Korea’s social and cultural factors affect participants’ recognition of their own dignity. To extend our understanding of Koreans’ distinctive recognition of human dignity, it is necessary to shed new light on Koreans’ consciousness of values, achievement, and emotional satisfaction.

Values

Korea’s societal values showed distinct changes between the 1970s and the 1990s. Generally, the more rapidly values change, the wider the generation gap. Na and Cha’s (1999) research showed a distinct increase in the generation gap regarding these items: making much of abundant life, making light of a sense of virtue, making light of the value of older adults and making much of individualism and related values. Current changes include increases in the social value of ability versus modesty. Most participants of this research were middle-aged; they display strongly the traditional social and collective consciousness. These adults will likely accept the changing values of the times more slowly than will younger Koreans. Erikson (1975) said that the most important developmental stage in the middle years is to get to the next stage, generativity. The goal of generativity is to spend the rest of one’s life wisely and happily. But challenging existing worldly values can lead to a crisis of estrangement, distrust and loss of self-dignity.

Koreans make much of values related to happiness, health and respect for life (Hahn, 2006). Happiness is a value for individuals and communities. We see, in participants’ statements, that human dignity based on the pursuit of happiness through forming positive connections with others; through a mental attitude that positions oneself properly through self-discipline, autonomy and frank expression; and through a sense of accomplishment through endeavours. The pursuit of happiness agrees with the concept of human dignity that participants described as a sense of accomplishment, being together, positive thought, consideration, autonomy, value, not being compared with other people, overcoming crises and sharing. The feeling of wellbeing is a changing thing and is based on individual recognition and feelings. Situational variables that reflect on individual character will also have an effect on forming a person’s values and human dignity. Therefore, it remains necessary to reaffirm the common and divergent points of Koreans’ detailed concepts of human dignity and happiness.

Achievement

Reinforcement of dignity appeared in research participants’ statements as modesty that acknowledges one’s weakness and as the interpersonal process factor that recognizes coexistence with others. This shows that self-value is formed in relations with others through small practices of sharing as well as through the results of one’s independent effort and sense of accomplishment. Koreans value these characters of life: ‘traditional paternalism’; ‘traditional communalism’; ‘individualism’; ‘cultural openness’; ‘materialistic life’; ‘social consciousness’; ‘ability and role system’; and ‘traditional rank consciousness’ (Whang and Yang, 2002). In particular, middle-aged Koreans perceive money as the greatest necessity for an abundant life (Na and Cha, 1999). This perception may result from direct connection with realistic situations, related to the life cycle, that tend to shake one’s small virtues. Participants recognized that land speculation, social structure factors and individual efforts toward economic affluence are factors that injure one’s dignity and humanity.

In one analysis of Koreans’ accomplishment consciousness (Park, 2000), Koreans recognized self-regulation, such as endeavor, intention and patience, as the core factor of achievement. Adults, as well as students, have a strong thirst for academic achievement. Because Koreans have faith that self-regulation is the most efficient method for accomplishment in studies or occupation, they make every effort to accomplish their goals. Koreans’ tendency to consider self-regulation as important is judged meaningful in psychological dynamics, such as in attribution style and in coping with stressful as well as achievement situations.

Korea has traditionally belonged to a Confucian cultural area. Confucianism emphasizes social harmony and mass goodness rather than individual creativity or rights (Chang, 2004). Also, attitudes of respect for older adults and for rank suggest a model for maintaining harmonious human relations in the group and for harmonious power transitions (Choi and Kim, 2000). This structural characteristic is vulnerable to criticism in regards to resource allocation. In international society, transparent system development is based on fair competition or ability to compete (Park, 2000). Also, the Confucian emphasis on group harmony is mainly applicable to members within an in-group; it excludes those in out-groups (Chang, 2004).

Emotional satisfaction

Emphasis on relationships leads Asians to experience emotional satisfaction in strong human relationships. In particular, Koreans’ emotional satisfaction is often induced by social evaluation, and their life satisfaction or feeling of well-being is affected by others’ recognition (Lee et al, 2005). The participants stated that others-centric emotions, resulting from competition, comparisons with other people and feelings of inferiority, were reasons for feeling the enfeeblement of dignity and loss of dignity. The participants also indicated loss of health as a factor that undermined self-dignity. These statements exemplify how Koreans specifically see interdependent emotion as a very important psychological factor. Chon (2000) demonstrated that individuals’ tendency to reduce and control the experience and expression of anger is a characteristic of collective culture. This tendency has appeared as a risk factor for cardiovascular disease.

Confucianism as an ideological matrix of collective culture gives more weight to the society than to the individual and emphasizes the recovery of sociality (human interdependence) and integrity (interests, consideration and devotion for other people) (Chang, 2004). Koreans see human relationships as based on morality and on considering the interests of other people and of society rather than one’s pursuit of profit. Kim and Im (2005) saw it as the moral norm, linked to moral personality, that a man in Korean culture should do activities suitable for one’s obligation as a man, which is to be of human character, to be humane. In particular, the expectations and obligations inherent in the parent–child relationship were seen as the standard for judging personal character or a humane life. This more or less reflects the character of Korean society, which emphasizes relationships and is affected by Confucian values. The participants of this research stated that reinforcement of dignity is through being humane, which means expressing the moral emotions of consideration and respect for others, pity and modesty, love and sociality. We can see that Koreans’ emotional satisfaction is based on relationship-centric morality, social harmony and the tendency to respond sensitively to social needs.

Koreans value the pursuit of happiness, which is described to include a feeling of wellbeing and fullness of self-dignity. Achievement consciousness appears as a result of Koreans’ diligence and self-regulation, and the idea of humane living is related to a sense of accomplishment and the reinforcement of self-dignity. Koreans’ emotional satisfaction is increased with relationship-centric harmony and self-evaluation through comparison. However, the fact that Koreans’ emotional satisfaction is centred on other people can intensify loss of dignity and enfeeblement of dignity. Understanding Korean culture’s relationship-oriented values are useful to support human dignity by healthcare providers carrying out palliative care in hospice.

Conclusion

From a Korean cultural viewpoint, human dignity is a contemporary social issue. This study recounted Korean adults’ experiences of human dignity. This will be of service to hospice nurses who aim to understand Koreans’ conduct when it differs from the nurses’ own cultural expectations, and to maintain Korean patients’ human dignity while providing end-of-life care. In particular, within the field of hospice nursing, developing compassionate and effective interventions, which are individually tailored and sensitive to a patient’s culture and notion of dignity, is a critical challenge. Knowing how to provide dignity-conserving care requires insight into the holistic experience. These insights will provide the foundation for novel and compassionate approaches intended to support dignified dying.