What are the dignity therapy questions?

Where the questions come from

In the early 2000s, Harvey Chochinov, a psychiatrist at the University of Manitoba, set out to learn what dignity actually means to people who are dying. Not as a word on a brochure — as something that could be protected. Out of that work came dignity therapy: a single guided conversation, built around nine plain questions, recorded, transcribed, and edited into a document the person keeps or leaves behind. The protocol calls this a generativity document. A family would call it the story, finally written down.

In the first study of the practice, published in 2005, 100 terminally ill patients in Canada and Australia sat for it. 91% said they were satisfied with the experience, and 81% said the document had already helped their family or would. Those numbers are why the practice spread through palliative care worldwide — and they are worth sitting with, because nothing in the nine questions requires a hospital or a therapist. They require a person with a life, and someone who wants to hear about it.

The nine questions

The dignity therapy question protocol, as published in its randomized trial — wording as written, punctuation lightly smoothed for reading:

1. “Tell me a little about your life history; particularly the parts that you either remember most or think are the most important. When did you feel most alive?”
2. “Are there specific things that you would want your family to know about you, and are there particular things you would want them to remember?”
3. “What are the most important roles you have played in life — family roles, vocational roles, community-service roles? Why were they so important to you, and what do you think you accomplished in those roles?”
4. “What are your most important accomplishments, and what do you feel most proud of?”
5. “Are there particular things that you feel still need to be said to your loved ones, or things that you would want to take the time to say once again?”
6. “What are your hopes and dreams for your loved ones?”
7. “What have you learned about life that you would want to pass along to others? What advice or words of guidance would you wish to pass along?”
8. “Are there words or perhaps even instructions that you would like to offer your family, to help prepare them for the future?”
9. “In creating this permanent record, are there other things that you would like included?”

Read them again and notice what isn’t there. Not one question is about illness, and none of them face forward into what’s coming. Every question faces backward and inward — roles, pride, the thing still unsaid. That’s the design: the protocol treats a person as the leading expert on their own life, and the interview simply gets the testimony down.

What the research found

In 2011, Chochinov’s team published a randomized controlled trial in The Lancet Oncology — 326 patients across Canada, the United States, and Australia, comparing dignity therapy against two other kinds of care. The honest result first: on the trial’s primary measure, reducing distress, dignity therapy did no better than the alternatives, largely because most patients weren’t in high distress to begin with. Where it separated was the experience itself. Patients who received it were significantly more likely to say it had helped them, improved their quality of life, and increased their sense of dignity — and that it had changed how their family saw and appreciated them, with help that would keep arriving after they were gone.

That split is the finding. Dignity therapy isn’t medicine for despair. It’s a structured way to make the telling happen, and the telling itself is what does the good — for the person answering now, and for the family holding the answers later. What a life story keeps is our longer case for that second half: the document outlasts the conversation.

Five questions for a kitchen table

Nine questions is a protocol, and nobody’s family needs a protocol. If you’re not a therapist and the person across the table isn’t a patient — just a mother, a grandfather, a friend getting older — here are five of the nine, worn smooth for ordinary use:

1. When did you feel most alive? (question one)
2. What do you want us to know about you that we’ve never asked? (question two)
3. What are you proudest of? (question four)
4. What still needs to be said? (question five)
5. What have you learned that you want passed on? (question seven)

Ask one, not all five. The protocol was built for a single structured session with a therapist keeping time; a family gets afternoons, which are better. One question can carry a whole visit, and the fifth question asked on the fifth visit lands differently than it would have on the first.

How to ask them

Out loud, and recorded — a phone on the table is enough. The answers will be voice-shaped: half of what they’re worth lives in the pauses and the laugh before the good part, and no transcript keeps those. Ask late in a visit, after the easy stories have warmed the room. Let the answers wander, because the wandering is usually the story. And when the telling contradicts the family’s official version, write down their version anyway — the disagreement belongs in the record; it is not an error in it.

The fuller craft — how to start, what to ask about an ordinary Tuesday, why fragments beat an archive — is in how do you write a life story while the person is still here. The questions above are only the doorway. What should carry weight is who built them and what held up: a protocol written by people who spend their working lives beside the dying, tested in controlled trials, and found to work not by treating anything, but by making the telling happen. You don’t need the diagnosis to borrow the tool. You need the person, while they’re here.