Revisiting respect for persons: conceptual analysis and implications for clinical practice

Abstract

In everyday conversations, professional codes, policy debates, and academic literature, the concept of respect is referred to frequently. Bioethical arguments in recent decades equate the idea of respect for persons with individuals who are capable of autonomous decision-making, with the focus being explicitly on ‘autonomy,’ ‘capacity,’ or ‘capability.’ In much of bioethics literature, respect for persons is replaced by respect for autonomy. Though the unconditional respect for persons and their autonomy (irrespective of actual decision-making capacity) is established in Kantian bioethics, current argument and debates often revolve around a thin concept of autonomy, focusing on capacity and capability: persons are owed respect because they are ‘rational beings’ or with a focus on ‘agency’ and ‘decision-making abilities.’ However, these aspects alone are insufficient while engaging the concept of respect for persons, particularly in healthcare settings. This paper sets out to explore if the concept of respect for persons—as opposed to a thin concept of autonomy—could help us engage better in healthcare practices. We shall probe the practical value of the experiential aspect of respect—understood as the recognition of persons as respect-worthy through certain dispositions and deliberative acts—by reflecting on instances in clinical practice that tend to be dismissed as negligible or even unavoidable in a stressful environment such as a busy hospital. We shall argue that these instances are far from trivial but carry moral significance and express an unacceptable—disrespectful—attitude that can compromise the moral habitus in hospital settings. In our conclusion, we call for practicing recognition respect in the health professional–patient encounter by focussing on manners, attitudes, and behaviors. Furthermore, we call for continuous medical ethics education programs to address the moral significance of disrespectful behaviors and their manifestations in particular socio-cultural contexts.

(Dis)respect and shame in the context of ‘medically unexplained’ illness

“…I aim to explore respect, in Subramani and Biller-Andorno's words, 'as an embodied concept': respect as it is experienced (in its presence or absence) and expressed in two first-person accounts. 25 I am especially interested in the potential links between (dis) respect and shame in these 'medically unexplained' contexts. I take shame to be a negative self-conscious emotion that results from feeling seen (whether the other is actually present or merely imagined) to be faulty, inadequate or worthless.…”

“…However, my primary focus in this paper is experiential, not theoretical. I aim to explore respect, in Subramani and Biller‐Andorno's words, ‘as an embodied concept’: respect as it is experienced (in its presence or absence) and expressed in two first‐person accounts 25 …”

Philosophy and the clinic: Stigma, respect and shame

“…We might call this the phenomenological or existential turn in the respect for persons literature. This turn to basing respect for persons on the experiential aspect or the lived experience of being respected has been particularly significant in the context of thinking of respect for persons in healthcare encounters 64 . Our final subtheme in this Philosophy Thematic introduces the notion of respect for persons to the discussion of shame.…”

“…As noted, in bioethics, the moral concept of ‘respect for persons’ has gained significance in recent times 68–70 . While the dominant understanding of ‘respect’ in bioethics has focused on ‘autonomy’, this conception has been problematized by considering phenomenological accounts of how healthcare is experienced from a patient's point of view 64 . Phenomenological accounts reveal that affective states, especially negative self‐conscious emotions, are central to understanding respect and disrespect within healthcare encounters.…”

“…Many of the debates in moral philosophy around what respect for persons amounts to have been based on an analysis of what the concept of personhood entails. This is sometimes interpreted as deriving a conception of the person from an account of persons as moral agents or based on their ascribed moral status 64,65 . We can see this understanding in early bioethics debates where the concept of personhood is linked to moral status, 65 for example, in abortion, brain death and assisted reproduction discussions.…”